The Relationship Between Sleep Quality and Quality of Life in Adolescents Aged 16–18 Years : A Cross-Sectional Study

Article information

Sleep Med Res. 2025;16(4):241-247

Publication date (electronic) : 2025 December 31

doi : https://doi.org/10.17241/smr.2025.03195

Çiğdem Müge Haylı, MSc, PhD

Department of Nursing, Hakkari University, Faculty of Health Sciences, Hakkari, Türkiye

Corresponding Author: Çiğdem Müge Haylı, MSc, PhD, Department of Nursing, Hakkari University, Faculty of Health Sciences, Hakkari 30000, Türkiye, Tel +90-5345801736, E-mail mugehayli@hakkari.edu.tr

Received 2025 September 29; Revised 2025 November 13; Accepted 2025 December 5.

Abstract

INTRODUCTION

Sleep is a basic physiological process like air, water and food, which are the most important components of all living things [1]. Sleep, which is necessary for a healthy life, has been described as a state of semi-unconsciousness and has been defined as the preparation of the human body for life [2]. Sleep physiology and pathology differ in the neonatal, infancy, preschool, school child, and adolescent periods. Infants spend 16–18 hours of their day sleeping in the first trimester. While this period consists of equal number of sleeping and waking periods during the day and night in a sleep pattern, sleep in the preschool period gains the characteristics of the adult period. In the period of school children and adolescence, sleep turns into night sleep, which is not physiologic, that is, sleep once in 24 hours, due to the obligations of school life [3]. Sleep has an important role in strengthening physical growth and academic performance in individuals. Especially in adolescents, adequate sleep is effective in the normal development of cognitive and physical functions compared to their peers [4].

Sleep is a basic physiologic, psychological, and social need and when this need is not met, sleep problems occur and directly and indirectly negatively affect daily life activities and quality of life of individuals of all ages [5–7]. Although sleep problems are observed in children in general, especially in adolescents, they pose a great problem in physiologic and psychological dimensions for their families and caregivers [8,9]. Sleep problems frequently seen in adolescents are listed as waking up at night, waking up frequently, napping, and sleepwalking [10]. When the risk factors related to sleep problems are examined, female gender, daytime dysfunction, previous sleep disorders, time to fall asleep, subjective sleep quality, previous physical illness, and daily life habits have been mentioned [10,11]. Economic characteristics of the family and the community cause sleep problems in children and negatively affect their quality of life [12,13].

According to the World Health Organization, quality of life is defined as “the perception of one’s own life in a culture and value system according to one’s own goals, expectations, standards and interests” [14,15]. Another definition is related to the individual’s personal perception of health status or non-health related aspects of life [16]. Good sleep is one of the components of a good quality of life [17]. According to many epidemiologic studies, it has been observed that individuals who sleep 7–8 hours throughout the night have a poorer quality of life compared to individuals who sleep less and sleep more. As there are many health problems caused by poor quality sleep, encountering these health problems also affects the quality of life of the individual [18].

Life satisfaction, which is a judgment process in which the individual evaluates his/her own life within the framework of self-determined criteria, has a direct relationship with quality of life [19]. The concepts of sleep and quality of life affect each other bidirectionally. In other words, a life full of sleep problems not only affects life satisfaction but also decreases the quality of life. Especially adolescents, whose quality of life decreases, start to not enjoy life; this directly affects the life satisfaction of adolescents. Likewise, psychological and physiological problems can be observed in adolescents with low quality of life and these problems can negatively affect the sleep patterns of the individual [20]. Although the effects of sleep on health can be counted in a wide range, it is observed that compared to adolescents with normal sleep patterns, individuals with short or long sleep patterns experience psychological and physiological problems and this directly affects their quality of life. Keskin and Tamam [21] emphasized that poor quality sleep reduces the quality of life of adolescents and causes health problems.

