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Ann. psychophysiol. 
ISSN 2412-3188 (Online)|2410-1354 (Print) 

APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v9.i1.2022.06-16 
 

 
Original Article 

Sleep disturbances and lack of exercises: 
accumulating factors for altered BMI in 
medical students of public sector 
universities 
Tehlil Rizwan1, Rabbiya Khan1, Fauzia Imtiaz1 , Sonia Siddiqui1 ,  

Muhammad Ashraf Hussain2  & Farhia Khalid3  

1Department of Biochemistry, Dow University of Health Sciences, Karachi-Pakistan 
2National University of Health Sciences (NUMS), Rawalpindi-Pakistan 
3Shaukat Omar Memorial Hospital, Fauji Foundation, Karachi-Pakistan 
 

Abstract 
Background: Changes in lifestyles such as lack of exercises and sleep can have 
negative effects on the body weight. Therefore, the present study was designed to 
investigate the association of the pattern of sleep, exercise, and diets with the body 
mass index (BMI) of medical students. 
Methodology: This is a cross-sectional study that incorporates self-developed 
questionnaires. Participants are medical university students (250) living in 
Karachi, Pakistan. Correlation and Pearson’s chi-square test for independence was 
applied to observe the association between BMI, sleep patterns, exercise and eating 
habits.  
Results: The age of the students were between 19-25 years.  The data show a 
significantly higher number of students (70.6%) with low BMI. Significantly high 
numbers of students have disturbed sleep (47.4%) during the nights and an 
increased number of students feel irritated (78.7%) about their sleeping pattern. 
Because of this, students (61.1%) experienced difficulties at work. Moreover, it was 
found that only 67 students are doing exercise while 154 students are not doing 
any exercises. However, they are taking enough 5-6 (47.1%) or 6-8 hours (29.9%) 
sleep.  The majority of the students do not smoke (96.8%) or eat big meals before 
bed (62%) or consume junk foods (68.8%) on a daily basis. Nevertheless, most of 
them felt tired (61.1%) but not sleepy (57%) before going to bed. The majority of 
the students (81.4%) have problems waking up in the morning.  
Conclusion: A Significant correlation was found between BMI and sleep duration. 

Irregular sleeping pattern and lack of physical activities are accumulating factors 

for students to be underweight. Sleep disturbances affected their focus on the 

academic studies. Therefore, it is strongly recommended for students to participate 

in physical activities. 
 

Keywords 
Sleep disturbances, BMI, Exercises, Medical students. 

 

Citation: Rizwan T, Khan R, Imtiaz F, 
Siddiqui S, Hussain MA, Khalid F. Sleep 
disturbances and lack of exercise: 
accumulating factors for altered BMI in 
medical students of public sector 
universities. APP. 2022;9(1) :06-16 
 
Corresponding Author Email: 
f.imtiaz@duhs.edu.pk 
 
DOI: 10.29052/2412-3188.v9.i1.2022.06-16 
 
Received 26/02/2022 
 
Accepted 06/04/2022 
 
Published 01/06/2022 
 
Copyright © The Author(s). 2022. This is 
an open-access article distributed under 
the terms of the Creative Commons 
Attribution 4.0 International License, 
which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author and 
source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors have 
declared that no competing interests 
exist. 
 

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https://orcid.org/0000-0002-3806-5008
https://orcid.org/0000-0001-6842-801X
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Introduction  
Obesity is defined as a condition in which a 
person has accumulated an increased 
amount of fat that it might have a negative 
effect on their health. Obesity comorbidities 
include coronary heart disease, hypertension 
and stroke, dyslipidemia, non-insulin-
dependent diabetes mellitus, sleep apnea 1-4,6 

7,8. 
 
During the recent pandemic of obesity, 
Pakistan too has seen an increase in the 
population of overweight people, probably 
due to its increasing urbanization. This 
makes Karachi, one of the most urbanized 
regions of Pakistan, a high risk city9. The 
International Obesity Task Force has set the 
following cut-off points for adults in the 
Asia-Pacific region: overweight at BMI >23 
and obesity at BMI >25. These lower cut-off 
points are set because studies show that 
Asian people are likely to develop co-
morbidities at lower BMI10. Students in 
different colleges regardless of the 
professions such as medical or basic sciences 
students experiencing a marked change in 
curriculum, peer pressure, social pressure, 
erratic schedule and stress/anxiety. Major 
shift in lifestyle habits most of the times such 
as unbalanced diets, alcohol intake, and lack 
of sleep can be very harmful for student’s 
health11, 12, 13. 
 
