Global Sleep Quality and Uncontrolled Eating Among Romanian Healthcare Students: The Mediating Pathway of Emotional Eating

Abstract

Background: Healthcare university students face disruptive sleep schedules and irregular meals caused by busy schedules, multiple activities, and stressful internships. This study aimed to investigate the complex relationships between sleep quality, psychological eating dimensions (cognitive restraint, uncontrolled eating, and emotional eating), accommodation, history of diets and late-night food intake, while evaluating the impact of demographic factors such as age, sex, and residential background. Methods: A cross-sectional survey was conducted among a sample of Romanian healthcare university students (n = 265; 74.3% women). Psychometric evaluation included the Pittsburgh Sleep Quality Index (PSQI) and the Three-Factor Eating Questionnaire (TFEQ-R21). Sociodemographic data (age, gender, environment and accommodation) and information about diets were collected. Late-night food intake was defined as eating after 21:00. Data processing and analysis were performed using IBM Statistical Package for the Social Sciences (SPSS) for Windows, version 26 (SPSS Inc., Chicago, IL, USA). Results: Students exhibit poor global sleep quality, which positively correlated with all TFEQ-R21 subscales. Students with a prior history of following weight-loss diets demonstrated significantly elevated levels of intentional food monitoring and psychological eating disinhibition compared to non-dieters. Urban students feel greater psychological pressure to constantly and consciously control what they eat. Students living in dormitories (Mdn = 2.50, IQR = 1.83) and those living in rented apartments (Mdn = 2.17, IQR = 1.50) reported significantly higher Emotional Eating scores compared to students residing with their parents. Male students demonstrated a substantially higher prevalence of late-night food consumption compared to female students (77.9% vs. 59.4%). Cognitive restraint and female gender protect against nighttime snacking, while uncontrolled eating and poor-quality sleep significantly increase this risk. After adjusting for age, sleep disturbances were positively associated with emotional eating (Path a: B = 0.0967, β = 0.320, p < 0.001, R2 = 0.109), which in turn was strongly associated with uncontrolled eating (Path b: B = 0.4621, β = 0.709, p < 0.001). While the model explained 52.16% of the variance in uncontrolled eating, this was driven almost entirely by path b, as the initial contribution of sleep was considerably smaller (Path a: R2 = 0.109), yielding a significant standardized indirect association (β = 0.227, 95% BootCI [0.148, 0.309]). Conclusions: Sleep disturbances are linked to uncontrolled eating patterns primarily through their shared indirect association with emotion-driven eating. Prioritizing weight loss over health promotion increases students’ psychological vulnerability.