Chronotype and Sleep Quality in College Students Undergoing Clinical Placement: A Moderated Moderation Model of Sleep Reactivity and Resilience

Renny Wulan Apriliyasari; Jia-Wei Liu; Chia-Wen Chou; Jin-Hua Chen; Pei-Shan Tsai

doi:10.1097/jnr.0000000000000681

Chronotype and Sleep Quality in College Students Undergoing Clinical Placement: A Moderated Moderation Model of Sleep Reactivity and Resilience

J Nurs Res. 2025 Jun 23. doi: 10.1097/jnr.0000000000000681. Online ahead of print.

Authors

Renny Wulan Apriliyasari^{1

2

3}, Jia-Wei Liu^{2

3}, Chia-Wen Chou¹, Jin-Hua Chen^{4

5

6}, Pei-Shan Tsai^{1

7

8}

Affiliations

¹ School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
² Department of Nursing, Institute of Health Technology, Cendekia Utama Kudus, Kudus, Indonesia.
³ Contributed equally.
⁴ Graduate Institute of Data Science, College of Management.
⁵ Institutional Research Center, Office of Data Science.
⁶ Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁷ Department of Nursing and Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
⁸ Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.

PMID: 40550007
DOI: 10.1097/jnr.0000000000000681

Abstract

Background: Chronotype, also referred to as morningness and eveningness, describes the natural preference of the body for wakefulness or sleep at different times during a 24-hour period. Individuals demonstrating late chronotypes and low resilience tend to have poor sleep quality, and the association between late chronotypes and sleep quality is known to be moderated by sleep reactivity. The mediating roles of sleep reactivity and psychological resilience in the association between chronotype and sleep quality in college students under situations of high stress have yet to be investigated.

Purpose: This study was designed to evaluate the degree to which resilience moderates the moderating role of sleep reactivity on the association between chronotype and sleep quality in college students undergoing clinical placement.

Methods: A cross-sectional study involving 225 college students undergoing clinical placement was conducted. The Chinese version of the Pittsburgh Sleep Quality Index was used to assess sleep quality, chronotype was assessed using the Morningness-Eveningness Questionnaire, sleep reactivity and resilience were respectively assessed using Ford's Insomnia Response to Stress Test and Brief Resilience Scale, and the SPSS PROCESS macro Version 4.3 (Hayes) was employed in moderated moderation analysis.

Results: Resilience was shown to moderate the relationship between sleep reactivity and sleep quality (β=0.079, P=0.039) as well as the moderating role of sleep reactivity in the chronotype-sleep quality relationship (β=-0.002, P=0.027).

Conclusions: In this study, sleep reactivity and chronotype both exhibited inverse effects on sleep quality in the moderate- and high-resilience groups. However, those in the low-resilience group with high sleep reactivity exhibited low sleep quality regardless of chronotype. Considering these findings, sleep reactivity and resilience should be adequately monitored during interventions designed to enhance sleep quality.

Keywords: chronotype; college student; resilience; sleep quality; sleep reactivity.