The relationship between sleep and quality of life in adolescents is important in terms of strengthening thinking, behavioral and emotional abilities, cognition and memory, behavior regulation, daily activities, individual factors, and changes in the environment and continuity of health. This cross-sectional study aimed to investigate subjective sleep quality and the relationship between sleep quality and quality of life in adolescents aged between 16 and 18 years. We posited that; Hypothesis H1—Adolescents aged 16–18 have poor sleep quality, Hypothesis H2—There is a relationship between sleep quality and quality of life among adolescents aged 16–18.

METHODS

RESULTS

Table 1 shows that adolescents between the ages of 16 and 18 years (n=350) who participated in the study were analyzed according to age groups; 52.0% were 18 years old, 32.0% were 17 years old, and 16.0% were 16 years old. Of the adolescents, 56.3% were girls and 43.7% were girls. When class levels were examined, it was concluded that the majority of adolescents were studying in the first year of high school (29.4%).

Table 1

Sociodemographic characteristics of adolescents aged 16–18 years (n=350)

Table 2 shows that the mean and standard deviation values of PSQI subgroups and total PSQI scores of adolescents aged 16–18 years are shown. The average PSQI score was 8.92±4.67. The PSQI subgroup of adolescents had the highest mean value in the habitual sleep efficiency dimension, followed by the sleep disorder dimension. Additionally, Table 2 shows that according to the distribution of the results of the PSOI scale, PSQI <5 (good sleep quality) and PSQI ≥5 (poor sleep quality) were evaluated in 16–18-year-old adolescents participating in the study. According to these results, it was determined that 78% (260 people) had poor sleep quality and constituted more than half of the sample of the study. A total of 22% (90 people) were found to have good sleep quality. These results show that adolescents in the relevant age group were generally found to have poor sleep quality.

Table 2

PSQI averages of adolescents and subgroups aged 16–18 and findings regarding the distribution of PSQI scale

Fig. 1 shows there is a negative relationship between physical function and the PSQI scale (r=−0.462, p<0.01), and a negative and moderate relationship between physical role difficulty and the PSQI scale (r=−0.721, p<0.01). A negative relationship was observed between emotional role difficulties and the PSQI scale at a moderate level (r=−0.432, p<0.01), a negative relationship between vitality and the PSQI scale at a low level (r=−0.184, p< 0.01), and a negative relationship between mental health and the PSQI scale. A relationship was observed between spiritual health and the PSQI scale negatively and at a low level (r=−0.288, p<0.01), between social functionality and the PSQI scale negatively and at a moderate level (r=−0.366, p<0.01), and between pain status and the PSQI scale in a negative direction. A negative and low-level (r=−0.291, p<0.01) relationship was observed between general health perception and the PSQI scale (r=−0.277, p<0.01). When the relationships between the variables are examined, significant negative relationships between the PSQI index and the sub-dimensions of the SF-36. According to this result, it can be said that when one of the variables increases, the other will decrease.

Fig. 1

Relationship between SF-36 subscales scores and Pittsburgh Sleep Quality Index score.

DISCUSSION

According to research results, it shows that 52.0% were 18 years old, 32.0% were 17 years old, and 16.0% were 16 years old. In general, it was found that the participation rate of girls was higher.

In this study, the PSQI subgroup of adolescents had the highest mean value in the habitual sleep efficiency dimension, followed by the sleep disorder dimension (8.92±4.67) and their sleep quality is poor, albeit in a different population group. This finding sleep quality, mental and physical health: a different relationship by Clement-Carbonel et al. [28], it was concluded that the sleep quality of adolescents was not good and that stress and anxiety negatively affected their sleep quality. The results of different studies also show that sleep quality in adolescents is low [29,30]. The results of Potter et al.’s [31] study on sleep quality and quality of life in healthy high school athletes, Matos et al.’s [32] study on the perception of quantity and quality of sleep in adolescence and their relationship with health-related quality of life and life satisfaction, and Masoed et al.’s [33] study on social media addiction in adolescents: relationship with sleep quality and life satisfaction concluded that their sleep quality was poor. Zisberg et al. [34] determined the mean PSQI score as 9.37±4.04 in the elderly. Tetik and Şen [35] on the effect of sleep problems and habits of adolescents on sleep quality also show that adolescents have poor sleep quality due to some factors (smoking, waking up suddenly from sleep, etc.), and the results of the study by Kosova and Kosova [36] on the evaluation of physical activity levels and sleep quality of high school and university students during the COVID-19 pandemic are similar. In a study conducted in Korea as a different population, it was determined that the mean score of PSQI was >5 in the elderly (6.59±3.67 in women and 5.95±3.40 in men) [37]. In a study conducted in Europe, it was determined that sleep disorders were more common in the elderly, and in other studies, the sleep quality of the elderly was also poor [38,39]. Haylı and Kösem [40] concluded that sociodemographic characteristics affect sleep quality in the results of the study titled, “Evaluation of sleep and sleep habits in adolescents.”

