Knowledge and Healthy Habits Among Nursing Students Regarding Obstructive Sleep Apnea: A Cross-Sectional Study

Introduction

A third of a normal person’s life is spent sleeping, and sleep is a vital indicator of bodily health and function. The most prevalent of the numerous respiratory problems linked to sleep that disrupt regular sleep cycles is obstructive sleep apnea (OSA).^1,2 It is a clinical condition that causes repetitive bouts of total or partial blockage of the upper airway lasting over 10 seconds in spite of the continued respiratory attempts. Other than loud snoring accompanied by choking or gasping for air, OSA causes frequent fragmentation of sleep and recurrent arousal. This disturbance of the continuity of sleep produces additional outcomes, such as tiredness, headache, and intellectual weakness.^3,4 In addition, frequent airway obstruction may result in hypoxia and hypercapnia, which leads to an extreme impact on the metabolism and cardiovascular systems of the body. OSA has also been further suggested to be a risk factor for an acute myocardial infarction when undiagnosed or untreated.⁵

Healthy habits consist of practices, both physical, mental, and emotional, and are associated with overall good health. This involves nutrition, exercise, sleep, mental health, and social ties habits. These habits can help in the long-term health and prevent chronic illness.⁶

Craniofacial anatomical variables also increase the number of craniofacial variables that decrease upper airway patency and possibly lead to the development of OSA. It has been reported that 25-30 percent of men and 9-17% of women in the United States satisfy the conditions of obstruction of sleep apnea.⁷ Its prevalence is more common among Hispanic, Black, and Asian groups. The prevalence also rises with age, and at the age of 50 years or even above, more women than men develop the disorder. The growing trends of OSA are attributed to the rising trend of obesity, which is between 14% to 55%. Obesity and the upper airway’s soft tissue structure are among the risk factors that are genetically inherited.⁸

Assessment of existing knowledge will be useful as it will allow educational institutions to determine the gaps in the nursing curriculum in the case of sleep disorders. This will be able to result in improved training and resources regarding OSA and other communicable conditions. The research on health habits could offer information in the way in how future nurses take care of their own health, including sleep disturbance.⁹ This is relevant because an insufficient sleep routine may interfere with their school results and general health. Being informed about OSA, nursing students will be able to bring better care outcomes to the patients with a sleeping disorder by means of successful management and care strategies.¹⁰ This study aimed to determine the level of knowledge with regard to obstructive sleep apnea and the prevalence of healthy sleep habits among nursing students at the University of Basrah.

Methods

A descriptive cross-sectional study aimed to assess Knowledge and Healthy Habits Among Nursing Students Regarding Obstructive Sleep Apnea. The research period was prolonged from November 1, 2024, to April 1, 2025. Formal administrative approvals were acquired before data collection for the project. This study has been performed in accordance with the principles stated in the Declaration of Helsinki. Each participant has voluntarily signed the written formal approval. This study has approval from the Research Ethical Approval Committee at the College of Nursing/University of Basrah, as the Institutional Review Board (IRB) with date 29 October and order 7/18/1451. It was determined that the research maneuver would cause no real or prospective injury to the study sample. The study was conducted at the University of Basrah/College of Nursing.

One hundred and sixty nursing students were collected through a self-reported questionnaire by using a non-probability (purposive sampling method). Ten students did not include samples from the pilot study. Students (male and female) who consent to engage in this study are among the inclusion requirements. Students who declined to take part in the research were not included. Based on a careful analysis of pertinent literature and earlier research, the researcher created a questionnaire to accomplish the goals. Data for Healthy Habits and Obstructive Sleep Apnea were then gathered using this questionnaire. It consists of four parts. Part (I): Questionnaire Related to the Demographic. This section is focused on collecting basic demographic data. Data was collected from students via direct interviews and included the following items: gender, stage, type of study, and age.

Part (II): Questionnaire Related to related to Obstructive Sleep Apnea. The purpose of this section was to evaluate the students’ knowledge of obstructive sleep apnea. There were eighteen items in all. Section III: Survey Concerning Nursing Students’ Healthy Lifestyles: This section was created to evaluate nursing students’ knowledge of obstructive sleep apnea-related healthy behaviors. There were eight items in all.