Sleep deprivation is another issue plaguing 
urbanized cities such as Karachi. Many 
longitudinal studies show a correlation 
between sleep loss and weight gain in adults. 
However, some other studies prove that 
sleep quantity does not have a significant 
effect on weight gain in adults but sleep 
quality does. It also allows to predict overall 
health of an individual such as depression, 
fatigue and complaints14. Gathered results 
showed insufficient poor quality of sleep is 
associated with sleep dissatisfaction in 

young adults. Reported earlier an imbalance 
between calorie intake and physical 
activities are the precipitating factors 
involving obesity15,16. However numerous 
other factors are also known to be involved 
in the contribution of BMI-related obesity 
such as sleep17,18. Besides obesity an 
increasing number of young adults have 
been shown to be associated to their body-
image. This body-image dissatisfaction 
induces an increased weight loss behavior 
among young females19. Using of non-
scientific physical activity and poor diets 
were identified in underweight people. 
Apart from this several dietary regimes such 
as lack of water intake resulted in increased 
confusion, stress, fatigue20,21,22 and tension 
with decreased vigor both in men and 
women.  
 
Due to the conflicting results in different 
regions, it is hard to predict if there would be 
such a correlation in each setting. The link 
between sleep pattern with BMI and diets 
had not been studied in Karachi before. 
Therefore, we carried out a cross sectional 
study to determine the effects of quality of 
sleep on general health of medical students 
in Karachi. We hypothesized to investigate 
the association of the pattern of sleep, 
exercise, and diets with the body mass index 
(BMI) of medical students. 
 

Methodology 
Participants 
The current study used a sample of 467 
college students, a randomly selected sample 
size at registered colleges located in Karachi, 
Pakistan. There were 204 males, and 263 
were females (153 from the extended family 
system while 314 from the nuclear family 
system). Participants' age ranged from 16 to 
24 years. 
 
 



 
 

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Measures 
Participants and Study Design 
It is a cross sectional study on medical 
students at a public sector university, from 
Year 1 to Year 5. The study was conducted 
on medical students of a public sector 
university during the period of 1st Feb to 
31st July, 2019. A sample size of 250 was 
calculated by using open epi an online 
software (Confidence level=95 %). The 
sampling technique used was non 
probability convenience sampling. The mean 
age of the participants were 23.6 years.  
 
The participants included in the study were 
students of all ethnic groups and both 
genders, studying in a medical college. 
Students with sleep disorders (narcolepsy, 
Insomnia, Snoring, sleep talking, Night 
terrors, Rapid eye movements behavior 
disorders, obstructive sleep apnea) and those 
taking medications to manage their weight 
were excluded from the study. Measures of 
memory or focus were made by the 
information recorded by the participants 
that their memory and focus on the study has 
changed since they have weight and sleep 
issues. Moreover, the information also 
included that they have difficulties in 
retaining the knowledge and felt agitated. 
These symptoms only occurred when their 
sleep pattern changes otherwise they did not 
have problems in focusing (thinking about 
other things besides studying). No one has 
attention deficit disorders. 
 
Self-administered questionnaire 
Verbal consent was taken from all 
participants. The questionnaire consisted of 
34 close-ended questions, out of which the 
first 5 asked for demographic figures (age, 
gender, year of study, weight and height). 
The next 16 questions were related to sleep 
and factors that could affect the quality and 
the quantity of sleep (frequency and amount 
of caffeine intake). The Next 10 questions 
were related to weight and factors that could 

cause weight change, for instance exercise 
and dietary patterns. To ensure the 
participants were not hesitant to answer all 
questions honestly, we provided full 
anonymity – by not asking for their names, 
contact numbers, or any other personal 
details. We reduced interviewer bias by 
using questionnaires instead of verbal 
interviews. 
 
Body Mass index (BMI) 
Body Mass Index (BMI) was calculated as 
described previously. 19 Briefly weight of an 
individual in kilograms is divided by height 
measured in meters squared. BMI from 18.0 
to 25 is considered normal weight, BMI <18.5 
is considered underweight, BMI 25 to 28 is 
considered overweight. 
 
Actual BMI= weight (kg) (measured weight) 
/ Height2 (m) 
 
Statistics 
Data was analyzed by using SPSS version 
16.0 software. Bivariate Correlations and 
Pearson’s chi-square tests for independence 
were used. Value of P < 0.05 was considered 
significant.  
 

