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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 135-141

Night eating syndrome and sleep quality among Turkish university students in COVID-19 pandemic


1 Department of Nutrition and Dietetics, Faculty of Health Sciences, Üsküdar University, Istanbul, Turkey
2 Department of Physiotherapy, Vocational School of Health Sciences, Üsküdar University, Istanbul, Turkey
3 Department of Software Engineering, Faculty of Engineering and Natural Sciences, Üsküdar University, Istanbul, Turkey
4 Department of Nutrition and Dietetics, Faculty of Health Sciences; Department of Biomedical Device Technology, Vocational School of Health Sciences, Üsküdar University, Istanbul, Turkey

Date of Submission03-Jun-2021
Date of Acceptance25-Jun-2021
Date of Web Publication13-Aug-2021

Correspondence Address:
Mesut Karahan
Üsküdar University, Mimar Sinan, Selmani Pak, 34672 Üsküdar, İstanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnbs.jnbs_27_21

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  Abstract 


Backround: There is a positive relationship between night eating syndrome (NES) and sleep quality. However, it is not known how this situation changes among students during the COVID-19 pandemic. Aims and Objectives: This study aimed to reveal the relationship between anthropometric measurements, NES, and sleep quality in university students during the COVID-19 pandemic. Materials and Methods: Data were obtained through an online survey from March to June 2020 during pandemic in Turkey from university students (n = 100). They completed an online Pittsburgh Sleep Quality Index and Night Eating Questionnaire, also anthropometric measurements were taken. Results: University students had sleep disturbance. The sleep disturbance had an effect on NES (P < 0.001, rho = 0.386). A positive relation was found between sleeping pill use and NES (Z = −2.218, P = 0.027) and appetizing drugs and sleep (Z = −2.410, P = 0.016). Conlusion: The occurrence of sleep disturbances in students may increase the incidence of NES during COVID-19 pandemic. This study achieved a short-term result in a limited sample, and we suggest conducting large-scale studies on student health. University students should be considered and public health policies should be implemented in terms of eating disorders and sleep quality.

Keywords: COVID-19, health, lockdown, night eating syndrome, sleep disturbance, students


How to cite this article:
Yildiz MB, Sarikaya S, Temi?r鏸?n S, Dener BG, Kocat黵k RR, Sariyer ET, 莈vi?k E, 莖lak H, 謟can 种, Erg鼁el TT, Karahan M. Night eating syndrome and sleep quality among Turkish university students in COVID-19 pandemic. J Neurobehav Sci 2021;8:135-41

How to cite this URL:
Yildiz MB, Sarikaya S, Temi?r鏸?n S, Dener BG, Kocat黵k RR, Sariyer ET, 莈vi?k E, 莖lak H, 謟can 种, Erg鼁el TT, Karahan M. Night eating syndrome and sleep quality among Turkish university students in COVID-19 pandemic. J Neurobehav Sci [serial online] 2021 [cited 2021 Oct 25];8:135-41. Available from: http://www.jnbsjournal.com/text.asp?2021/8/2/135/323810




  Introduction Top


The coronavirus (COVID-19) pandemic has had a universal impact on night eating syndrome (NES) and sleep disorders. NES may occur as an independent syndrome or accompany other comorbidities such as depression.[1] The risk of developing NES in the young population is higher than in other age groups. Students can face NES due to high level of stress accompanied by insomnia and irregular meal timings.[2] In a cross-sectional study among 1017/1132 students, 13.9% were at risk of eating disorders.[3] Amount and quality of sleep among university students vary in related studies. There is a high suspicion of sleep disorders among young people. NES can be observed more on students who sleep <6 h, smoke, consume more tea or coffee, and have a physician-diagnosed disease.[4] In addition, students are going to different cities to study, changing their sleeping and eating patterns, and spending long hours on studying those conditions tends them to NES.[5] Globally, 1.5 billion students were affected by COVID-19 and receiving distance education using digital platforms which led students to tend more on mental disorders, sleep problems, and weight gain due to inactivity.[6] Some surveys provide the evidence of sleep patterns impaired in students and the online education can create serious psychological problems in students during the COVID-19 pandemic.[7],[8],[9],[10],[11] Marelli et al. reported that 307 students and 93 university administration staff workers showed an increase in bedtime hour, sleep latency, and wake-up time during the COVID-19 lockdown.[8] Similarly, Romero-Blanco et al. reported that sleep quality of 207 nursing students was worsened during the lockdown.[9] In addition, the incidence of insomnia symptoms increased by 23.2%. among 11,835 adolescents and young adults during the COVID-19 epidemic.[10] Students were trying to cope with negative effects of the current pandemic to get away from boredom and depressive thoughts.[11] Therefore, during the pandemic, psychological and sleep impairment may effect on a sleep-related NES.[12] Sleep begins 1–4 h after the last meal, depending on the person's lifestyle, psychological state, and duration of sleep. Therefore, the night is characterized by a long fasting period typically associated with sleep.[13] Sleep tends to be shorter because the person spends this period by eating. Therefore, disturbed sleep processes can be observed. Low sleep time is also associated with metabolic disorders, obesity, and NES.[14] The variability of psychological states, sleep disturbances, and unhealthy eating habits increased and will increase even more in COVID-19 pandemic, and these processes may have major effects on NES. The aim of this study was to reveal a relationship between sociodemographic information, body composition, sleep quality, and NES among university students receiving lockdown. No previous studies have been reported to measure the relationship between NES and sleep among the students during COVID-19 pandemic. The limitations of this study are sample size and short time results. This study should lead to large-scale studies over a long period of time.