Our relationships between the variables are examined, significant negative relationships between the PSQI index and the sub-dimensions of the Quality of Life scale. Sleep, sleep quality, physical and mental health, and quality of life are interacting conditions. Sleep is a regulator of the endocrine and immune system and metabolism, improves health, provides mental and physical restoration and improves quality of life [41]. In Fischer et al.’s [42] study titled “Explanation of sleep duration in adolescents: the effect of socio-demographic and lifestyle factors and working status,” it was concluded that sleep duration and quality of life are related to sleep duration, and that sleeping outside of the normal hours that should sleep negatively affects psychological and physical quality of life. In Erickson et al.’s [43] study on fatigue, sleep-wake disturbances, and quality of life in adolescents receiving chemotherapy, it was concluded that the higher the sleep disturbance, the worse the quality of life. According to the results of our study, there is a negative correlation between sleep quality and the physical function, physical-emotional role difficulty, social functioning, general health perception, and pain sub-dimensions of quality of life. It is seen that our study has similar results with other studies [44–47], which revealed that there is a relationship between sleep disturbance and sleep quality and quality of life, and that quality of life is poor in adolescents with sleep disorders or poor sleep quality. As a result of the study on the relationship between non-restorative sleep and quality of life in Chinese adolescents in Chen et al. [48], it was found that low sleep quality caused problems in fulfilling social skills in their quality of life. The results of Matsui et al.’s [49] study on the relationship between the subjective quality and quantity of sleep and quality of life in the general population and Yang et al.’s [50] study on greater mental resilience, increased sleep quality and quality of life (social, psychological and emotional skills, etc.) in early and middle adolescence are similar to our findings. The results of de Lima and Silva’s [41] study on the relationship between sleep quality and sociodemographic factors and lifestyle in adolescents in southern is similar to our findings.

For future studies on the subject, case analysis and focus groups, which are qualitative research methods, and descriptive and correlation methods, which are quantitative research methods, will be beneficial in obtaining reliable and valid results. Our study has several limitations. First, although this study is primarily a prospective cross-sectional study, one of its limitations is the small number of adolescents participating because of limited permission from their families and it is voluntary. Second, in terms of accessibility, the sample size is narrow and does not reflect the general population. Third, the limited duration of data collection due to the limited number of participating adolescents may have led to underreporting of the relationship between sleep quality and quality of life. Finally, a fourth limitation of our study is that sleep quality and sleep disturbance are evaluated subjectively and cannot be supported by objective measures. The results of the research findings are guiding for future research, and the health professionals working in the clinic. It will support children who receive inpatient or outpatient treatment in hospitals to establish a relationship between their sleep and quality of life, and what factors affect them, and to make decisions to maintain their health.

In conclusion, adolescents with sleep disorders experience sleep problems and their quality of life decreases. Sleep quality should be evaluated and considered as a factor affecting the quality of life of adolescents. Environmental regulation, establishment and maintenance of routines for coping with stress, evaluation of sleep quality at regular intervals, and psycho-social and physical functions and roles should be supported. This study is an important study in terms of revealing the need for longitudinal studies evaluating the cause and effect relationship between sleep quality, sleep disorders, health problems, and quality of life. It is recommended to conduct studies examining the effectiveness of education and counseling programs for adolescents in improving their sleep quality and quality of life.

Article information Continued