Result 
There were 73.3 % female and 26.7 % male 

students (Table 1). The data show that 

mostly students (156) are underweight and 

very few (7) are overweight. Nevertheless 58 

students have normal BMI. Chi-square test 

for independence show that there was a 

significant association of BMI with the 

sleeping hrs (p<0.00005). The data show that 

significantly (p<0.0005) increased numbers 

(98 vs 58) of students are aware about the 

importance of sleep (Table 1). It has been 

observed that students with low BMI (47%) 

are taking 5-6 hours and 43% are taking 6 to 

8 hours sleep. While students (50%) with 

normal BMI are also taking 5-6 hours and 



 
 

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34.5% are taking 6-8 hours sleep. In our 

study we have very few students (7) who 

were overweight. Nevertheless, the data 

show mostly they are sleeping either less 

than 5 hours or 6-8 hours (Table 2). Current 

study also showed significant association 

between BMI and disturbed seeping pattern 

during the night. It showed an increased 

number of students (74 %) who were 

underweight have disturbed sleep. They 

either wake up once (47.4%), twice (27.6%), 

or more than twice (6.4%) during a night. 

Students with normal weight also shows 

disturbances in the sleep, 50% of students 

wake up once and 20 % wakeup twice (Table 

3). Significantly (p<0.0005) increased 

number of students are not doing any 

physical exercises (67 vs 154) and those who 

does (67), mostly spent their times in either 

cycling, walking or other aerobic activities 

(Table 1). The duration of physical activities 

was mostly (14.9%) less than 30 mins. 

However significantly less number (5.4%) of 

students go beyond 60 mins of exercise 

(Table 4). Significantly (p<0.0005) higher 

number of students (59.3%) don’t work or 

don’t stay awake at night (73.3%). 

 

We have also investigated the quality of 

sleep among different classes of students. 

The data show a significant (p<0.0005) 

association between quality of sleep and 

students studying in different academic 

year. It was found that as students were 

promoted to the next higher classes the 

sleeping in the evenings were reduced. 

However significant amount of students is 

taking enough sleep (59.3%) nevertheless 

students are irritated about their sleeping 

patterns (78.7%). Many students 

experiencing wakefulness at least once 

(35.3%) and twice (47%) during night sleep. 

However, 43% student did not have 

disturbed sleep. Students that are feeling 

irritated (Table 5) about their sleeping 

pattern did not feel sleepy (57%) before 

going to bed however remained tired (61.1%) 

all night. This has put a significant negative 

effect on their work (61.1%). This habit can 

be associated with the fact that significant 

(p<0.0005) number of students (46.2%) were 

not hydrating themselves with enough 

water (Table 5). Apart from the sleeping 

habits, eating habits of all the students 

remained significantly (p<0.0005) 

satisfactory. Increased number of students 

(171) indulged themselves by eating fruits 

and avoid smoking (214), big meals (190) and 

junk foods (152) before going to bed (Table 1, 

5).  

 

Nevertheless 40.7% of the students are not 

taking enough sleep and 69.7% students are 

not doing exercises. Majority of the students 

(70.6%) are underweight (low BMI). This has 

reflected on their lack of interests in the 

studies and work (Table 1, 6).  

 

 

Table 1: Demographic characteristics of medical students in Pakistan. 

 

Variables (Means ± SD) 

Age   

Male  23.6 ±1.07 

Female 23.6 ±1.07 

Gender n (%) 



 
 

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Male 59 (26.7) 

Female 162 (73.3) 

BMI  

Normal weight 58 (26.2) 

Under weight 156 (70.6) 

Overweight 7 (3.2) 

Enough Sleep  

Yes 131 (59.3) 

No 90 (40.7) 

Knowledge about Sleep  

Yes 98 (70.6) 

No 58 (26.2) 

Smoking   

Yes 7 (3.2) 

No 214 (96.8) 

Physical Exercise  

Yes 67 (30.3) 

No 154 (69.68) 

 

Table 2: The association of BMI with different sleep hours of medical students in Pakistan. 

 

Variables 
Sleep hours 

BMI (Frequency %) χ2 p-
Value underweight Normal 

weight 
overweight 

< 5 hours 29 (18.6) 6 (10.3) 3 (42.9) 2.7 0.0005 
 
 

5-6 hours 74 (47.4) 29 (50) 1 (14.3) 

6-8 hours 43 (27.6) 20 (34.5) 3 (42.9) 

> 8 hours 10 (6.4) 3 (5.2) 0 (0.0) 

  

 

Table 3: The association of BMI with irregular sleep pattern of medical students in Pakistan. 