Using the Statistical Package for Social Science Program (SPSS), the reliability of the test’s thirty items was examined using Cronbach’s Alpha. A constructive knowledge questionnaire was used by the researcher to gather data, and direct interviews were used to get the answers. The date of the data collection was moved from November 27, 2024, to February 27, 2025. Three³ three-point Likert scales, with a range of 1 to 3, were employed. The 31 items that make up this scale were scored using a three-point Likert scale, with 1 denoting “don’t know,” 2 denoting “uncertain,” and 3 denoting “know.” Each student was given ten to fifteen minutes to complete the test. Each knowledge scale item’s assessment level was determined by determining the cut-off point for the score mean, and the results were scored as follows: The researcher identified moderate knowledge as 1.67–2.33, high knowledge as 2.34–3, and poor knowledge as 1–1.66.

Results

The sociodemographic details of the nursing students participating in this study are displayed in Table 1. The age group was more than 30 years (44.7%), most of them were female (59.3%), most of the students were from the fourth stage (72%), and more than half of the students were from morning study (53.3%).

According to Table 2, most of the students answered true to all questions regarding Obstructive Sleep Apnea (with good assessment in all questions except in Q2, Q3, Q7, Q12, and Q14, with moderate assessment).

The results of Table 3 show that, about the mean score and standard deviation (2.51 + 0.705), the majority of students (89.3%) have good knowledge about obstructive sleep apnea, 10.7% have moderate knowledge, and none have poor knowledge.

According to Table 4, most of the students answered sometimes to all questions regarding healthy habits regarding Obstructive Sleep Apnea (good healthy habits in all questions).

Based on the mean score and standard deviation (2.51 + 0.705), the results of Table 5 show that all students (100%) have good, healthy habits regarding obstructive sleep apnea.

This table’s results demonstrate a substantial correlation (P-value = 0.000) between nursing students’ sex and their knowledge of obstructive sleep apnea. The results of Table 6 demonstrate that, at a P-value > 0.05, there is no significant correlation between nursing students’ knowledge of obstructive sleep apnea and their sex, college, stage, or type of study.

Discussion

The findings showed that the majority of the respondents were aged above 30 (44.7%), female (59.3%), and at a fourth-stage academic level (72%). This age distribution implies a rather developed and mature group and may increase their knowledge level about such complicated health issues as Obstructive Sleep Apnea (OSA). Chung et al.¹⁰ also posit that academic maturity positively affects the level of awareness of chronic conditions among healthcare students.

Most of the students (89.3%) were good in terms of their knowledge about OSA, with none having poor knowledge. This finding underscores the usefulness of nursing education in raising awareness of sleep-related disorders. Young et al.¹¹ also established that early education on OSA is of paramount importance to enhance the diagnosis and reduce the complications. Nonetheless, certain topics, such as evidence of association between obesity and OSA and the impact of lifestyle changes on the severity of OSA, demonstrated a moderate level of understanding, which is consistent with Bahammam et al.,¹² who also identified the same knowledge gaps even in the healthcare provider group.

The respondents indicated that they all maintained good health habits that were linked to lowering the risk of OSA, such as engaging in physical activities, minimizing exposure to smoking, and being mindful of their eating behaviors. Peppard et al.¹³ highlighted that lifestyle changes, including healthy weight and physical exercise, are some of the major preventive measures of OSA. However, quite a significant proportion (29.3%) slept less than six hours during weekdays, and this might predispose them to sleep disorders, as Medic et al.¹⁴ highlight.

The correlation was significant between age and knowledge on OSA (p = 0.000), with younger students (18-22 years) having a high degree of knowledge. No important correlations were found about sex, level of study, or even the study type (morning/evening). The findings are in accordance with those of Al-Ghanim et al.,¹⁵ who observed that age and clinical exposure had a considerable influence on the knowledge of healthcare students with relation to respiratory conditions.

The knowledge bases and positive health behaviors of students can be explained by: A well-organized nursing curriculum that focuses on chronic disease understanding, Clinical training opportunities that emphasize theoretical learning, and Modern trends in health education that suggest the inclusion of sleep health in the main courses.

Conclusion

This paper has shown that nursing students have a good understanding and a healthy lifestyle in relation to OSA, which makes them important resources in the societal health awareness and early-stage diagnosis campaigns. Nevertheless, specific educational programs should be implemented to enhance the knowledge of some risk factors and the lifestyle influence on OSA.

Ethics and consent

This study has been performed in accordance with the principles stated in the Declaration of Helsinki. Each participant has voluntarily signed the written formal approval. This study has approval from the Research Ethical Approval Committee at the College of Nursing/University of Basrah, as the Institutional Review Board (IRB) with date 29 October and order 7/18/1451.