Sleep Quality and Academic Performance Among Nursing Students: Palestinian Perspective — A Cross-Sectional Study

Introduction Sleep is essential to health and vital for learning, especially for college students. This study investigated relationships between sleep quality and academic performance in Palestinian nursing institutions. This study's focus on the Palestinian context is analytically important, as it highlights how socio-political and resource-related stressors may uniquely shape sleep and academic outcomes in nursing education. Method A cross-sectional study using convenience sampling was conducted from November to December 2024 on 230 4th-year nursing students. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI), and academic performance was measured using self-reported grade point average (GPA). The PSQI demonstrated acceptable internal consistency (Cronbach's α = 0.78). Results The average global PSQI score was 6.8 ± 1.6, with 96.5% of respondents classified as having ‘poor sleep quality’ (PSQI ≥ 5). A component-level analysis revealed that the most elevated PSQI sub-scores were for sleep latency (1.6 ± 0.7), daytime dysfunction (1.5 ± 0.6), and subjective sleep quality (1.4 ± 0.6). The mean GPA was 2.6 ± 0.5. A significant negative correlation was found between PSQI and GPA (Pearson's r = −0.639, p < 0.001), indicating lower sleep quality is associated with declining academic performance. Females reported slightly poorer sleep quality (mean PSQI = 6.9 ± 1.7) than males (mean PSQI = 6.7 ± 1.5). Participants with GPA ≥3.0 had significantly lower PSQI scores (5.4 ± 1.3) than those with GPA <3.0 (7.1 ± 1.5, p < 0.01, Cohen's d = 1.23). However, the cross-sectional design and self-reported nature of GPA limit causal inference and precision of estimates. Conclusion The study revealed a high prevalence of poor sleep quality among nursing students and its negative association with academic performance. The findings suggest contextualized, hypothesis-generating recommendations including sleep hygiene education, stress management, and flexible scheduling, though these require further empirical testing through intervention studies.