 

Variables 
 

Sleep disturbances 

BMI (Frequency %) p-Value 

underweight Normal 
weight 

overweight 

None 29 (18.6) 6 (10.3) 3 (42.9) 0.0001 

Once 74 (47.4) 29 (50) 1 (14.3) 

Twice 43 (27.6) 20 (34.5) 3 (42.9) 

> Twice 10 (6.4) 3 (5.2) 0 (0.0) 

 

 



 
 

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Table 4: The association of physical exercises with the duration of exercises. 

 

Variables 
Physical Exercise 

Duration of Exercise (Frequency %) χ2 p-Value 
< 30 mins 30-60 mins >60 mins 

Aerobics/Walking 33 (14.9) 22 (10) 12 (5.4) 8.72 0.0001 

 

Table 5: The association of influencing factors with the weight of the students 

 

 

 

 

Variables Frequency (%) df χ2 p-value 

Sleep duration     

<5 hrs  38 (17.2) 

138 7.95 0.0001 
5-6 hrs 104 (47.1) 

6-8 hrs 66 (29.9) 

>8 hrs 13 (13) 

Water Intake     

Regular Intake 119 (53.8) 
46 2.58 0.0001 

Not Regular Intake 102 (46.2) 

Irritation with Sleep pattern     

Irritated 174 (27.1) 
46 3.53 0.0001 

Not Irritated 47 (21.3) 

Sleep Pattern Effects on work     

Affected 135 (61.1) 
46 2.60 0.0001 

Not Affected 86 (38.9) 

Dietary Regime 

Junk Foods      

Yes 69 (31.2) 
46 2.81 0.0001 

No 152 (68.8) 

Feel Tired before bed time     

Yes 135 (61.1) 
46 2.58 0.0001 

No 86 (38.9) 

Feel Sleepy before bed time     

Yes 95 (43) 
2.92 46 0.0001 

No 126 (57) 

Spend More time in bed     

Yes 180 (81.4) 
2.83 46 0.0001 

No 41 (18.6) 

Meal Before Bed     

Yes 31 (14) 
2.69 46 0.0001 

No 190 (86) 



 
 

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Table 6: The association of influencing factors with the weight of the students. 

 

  Sleep 

Hours 
affect work Irritated Weight Height Exercise 

Exercise 

Duration 

Sleep 

Hours 

Pearson Correlation 1 .141** -.052** .083** .075** -.035** .011 

Sig. (2-tailed)  .000 .000 .000 .000 .000 .414 

N 12738 12738 12738 12738 12738 12445 5306 

affect work Pearson Correlation .141** 1 .109** -.026** .155** -.102** .071** 

Sig. (2-tailed) .000  .000 .003 .000 .000 .000 

N 12738 12794 12794 12794 12794 12501 5362 

Irritated Pearson Correlation -.052** .109** 1 .196** .106** -.081** .114** 

Sig. (2-tailed) .000 .000  .000 .000 .000 .000 

N 12738 12794 12839 12839 12839 12546 5406 

Weight Pearson Correlation .083** -.026** .196** 1 .427** -.189** .183** 

Sig. (2-tailed) .000 .003 .000  .000 .000 .000 

N 12738 12794 12839 12839 12839 12546 5406 

Height Pearson Correlation .075** .155** .106** .427** 1 -.093** .142** 

Sig. (2-tailed) .000 .000 .000 .000  .000 .000 

N 12738 12794 12839 12839 12839 12546 5406 

Exercise Pearson Correlation -.035** -.102** -.081** -.189** -.093** 1 -.223** 

Sig. (2-tailed) .000 .000 .000 .000 .000  .000 

N 12445 12501 12546 12546 12546 12546 5296 

Duration of 

exercise 

Pearson Correlation .011 .071** .114** .183** .142** -.223** 1 

Sig. (2-tailed) .414 .000 .000 .000 .000 .000  

N 5306 5362 5406 5406 5406 5296 5406 

**. Pearson Bivariate Correlation is significant at the 0.01 level (2-tailed). 

 

Discussion 
Current study included medical students 
from different colleges with different ethnic 
backgrounds, socio-economic status, and 
different life style choices. The students did 
not have any sleeping disorders, diabetes, 
obesity or any genetic diseases the time we 
have conducted the study. However, this 
does not mean that a student cannot acquire 
these diseases in any time of the course. The 
curriculum is itself is a very long and 
strenuous, many students comes under 

severe social pressure and stress that effects 
their sleep, body weight and mental health.  
 