  Materials and Methods Top


Ethics Committee Approval for the study was received from Uskudar University Non-Invasive Research Ethics Committee on 27.02.2020 (No:61351342/2020-93). “Informed Volunteer Consent Form” was obtained from the participants.

Participants

This study was designed to investigate the sleep-related state of NES in online-educated female and male Üsküdar University students aged >18 from March to June 2020. The study was a quantitative study due to anthropometric measurements and two questionnaires were applied.

Due to the online education during the pandemic, the questionnaires was made by the online system and the anthropometric measures was applied in Üsküdar University NP hospital dietitian clinic. Questionnaire consisting of a combination of several questionnaires was developed. All participants provided informed consent before proceeding to the survey questions.

Measures and procedure

The questionnaire used for this study consisted of a total of 6 pages, 4 parts, and 52 questions and was a combination of items from the following: sociodemographic information, age, gender; Pittsburgh Sleep Quality Index (PSQI) for the sleep questionnaire; the Night Eating Questionnaire (NEQ) about NES; and anthropometric measurements. Fourteen questions about demographic characteristics, questions related to sleep and eating patterns, and drug use was screened. Twenty-two questions related to the sleep pattern were screened. The answers were analyzed according to the seven factors of the PSQI.[15],[16] These factors are factor 1: subjective sleep quality, factor 2: sleep latency, factor 3: sleep duration, factor 4: habitual sleep efficiency, factor 5: sleep disturbances, factor 6: sleep medication use, and factor 7: provides information about daytime sleep function loss. Each of the factors was evaluated on a score of 0–3. The sum of the points given to the factors gives the PSQI score. The PSQI score ranges from 0 to 21 overall. Sleep quality of those with a PSQI score of 5 and below was evaluated as “good,” while those with a PSQI score >5 was evaluated as “bad.”[17] Fifteen questions were consisted in NEQ and screened for NES diagnosis. The questions were about how often night meals and snacks are eaten, what period of time they are eaten, what kind of problems eating at night creates in life, the amount of calories people take after dinner, the desire to eat at night, and the presence of eating behaviors and moods. NEQ had five multiple choice options: none (3 points)/very little (2 points)/some (1 point)/moderate (0 point)/extreme (0 point). In addition, for other questions, always (3 points), often (2 points), usually (1 point), and other options were 0 points. Thirty points were the cutoff point of this scale. If the total score is 30, the result will be considered “susceptible to eating behavior disorder”.[18],[19] At the last stage of the survey, the participants were screened for their measures as weight (kg), height (cm), body mass index (BMI [kg/m2]), neck circumference (cm), waist circumference (cm), and arm circumference (cm) by evaluating the anthropometric measurements related to the conclusion of the study.[20] BMI calculation: BMI values of the participants were determined by dividing the weight (weight) obtained with the information form by m2 (kg/m2).

Data analysis

Descriptive statistics were made to determine the distribution of sociodemographic variables of the participants. Whether the data conformed to normal distribution was determined by the normality test (Shapiro–Wilk or Kolmogorov–Smirnov values). All tests were selected from nonparametric tests. Spearman correlation analysis was performed to evaluate the relationships between the scales (NEQ, PSQI). Finally, the Mann–Whitney U-test and the Kruskal–Wallis test were used to evaluate the significance of demographic variables and scales. Data on students' sociodemographic characteristics were evaluated using numbers and percentages. The mean of students' age, BMI, and waist circumference values were determined by minimum, maximum, mean, and standard deviation. Statistical analysis was made using the SPSS version 24.0 (IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp). P < 0.05 showed significant relations between two variables.


