Academic adaptation in university students: Associations with stress and sleep quality

This study aimed to analyze the relationships between sleep quality, stress, and academic adaptation of university students, characterize sleep quality indicators, and analyze differences in the instrument factors according to demographic variables. A total of 489 university students participated, with a mean age of 22.46 years (SD=5.648), 78.1% of whom were female. The students answered the Academic Experience Questionnaire, Perceived Stress Scale, and Pittsburgh Sleep Quality Index online. The data were submitted to inferential statistics. The results indicated that 72.4% of the participants presented a poor classification concerning sleep quality, and 23.9% had some sleep disorder – better rates of adaptation to the university correlated with better sleep quality and lower sleep quality stress levels. The importance of developing positive emotional aspects in university students favoring the processes of academic adaptation is evident.


Stress/sleep associations in university students
Higher education imposes on the student the need to adapt to different situations, whether at a personal, interpersonal, professional, or academic level.
New skills are required to adapt to the demands of the graduation course, which are configured as stressors that trigger difficulties, and occur at the levels of the organization of the study practice, interpersonal relationships, and psychological aspects. The organization in relation to the new study methodology, relationships with colleagues and professors, evaluation periods, and carrying out activities, in general, is of paramount importance to guarantee the quality of the training and student well-being (Almeida & Castro, 2016). Since stress can interfere with the learning process and professional training (Delara & Woodgate, 2015), it is important to investigate its development and associated variables in order to develop preventive strategies for better levels of well-being. In addition to stress, other variables can impair academic adaptation and students' mental health, such as sleep disorders (Barros, Lima, Ceolim, Zancanella, & Cardoso, 2019).
Sleep disorders are understood as changes in the ability to sleep properly, and they result in disturbances in the social, professional, or academic spheres of those who have them. Symptoms present themselves as difficulties in the quality, duration, and quantity of sleep, resulting in a certain degree of suffering for the individual and/or impairment of their activities during the day (American Psychiatric Association [APA], 2014). Therefore, having good sleep quality is of paramount importance for the maintenance of physical and mental health, as well as for a good performance in university activities (Ge et al., 2019). If the sleep quality is unsatisfactory, it can affect the performance and the time used to carry out academic activities (Baraldi et al., 2015;Santos, Mussi, Pires, Santos, & Paim, 2020).
In the assessment of sleep disorders, biological aspects and the individuals' daily routine must be considered. In the case of university students, the distribution of time or the amount of time they have and allocate to carry out academic activities influences the quantity and quality of sleep, subsequently reflecting on their academic performance and their general health status. Sleep hygiene can therefore be impaired by inadequate routine habits, such as poor time management in performing tasks, excessive consumption of caffeine, nicotine, or alcohol in the final six hours before bedtime, heavy meals, and stressful physical or psychological activities close to the usual sleep time (Wilson et al., 2014).
Studies on sleep quality with university students indicate students of the evening period present greater somnolence and worse sleep quality indices when compared to students of the daytime period. In addition, sleep quality can be one of the reasons for academic dissatisfaction among university students and may impair concentration and performance in student activities (Baraldi et al., 2015).
Studies on the subject identified that students in the health and exact science areas presented poor sleep quality (Carvalho et al., 2013); that morning students had shorter sleep duration compared to others (Felden et al., 2015), both in Brazil and other countries; and that university students sleep less than the general population (Araújo et al., 2013). An exception to this last data was found by Ge et al. (2019) in relation to Chinese students who reported sleeping more than eight hours a day.
Understanding that university life is not always performed appropriately to maintain physical and mental well-being (Madzhie, 2017;Vizzotto et al., 2017); the research extracts proposed here provide answers, even if initial, for the gaps in the scientific production regarding the themes that have addressed each construct (stress, sleep quality and adaptation) in isolation, considering the issue of psychological distress in Higher Education students. Therefore, the aims were to analyze the relationships between sleep quality, stress, and the academic adaptation of university students, characterize sleep quality indicators, and analyze mean differences in the factors of the instrument according to demographic variables.
Regarding the year of the course, 22.5% (n=110) were in the first year, 27.8% (n=136) in the second year, 21.9% (n=107) in the third year, 19.8% (n=97) in the fourth year, 7.8% (n=38) in the fifth year and one person in the sixth year (0.2%).
Regarding professional choice, 57.7% (n=282) reported that the course they were 7 Stress/sleep associations in university students attending had been their first professional choice and 89.4% of them (n=438) were satisfied with the course. Of the sample total, 9.4% (n=46) lived alone, 75.7% (n=370) lived with their families, and 14.9% (n=73) in houses shared by students.
This was a convenience sample.