Previously studies have pointed out the 
correlation of sleep hours with an increase 
BMI. For example, according to Vergas and 
his colleagues (2014) sleep deprivation can 
induce an increase fat intake and 
predisposing to obesity. Other longitudinal 
studies over the years have also shown that 
reduced sleep is associated with weight gain 
contributing as a risk factor to obesity23.  



 
 

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In contrast to the previous studies, we 
showed 70 % of the students have low BMI, 
26.2 % have normal BMI and 3.2% have high 
BMI. Moreover 69.7 % students do not 
exercise or have any physical activities while 
only 30.3% are involved in physical activities 
such as cycling or walking for 30-60 mins. 
Furthermore 40 % students do not sleep 
enough and 75 % students have disturbed 
sleep. Moreover 78.7% students are irritated 
about their sleeping pattern and 61% 
students remained tired. In addition to this 
57 % students do not feel sleepy before going 
to bed and like (81.4%) to spend much time 
in the bed. These habits reflect poorly on the 
academic performances because majority of 
the students (61.1 %) have problems in 
learning and memorizing. The associations 
and correlations studies between BMI and all 
the categorical factors are significant in our 
study and this made all the authors to argue 
that either low BMI leading towards poor 
sleep pattern or poor sleep pattern leading 
towards lack of exercise or low BMI leading 
towards lack of exercise or lack of exercise 
leading towards the low BMI and poor 
sleeping pattern. All these scenarios can be 
true because these factors are interlinked 
with one another. Many studies have shown 
that students experienced sleep problems 
more often during their academic lives that 
put a negative impact on their well-being24-

31. To analyze the quality of life one must 
observe sleeping pattern because it covers 
many clinical aspects such as depression, 
fatigue, and sleepiness. There is significant 
link between poor sleep, high calorie rich 
diets and lack of physical exercises with 
obesity11,16. Neurochemicals in humans for 7-
8 hours consolidated sleep induces an 
inhibition towards glucose utilizations and 
glucose production in the first few hours and 
increases rapidly just before dawn32,33 hours. 
Upon disturbed sleep the glucose utilization 
pathways are altered which means constant 
blood glucose levels remains all night 

leading to the development of insulin 
resistance, cardiovascular diseases and 
obesity1,6,7,34,17,35,36. Disturbed sleep but not 
sleeping hours also changes the levels of 
hormones such as ghrelin (increase hunger) 
and leptin (inhibit hunger)37,38,1,2,3,5,8 that 
decreases the insulin sensitivity, reduced 
glucose tolerance, diabetes39 and appetite 
control. These factors also lead to the poor 
and unbalanced diet behaviors and lower the 
physical activity levels in young people40,41. 
The low BMI and disturbed sleep in the 
current study can be explained in that 
context. Recently, in China underweight 
people are considered to be beautiful, this 
stir image consciousness in female students. 
This puts lots of social pressure to achieve 
weight-loss goals by taking weight reducing 
products42. People having BMI <18.5 is 
considered as underweight and put them at 
risk for having health issues in longer term. 
There is reduced synthesis of sex hormones 
and bone mineral density, anemia, low blood 
pressure, fatigue, discomfort. They will have 
higher chances to develop eating disorders 
such as anorexia nervosa, bulimia nervosa 
and binge eating disorders43-47 In addition to 
this underweight people might experience 
infertility and preterm birth48-51. Medical 
students often complain of stress due to 
burden of their heavy curriculum because of 
which they tend to skip meals during their 
day. Increased work load resulting in stress 
causes the body to consume more energy 
than is being consumed as food which can 
cause weight loss. Another possible reason 
can be due to the fact that the medical 
students become more health conscious to 
maintain a good physique because they are 
aware of how obesity can be a risk factor for 
many chronic and long term diseases like 
diabetes and cardiovascular comorbidities. 
Our findings suggest the importance of 
exercises or physical activities to improve 
the blood oxygen levels in the body which 
increased muscular strength, endurance, 
improve sleep, maintain weight, increased 



 
 

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energy levels, improve brain, heart and 
lungs functions. 
 

Limitations 
A total of 250 students were approached 
with the questionnaire. Out of these, 16 
students refused participation, while 13 
students left the questionnaire incomplete 
and were excluded from the study. 
Accumulation of the data lasted for a period 
of six months among medical students in 
Karachi. Future studies should incorporate a 
larger sample size with students from the 
different disciplines. 
 