  Results Top


Sociodemographic information

A hundred university students were participated as a 84% (n = 84) female and 16% (n = 16) male. The appetite-stimulating drug use of the participants was examined and it was determined that 7% (n = 7) used drugs and 93% (n = 93) did not use drugs. The sleeping pill use was examined, it was determined that 10% (n = 10) used drugs, and 90% (n = 90) did not use drugs. The regular exercise status was examined, it was determined that 37% (n = 37) did sports, 63% (n = 63) did not do sports. Skipping meals were examined, 32% (n = 32) skipped meals, 10% (n = 10) did not skip meals, and 58% (n = 58) sometimes skipped meals. About 31% (n = 31) skipped morning meals, 58% (n = 58) skipped lunch, and 11% (n = 11) skipped evening meals. BMI group data were examined, 10% (n = 10) were underweight, 12% (n = 12) were acceptable weight, 49.5% (n = 49) were at normal weight, 24% (n = 24) was slightly obese, and 5% (n = 5) was obese Stage 1 [see in [Table 1]].
Table 1: Sociodemographic variables (n=100)

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Sleep disorders and night eating syndrome

Minimum score obtained from PSQI was 6 (scores >5 described poor sleep quality). Therefore, our entire sample was found to have a sleep disturbance problem. The maximum score for NEQ was 39 so that there were individuals with NES (30 < indicates an eating disorder) [see in [Table 2]b].
Table 2: Average age, body mass index, waist circumference, and descriptive statistics of scores obtained from Night Eating Questionnaire and Pittsburgh Sleep Quality Index Scales of the participants (n=100)

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Spearman correlation analysis showed a positive correlation between NEQ and PSQI total scores (P < 0.001, rho = 0.386) [Table 3]. NEQ total scores did not show a statistically significant difference between appetizing drug users and nonusers [PSQI showed (Z = −2.410, P = 0.016)]. There was no statistical difference between the total scores of the PSQI between those using and not using sleeping pills (NES showed [Z = −2.218, P = 0.027]). PSQI and NEQ total scores did not show a statistical difference between those who exercise regularly and gender [see in [Table 4]]. No statistical difference was observed between the total score of scales and age, skipping meals, and BMI groups [see in [Table 5]].
Table 3: Correlation results regarding the scores obtained from the scale and subscales

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Table 4: Comparison of the scale and subscale scores of the participants in terms of gender, appetite medication use, sleeping medication use, and regular exercise with Mann-Whitney U-test

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Table 5: Comparison of the scale and subscale scores in terms of age groups, skipping meals, and body mass index groups using Kruskal-Wallis

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  Discussion Top


Eating behavior and body weight of individuals may be affected by many factors. Catecholaminergic pathways and physiological reactions in the nervous system play an important role in eating behavior.[21] Serious problems such as nutritional deficiency, overnutrition, depression, substance abuse, and anxiety can occur with the emergence of eating disorders.[22] More than 90% of eating disorders cases were under the age of 25. There was also an increase in the prevalence of eating disorders, especially among high school and university students.[5] Disturbed sleep can lead to eating disorders. Bektaş et al. showed an important relationship between sleep and NES was found (P < 0.001).[23] Likewise, our study had significant results (P < 0.001, rho = 0.386), and the importance of our study was the application that was done during the lockdown (COVID-19 pandemic). Öner et al. reported that although NES incidence was found more in women, no significant difference was found between genders among 179 university students.[24] Likewise, in our study, mean scores obtained in women were higher, but no statistical significance was found between NES (P = 0.597) and sleep (P = 0.242). As in our study (P = 0.074), no statistically significant difference was found between age groups and sleep in another study.[25] de Zwaan et al. found a positive correlation between the weight and NES.[26] There was no significant relationship between NES (P = 0.326), sleep (P = 0.873), and BMI classification in our study. There are conflicting results about BMI and weight gain, yet it can have a strong correlation between sleep and NES. The findings of NES and sleep were not related to weight and this result may be due to the insufficient sample size. Similar to our study (P = 0.088), Farhangi found that no significant relationship was found between sleep and sleep-inducing drugs among 107 young individuals.[27] Kaya[28] found a significant relationship between the use of sleep-inducing drugs and the NEQ. In addition, in our study, NEQ scores were found to be higher in patients using sleep-inducing drugs compared to those who did not use appetizing drugs (P = 0.016). Furthermore, no significant relationship (P = 0.262) was found between the NES and appetizing drugs use. Our study was the first to investigate the relationship between NES, sleep, and appetizing medication use. In addition, the use of sleeping pills and the use of NES showed a significant relationship (P = 0.027). It may mean that people with disturbed sleep have a higher risk of NES. Sütçü[29] reported that there was no statistical difference in NES between the groups that exercised regularly and those who did not. Furthermore, Kaya[28] reported that there was no relation between sleep in individuals who exercised regularly and those not. As in our study, no significant difference was found between exercising regularly on sleep (P = 0.087) and NES (P = 0.055). To our knowledge, there is no study describing the relationship between sleep and meal skipping in the literature; hence, our study revealed that there was no significant relationship between this sleep and meal skipping. The importance of our study was in terms of being conducted among lockdown students in COVID-19 pandemic. In a study conducted with 207 nursing students, it was found that sleep quality was worsened during the lockdown.[9] In our results, sleep quality was disturbed. Similarly, Zhou et al. found that the prevalence of insomnia symptoms increased to 23.2% more among 11,835 adolescents and young adults during the COVID-19.[10] In a cross-sectional study that was conducted among 1017/1132 students, 13.9% of the university students were at risk of eating disorders.[3] In our study, NES as an eating disorder was seen among students and related to sleep quality. The presence of sleep disturbances in all individuals in this study can be considered as an effect of the COVID-19 pandemic. The prevalence of sleep problems, eating disorders, depression symptoms, and weight gain increased when studies before the pandemic and the studies during the pandemic period were compared. There were serious disturbances in sleep patterns between the students and adults.[3],[7],[8],[9],[10],[11]