Instruments
• Demographic questionnaire (developed for this study): to collect data regarding sex, age, socioeconomic level, course, and the period of graduation enrolled.
• Perceived Stress Scale (PSS-10) (Cohen & Williamson, 1988adapted by Dias, Silva, Maroco, & Campos, 2015: it consists of 10 items (α=.78) and is intended to efficiently discriminate according to how much the subject evaluates that they lived in an unpredictable, uncontrollable and overloaded way in the month prior to the evaluation. It analyzes the presence of specific agents that would trigger stress, and the physical and psychological symptoms of stress, and a general comprehension of stress unrelated to a cause. The instrument consists of 10 items answered on a Likert-type scale ranging from 1 (Totally disagree/never happens) to 5 (Totally agree/happens very often). self-report questions, which form a set of seven components (α=.73). These components assess subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disorders, use of sleep medication, and daytime dysfunction, according to a 0-3 weight scale. The scores for these components are added together to establish an overall score, ranging from 0 to 21. The higher the score, the lower the subject's sleep quality.

Procedures
The study was approved by the Research Ethics Committee of the University of Western São Paulo (CAAE 08029119.8.0000.5515) and complied with Resolutions 446/12 and 510/16 of the National Health Council. The collection protocol was designed on the Google Forms platform and contained the consent form, demographic questionnaire, Academic Experiences Questionnaire (reduced version), PSS-10, and the PSQI. The protocol access link was disclosed on online social networks and through the institutional e-mail available on the educational institutions' platforms. Only participants that agreed with the consent terms had access to the instruments. The collection took place between March and July 2019.

Data Analysis
Analyses were performed using the SPSS software (version 23), with descriptive statistics used to characterize the sample and frequency of sleep disorders and the use of inferential statistics. Student's t-test (with simple sampling) was used to compare the means in the instruments as a function of gender, type of institution, and satisfaction with the course; and analysis of variance (ANOVA) with Tukey's post hoc test for the year of graduation and course area variables. To assess the associations between the constructs, Pearson's correlation was performed between the instruments' components; and the coefficients were interpreted based on the criteria of Duffy, McLean, and Monshipouri (2011).

Results
Initially, the aim was to characterize the frequency of the sleep-related    Regarding the subjective sleep quality, more than half of the participants indicated that the quality of sleep was poor or very poor, as well as scored poor or very poor in relation to sleep latency, an aspect that indicates that the students take more than an hour to get to sleep after going to bed at a frequency of 3 or    From the scores in the QVA-r (Questionário de Vivências Acadêmicas), the 3rd year and Biological and Health Sciences students had the highest scores in Academic Adaptation, with the 1st year students indicating greater difficulty in this dimension.
Study adaptation was more endorsed by students of the Humanities and Social Sciences and 1st year students, differing from those that were in the 4th year.
Regarding stress, the 1st year students presented the lowest means, with an increase in the scores over the years. Finally, Pearson's correlation analysis was performed between the instrument factors, and the results are shown in Figure 3.3.  waking during the night, among others) and the lower the scores in the general score of the PSQI. Study adaptation, Career adaptation, and Institutional adaptation had higher correlations with dysfunctions during the day, indicating that the difficulties in staying awake during the day were greater when these factors increased.
Stress was significantly correlated with all the dimensions of adaptation.
Except for the Personal dimension, all correlations were negative, indicating that the greater the adaptation, the lower the perception of stress. The correlations between the general stress factor and sleep quality components were significant, and the associations were all positive.