Conclusion 
Irregular sleeping pattern and lack of 
physical activities are accumulating factors 
for students to be underweight. Sleep 
disturbances affected their focus on the 
academic studies. Therefore, it is strongly 
recommended for students to participate in 
physical activities. 
 

Acknowledgment  
We are thankful to the participants and 
Principal of Dow Medical College, Dow 
University of Health Sciences, Karachi-
Pakistan for providing all the necessary help 
for this research. 
 

References  
1. Nagai M, Tomata Y, Watanabe T, Kakizaki 

M, Tsuji I. Association between sleep 
duration, weight gain, and obesity for long 
period. Sleep Med 2013; 14: 206-10.  

2. Morselli L, Leproult R, Balbo M, Spiegel K. 
Role of sleep duration in the regulation of 
glucose metabolism and appetite. Best Pract 
Res Clin Endocrinol Metab. 2010; 24:687–702. 

3. Szinnai G, Schachinger H, Arnaud MJ, 
Linder L, Keller U (2005) Effect of water 
deprivation on cognitive-motor performance 
in healthy men and women. Am J Physiol 
Regul Integr Comp Physiol 289: R275–R280.  

4. Petri NM, Dropulic N, Kardum G (2006) 
Effects of voluntary fluid intake deprivation 
on mental and psychomotor performance. 
Croat Med J 47: 855– 861.  

5. Shirreffs SM, Merson SJ, Fraser SM, Archer 
DT (2004) The effects of fluid restriction on 
hydration status and subjective feelings in 
man. Br J Nutr 91: 951– 958.  

6. Ganio MS, Armstrong LE, Casa DJ, 
McDermott BP, Lee EC, et al. (2011) Mild 
dehydration impairs cognitive performance 
and mood of men. Br J Nutr 106: 1535–1543.  

7. Armstrong LE, Ganio MS, Casa DJ, Lee EC, 
McDermott BP, et al. (2012) Mild 
dehydration affects mood in healthy young 
women. J Nutr 142: 382–388. 

8. Pross N, Demazières A, Girard N, Barnouin 
R, Santoro F, Chevillotte E, Klein A, Le 
Bellego L. Influence of progressive fluid 
restriction on mood and physiological 
markers of dehydration in women. Br J Nutr. 
2013 Jan 28;109(2):313-21. doi: 
10.1017/S0007114512001080. Epub 2012 Apr  

9. Anstine D, Grinenko D. Rapid screening for 
disordered eating in college-aged females in 
the primary care setting. J Adolesc Health. 
2000; 5:338–42. 13.  

10. Wardle J, Haase AM, Steptoe A. Body image 
and weight control in young adults: 
international comparisons in university 
students from 22 countries. Int J Obes (Lond). 
2006; 30(4): 644–651. 

11. Yaemsiri S, Slining MM, Agarwal SK. 
Perceived weight status, overweight 
diagnosis, and weight control among US 
adults: the NHANES 2003–2008 Study. Int J 
Obes. 2011; 35:1063–70. 

12. Lei Zhang, Haihong Qian, Hua FuID. (2018). 
To be thin but not healthy - The body-image 
dilemma may affect health among female 
university students in China. PLoS ONE 
13(10). 

13. Perla A. Vargas, Melissa Flores, and Elias 
Robles (2014). Sleep Quality and Body Mass 
Index in College Students: The Role of Sleep 
Disturbances. J Am Coll Health. 62(8): 534–
541.  

14. Ruthig J, Haynes T, Stupnisky R, Perry R. 
Perceived Academic Control: mediating the 
effects of optimism and social support on 
college students' psychological health. Soc 
Psychol Educ. 2009; 12(2):233–49.  



 
 

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15. Nelson MC, Story M, Larson NI, Neumark-
Sztainer D, Lytle LA. Emerging Adulthood 
and College-aged Youth: An Overlooked 
Age for Weight-related Behavior Change. 
Obesity Res. 2008; 16(10):2205–11.  

16. Arnett, JJ. Emerging adulthood: 
Understanding the new way of coming of 
age. In: Arnett, Jeffrey Jensen; Tanner, 
Jennifer Lynn, editors. Emerging adults in 
America: Coming of age in the 21st century. 
Washington, DC: American Psychological 
Association; 2006. p. 3-19. 

17. Hicks RA, Fernandez C, Pellegrini RJ. 
Striking changes in the sleep satisfaction of 
university students over the last two 
decades. Percept Mot Skills. 2001; 93(3):660.  