Limitations

This study had some limitations, data obtained from the study were made among 100 online-educated students studying at Üsküdar University during the lockdown in 2019–2020 academic year. A limited number of participants were reached due to the COVID-19 pandemic. It will be more beneficial to repeat this study with larger participants.


  Conclusion Top


As a result, no relationship was found between BMI, waist circumference, skipping meals, demographic characteristics such as gender and age groups, and NES and sleep patterns. A positive relationship was found between sleep quality and NES. The sleep patterns interacted with NES (P < 0.001). In addition, the positive relationship between sleeping pill use and NES (P = 0.027) can be explained as the need to eat after the use of drugs, also appetite medications were associated with sleep patterns (P = 0.016). Furthermore, our entire sample had sleep disturbance problems. Same, during the COVID-19 lockdown, sleep patterns were found to be impaired in students.[9],[10],[11],[12] Despite limitations, the results in our study pose a great risk for online educated students for NES during the COVID-19 pandemic. Therefore, this study is important for educators and public health professionals in implementing policies and interventions for students and prevent their health problems according to sleep and nutrition. Large-scale studies should be conducted to better understand the impact of the pandemic on eating and sleep disorders among students. For this reason, NES risks were increasing day by day before the pandemic. The COVID-19 pandemic and even the various chronic disease risks it may cause can be out of control. These processes should be supported with studies and more studies should be done especially for the young population.

Patient informed consent

Informed consent was obtained.

Ethics committee approval

Ethics Committee Approval for the study was received from Üsküdar University Non-Invasive Research Ethics Committee on 27.02.2020 (No:61351342/2020-93). “Informed Volunteer Consent Form” was obtained from the participants.

Financial support and sponsorship

No funding was received.

Conflicts of interest

There are no conflicts of interest to declare.

Author contribution subject and rate

  • Melike Buse YILDIZ (%8): Data acquisition, interpretation of data for the study.
  • Sena Sarikaya (%8): Data acquisition, interpretation of data for the study.
  • Şevval Temirçi (%8): Data acquisition, interpretation of data for the study.
  • Buse Gül Dener (%8): Data acquisition, interpretation of data for the study.
  • Rümeysa Rabia Kocatürk (%8): Collection of review of literature, wrote the manuscript.
  • Esra Tansu Sariyer (%10): Conception/design of the work, help in data analysis.
  • Ekin Çevi (%10): Conception/design of the work, help in data analysis.
  • Hatice Çolak (%10): Conception/design of the work, help in data analysis.
  • Öznur Özge Özcan (%10): Conception/design of the work, help in data analysis and wrote the manuscript.
  • Türker Tekin Ergüzel (%10): Guided in developing the extent of the study and contributed to the manuscript with his critiques.
  • Mesut Karahan (%10): Guided in developing the extent of the study and contributed to the manuscript with his critiques.




 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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