Discussion
The correlations between the factors of the instruments showed that the less adapted the students were, the higher the stress levels. These data indicate the importance of developing strategies to integrate the student into the academic environment as a means of contributing to the learning process and to better levels of mental health (Padovani et al., 2014). Accordingly, the social support network (family, friends, and institutional) can be an important basis for strengthening the positive aspects of adaptation and performance throughout the course, as well as for reducing stress (Pascoe, Hetrick, & Parker, 2019).
Regarding the correlations between academic adaptation and sleep quality, longer sleep duration was related to greater Personal adaptation and less Study adaptation. Therefore, it is crucial to consider that oversleeping is also not healthy for individuals (Felden et al., 2015) and can harm students' organization of their study routines. In addition, the data indicated that adequate Career and Study adaptation were correlated with fewer dysfunctions during the day, reinforcing the importance of career planning actions, conscious course choice, management of the academic routine, and adequate sleep in order to increase the motivation and involvement with the university demands (Ambiel & Barros, 2018;Barros et al., 2019).
Regarding stress and sleep quality, it was observed that lower sleep quality indices equated to higher stress levels. Considering that the academic environment by itself already presents a series of stressors (Almeida & Castro, 2016), if the student has problems with sleep, there may be an intensification in the perception of the stressors and in the coping actions, demanding greater physical and psychological efforts (Madzhie, 2017) and impairing academic performance and adaptation. Therefore, considering that sleep quality directly affects the health of individuals much more than the number of hours slept (Wallace, Boynton, & Lytle, 2017), interventional actions are important for better sleep management in order to prevent high levels of stress and possible consequences in psychological disorders or physical illnesses.
When analyzing the mean differences in the academic adaptation factors, it was observed that the Personal Adaptation factor was the one that most   (Baraldi et al., 2015).
Regarding the assessment of stress, it was observed that female participants, students dissatisfied with the course, and students in the 2 nd year presented higher means when compared to the others. Concerning gender and dissatisfaction with the course, these results may be associated with poor sleep quality, considering that women and dissatisfied students also had worse overall indices in the PSQI.
Accordingly, in addition to good sleep hygiene (Baraldi et al., 2015) for better levels of well-being, other issues can contribute to reducing stress, such as adequate career planning in order to construct an academic trajectory and satisfactory employment (Ambiel & Barros, 2018). Also, changes in the environment can reduce psychosocial stressors that affect specific groups such as women and students starting the courses (Leonard et al., 2015).

Final considerations
Considering the impact of sleep quality on levels of physical and mental health, as well as on the learning and adaptation process of university students (Barros et al., 2019), this study aimed to analyze the relationship between sleep quality, stress, and academic adaptation and to verify the specificities regarding sleep quality and differences in the means of the instruments' factors according to demographic variables. Stress and sleep quality were negatively correlated with academic adaptation, with better-adapted university students presenting lower stress and better sleep quality indices. These findings are significant, as they can influence aspects such as academic performance, integration and satisfaction with the course, the institution, and colleagues.
In this study, it was possible to identify groups that showed worse indicators in relation to sleep and stress, with female participants, students dissatisfied with the course, and students in an earlier period of the graduation course (up to the 3 rd year) presenting greater impairments in the overall quality of sleep and higher levels of stress. Dissatisfied students also had lower means in adaptation, and women presented greater adaptation only in relation to the personal dimension.
The results can contribute to the development of specific actions in higher education institutions, aiming to integrate the student, provide adequate support for Stress/sleep associations in university students problem-solving, and identify students at greater risk of developing illnesses or inefficient adaptation and that may potentially drop out of the system.
The comprehension and identification of stress symptoms and poor sleep quality among university students can contribute to the prevention and adequate treatment of symptoms while simultaneously facilitating the academic adaptation process. Based on these results, the importance of working on the development of positive emotional aspects in university students should be considered, as their potentization could also favor academic adaptation processes. The promotion of mental health in higher education institutions contributes to better engagement and academic development of young people and adults. Following this premise, it is recommended that future studies could investigate interventional models that enable the development and maintenance of actions that promote well-being in higher education. Furthermore, to overcome the limitations of this study, it is suggested that studies be carried out, with a more representative sample of the Brazilian diversity, and investigations with qualitative methodologies with a clinical approach to the phenomena be analyzed.