18. Hill JO, Wyatt HR, Reed GW, Peters JC. 
Obesity and the Environment: Where Do We 
Go from Here? Science. 2003; 299(5608):853–
5. 

19. Veerman JL, Barendregt JJ, van Beeck EF, 
Seidell JC, Mackenbach JP. Stemming the 
Obesity Epidemic: A Tantalizing Prospect. 
Obesity Res. 2007; 15(9):2365–70. 

20. Al-Disi D, Al-Daghri N, Khanam L, Al-
Othman A, Al-Saif M, Sabico S, Chrousos G. 
Subjective sleep duration and quality 
influence diet composition and circulating 
adipocytokines and ghrelin levels in teen-age 
girls. Endoc J. 2010; 57(10):915–23 

21. Shankar A, Syamala S, Kalidindi S. 
Insufficient rest or sleep and its relation to 
cardiovascular disease, diabetes and obesity 
in a national, multiethnic sample. PLoS One. 
2010; 5(11):e14189.  

22. Taheri S, Lin L, Austin D, Young T, Mignot E. 
Short sleep duration is associated with 
reduced leptin, elevated ghrelin, and 
increased body mass index. PLoS Med. 2004 
Dec.1(3) . 

23. Stamatakis KA, Punjabi NM. Effects of Sleep 
Fragmentation on Glucose Metabolism in 
Normal Subjects. Chest. 2010; 137(1):95–101.  

24. Lesser DJ, Bhatia R, Tran WH, Oliveira F, 
Ortega R, Keens TG, Mittelman SD, Khoo 
MC, Davidson Ward SL. Sleep fragmentation 
and intermittent hypoxemia are associated 
with decreased insulin sensitivity in obese 
adolescent Latino males. Pediatr Res. 2012; 
72(3):293–8.  

25. Lucassen EA, Rother KI, Cizza G. Interacting 
epidemics? Sleep curtailment, insulin 

resistance, and obesity. Ann N Y Acad Sci. 
2012; 1264(1):110–34.  

26. Chaput JP, Brunet M, Tremblay A. 
Relationship between short sleeping hours 
and childhood overweight/obesity: results 
from the Quebec en Forme Project. Int J Obes. 
2006; 30(7):1080–5.  

27. Gangwisch JE, Malaspina D, Babiss LA, 
Opler MG, Posner K, Shen S, Turner JB, 
Zammit GK, Ginsberg HN. Short sleep 
duration as a risk factor for 
hypercholesterolemia: analyses of the 
National Longitudinal Study of Adolescent 
Health. Sleep. 2010; 33(7):956–61.  

28. Tasali E, Leproult R, Ehrmann DA, Van 
Cauter E. Slow-wave sleep and the risk of 
type 2 diabetes in humans. Proc Natl Acad 
Sci USA. 2008; 105(3):1044–9.  

29. Kong AP, Wing YK, Choi KC, Li AM, Ko GT, 
Ma RC, Tong PC, Ho CS, Chan MH, Ng MH, 
Lau J, Chan JC. Associations of sleep 
duration with obesity and serum lipid profile 
in children and adolescents. Sleep Med. 2011; 
12(7):659–65. 

30. Buxton OM, Cain SW, O'Connor SP, Porter 
JH, Duffy JF, Wang W, Czeisler CA, Shea SA. 
Adverse metabolic consequences in humans 
of prolonged sleep restriction combined with 
circadian disruption. Sci Transl Med. 2012; 
4(129):129–43 

31. Kobayashi D, Takahashi O, Deshpande GA, 
Shimbo T, Fukui T. Relation between 
metabolic syndrome and sleep duration in 
Japan: a large scale cross-sectional study. 
Intern Med. 2011; 50(2): 103–7.  

32. Markwald RR, Melanson EL, Smith MR, 
Higgins J, Perreault L, Eckel RH, Wright KP. 
Impact of insufficient sleep on total daily 
energy expenditure, food intake, and weight 
gain. Proc Natl Acad Sci. 2013; 110(14):5695–
5700.  

33. Roenneberg T, Allebrandt KV, Merrow M, 
Vetter C. Social jetlag and obesity. Curr Biol. 
2012; 22(10):939–43.  

34. Morris CJ, Yang JN, Scheer FA. The impact of 
the circadian timing system on 
cardiovascular and metabolic function. Prog 
Brain Res. 2012; 199:337–58.  

35. Seicean S, Kirchner HL, Gottlieb DJ, Punjabi 
NM, Resnick H, Sanders M, Redline S. 
SleepDisordered Breathing and Impaired 
Glucose Metabolism in Normal-Weight and 



 
 

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ISSN 2412-3188 (Online)| 2410-1354 (Print) 

 

APP| Published By AEIRC| Volume 9 Issue 1 

 

Overweight/ Obese Individuals The Sleep 
Heart Health Study. Diabetes Care. 2008; 
31(5):1001–1006.  

36. Zhang L, Qian H, Fu H (2018) To be thin but 
not healthy - The body-image dilemma may 
affect health among female university 
students in China. PLoS ONE 13(10) 

37. Lund HG, Reider BD, Whiting AB, Prichard 
JR. Sleep Patterns and Predictors of 
Disturbed Sleep in a Large Population of 
College Students. J Adolesc Health. 2010; 
46(2):124–32.  

38. Trockel MT, Barnes MD, Egget DL. Health-
related variables and academic performance 
among first-year college students: 
Implications for sleep and other behaviors. J 
Am Coll Health. 2000; 49(3):125–31.  

39. Gaultney JF. The prevalence of sleep 
disorders in college students: impact on 
academic performance. J Am Coll Health. 
2010; 59(2):91–7.  

40. Buboltz WC Jr, Brown F, Soper B. Sleep 
Habits and Patterns of College Students: A 
Preliminary Study. J Am Coll Health. 2001; 
50(3):131.  

41. Sing CY, Wong WS. Prevalence of Insomnia 
and Its Psychosocial Correlates Among 
College Students in Hong Kong. J Am Coll 
Health. 2010; 59(3):174–82.  

42. Kenney SR, LaBrie JW, Hummer JF, Pham 
AT. Global sleep quality as a moderator of 
alcohol consumption and consequences in 
college students. Addict Behav. 2012; 
37(4):507–12.  

43. Nyer M, Farabaugh A, Fehling K, Soskin D, 
Holt D, Papakostas GI, Pedrelli P, Fava M, 
Pisoni A, Vitolo O. Relationship Between 
Sleep Disturbance and Depression, Anxiety, 
and Functioning in College Students. 
Depress Anxiety. 2013; 00:1–8. 

44. Al-Disi D, Al-Daghri N, Khanam L, Al-
Othman A, Al-Saif M, Sabico S, Chrousos G. 

Subjectivesleep duration and quality 
influence diet composition and circulating 
adipocytokines and ghrelin levels in teen-age 
girls. Endoc J. 2010; 57(10):915–23. 

45. Shankar A, Syamala S, Kalidindi S. 
Insufficient rest or sleep and its relation to 
cardiovascular disease, diabetes and obesity 
in a national, multiethnic sample. PLoS One. 
2010; 5(11):e14189. [PubMed: 21152066]  

46. Taheri S, Lin L, Austin D, Young T, Mignot E. 
Short sleep duration is associated with 
reduced leptin, elevated ghrelin, and 
increased body mass index. PLoS Med. 2004 
Dec.1(3):e62.  

47. Stamatakis KA, Punjabi NM. Effects of Sleep 
Fragmentation on Glucose Metabolism in 
Normal Subjects. Chest. 2010; 137(1):95–101.  

48. Lesser DJ, Bhatia R, Tran WH, Oliveira F, 
Ortega R, Keens TG, Mittelman SD, Khoo 
MC, Davidson Ward SL. Sleep fragmentation 
and intermittent hypoxemia are associated 
with decreased insulin sensitivity in obese 
adolescent Latino males. Pediatr Res. 2012; 
72(3):293–8.  

49. Lucassen EA, Rother KI, Cizza G. Interacting 
epidemics? Sleep curtailment, insulin 
resistance, and obesity. Ann N Y Acad Sci. 
2012; 1264(1):110–34.  

50. Chaput JP, Brunet M, Tremblay A. 
Relationship between short sleeping hours 
and childhood overweight/obesity: results 
from the Quebec en Forme Project. Int J Obes. 
2006; 30(7):1080–5. 

51. Gangwisch JE, Malaspina D, Babiss LA, 
Opler MG, Posner K, Shen S, Turner JB, 
Zammit GK, Ginsberg HN. Short sleep 
duration as a risk factor for 
hypercholesterolemia: analyses of the 
National Longitudinal Study of Adolescent 
Health. Sleep. 2010; 33(7):956–61.  

 

 

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