Gender Differences in the Relationship between Sleep, Autonomic Function and Academic Performance: The Role of Sleep and HRV

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Gender Differences in the Relationship between Sleep, Autonomic Function and Academic Performance: The Role of Sleep and HRV

https://doi.org/10.21203/rs.3.rs-5320247/v1

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This study analyzed gender differences in the psychophysiological factors of stress and academic performance among university students. A cross-sectional design was employed with a sample of 601 university students (74.7% women) aged 15 to 47 years. Participants completed assessments on sleep quality, heart rate variability (HRV), personality traits, and psychological indicators such as anxiety, depression, and perceived stress. Results showed that women exhibited higher levels of neuroticism, anxiety, psychological inflexibility, and perceived stress compared to men, yet achieved better academic performance. Regression analysis revealed that sleep quality and HRV parameters, such as heart rate (HR) and the square root of the mean squared differences of successive NN intervals (rMSSD), were positively associated with academic achievement. Despite higher stress levels, female students seemed to employ more effective emotional regulation strategies, contributing to their academic success. These findings highlight the need for gender-sensitive approaches in stress management interventions to improve student well-being and academic outcomes. Future research should consider longitudinal designs to explore the temporal dynamics of stress and academic performance.

gender differences

psychophysiological stress

academic performance

university students

heart rate variability

emotional regulation

The prevalence of stress among university students has been increasing, becoming a significant public health issue. Academic stress negatively impacts students' quality of life, with studies indicating that approximately 31% of the student population experiences significant stress levels (Fang et al., 2022). Furthermore, between 40–50% of students report symptoms of generalized anxiety or depression (López-Rodríguez et al., 2017) (Nakie et al., 2022). The transition to higher education introduces various challenges, including increased academic demands, competitive environments, and new social dynamics, which can trigger stress responses, activating the sympathetic nervous system (Olivera et al., 2023) (Beltrán-Velasco et al., 2020). Common stressors in educational settings include teachers, test results, exams, group study, peers, time management, and self-inflicted stress (Olivera et al., 2023).

In this context, women have demonstrated a higher prevalence of anxiety, depression, and acute stress symptoms compared to men. In terms of personality traits, research has indicated that women tend to exhibit higher levels of neuroticism and openness to experience, while men typically show higher levels of extraversion. It is crucial to consider that gender may impact the relationship between emotional disorders and personal attributes such as resilience and social support in students. Thus, gender is an important factor when examining differences in psychometric and emotional profiles in response to stress(Rodriguez-Besteiro et al., 2021).

The influence of stress in the academic realm is linked to reduced student performance, attributed to the disruption of mental faculties such as attention and working memory(Beltrán-Velasco et al., 2018). Additionally, prior studies have revealed that heightened activity in the sympathetic system hinders the prefrontal cortex, leading to adverse effects on memory, information processing, decision-making, concentration capacity, and executive functions(Beltrán-Velasco et al., 2020). Upon activation, the hypothalamic-pituitary-adrenal axis, prompted by the release of glucocorticoids and catecholamines, delivers these chemical messengers to brain structures associated with memory and learning (Beltrán-Velasco et al., 2018)(Ramírez-Adrados, Fernández-Martínez, et al., 2020)(Ramírez-Adrados et al., 2022)(Ramírez-Adrados, Beltrán-Velasco, et al., 2020). The impact of stress on the brain's ability to change and form connections has been noted, leading to interference with learning and academic performance. Similarly, cognitive inflexibility, lack of resilience, and a reluctance to collaborate have been linked to poor stress management, which can negatively affect students' academic performance(Sánchez-Conde et al., 2022)(Beltrán-Velasco et al., 2021).

This study aimed to analyze the gender differences in psychophysiological stress factors and academic achievement of university students. We also postulated a second aim of this study, related with the analysis of the relationship between psychophysiological stress factors and academic achievement of university students. The main hypothesis was that female university student would present higher psychophysiological stress factors and lower academic archievement. The secondary hypothesis was that heightened levels of perceived stress, anxiety, state and symptoms of depression, as well as increased loneliness, would present lower academic performance. Additionally, higher levels of psychological flexibility and physical activity are predicted to be related to better academic performance. Lastly, the role of heart rate variability in modulating emotional regulation capacity during academic stress will be explored.

Participants

In the current study, 601 volunteer Colombian university students, aged between 15 and 47 years, with an average age of 19 ± 3.27 years, of which 74.7% were women (according to the sample obtained), were interviewed via online questionnaire in a period of 2 months, from February 2024 to March 2024. The inclusion criteria were enrolment in the current academic year, living in Colombia, students from any field, and not having any diagnosed illness or taking any medication. To avoid duplicate responses, students were required to provide their student ID, which was cross-checked with the university database. Additionally, the provided information was treated with strict confidentiality. All participants digitally signed an informed consent form, which outlined the study’s objectives and procedures. This research adhered to the Helsinki Declaration on Human Research and was approved by the University Ethics Committee (CIPI/2024(611)).

Procedure

To reach the aim of the present research, a cross-sectional study was developed to apply the following instruments with the students on the university campus before starting their classes. The student's academic average (GPA) was measured on a scale of 1 to 5, where 1 is low academic performance, and 5 is high academic performance. A reduced version of the Spanish adaptation of the Big Five Inventory was used to assess personality traits such as openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism. This abbreviated version consists of 10 items rated on a 5-point Likert scale, where 1 indicates strong disagreement and 5 indicates strong agreement(Rammstedt & John, 2007). Additionally, the Spanish version of the Zung Depression Scale was used to assess depression levels(Zung, 1965) and the Spanish version of the UCLA Loneliness Scale was used to measure loneliness(Russell, 1996). This scale assesses loneliness. A condensed version with three items, rated on a three-point Likert scale where 1 represents "never" and 3 represents "frequently," was utilized in this study. A reduced version of the Spanish adaptation of the Spielberger State-Trait Anxiety Inventory(Van Knippenberg et al., 1990) consisting of 6 items that assess anxiety and are rated on a 4-point Likert scale, where 1 indicates "not at all" and 4 indicates "very much," was used to measure anxiety. The Spanish version of the Acceptance and Action Questionnaire II(Bond et al., 2011) as employed to assess experiential avoidance or psychological inflexibility through 7 items rated on a 7-point Likert scale, where 0 represents "never true" and 7 represents "always true." The PSS-4, adapted by Herrero and Meneses(Herrero & Meneses, 2006) was used to measure perceived stress. This 4-item scale evaluates how often individuals feel stressed, with higher scores indicating greater perceived stress. Although Herrero and Meneses used a 1 to 5 scale, the original 0 to 4 scale by Cohen was applied in this study, where 0 represents "never" and 4 represents "very often." The scale demonstrated good reliability, with a Cronbach's α of 0.72, and accounted for 54% of the variance (Herrero & Meneses, 2006). These evaluations were carried out in the first period of the academic semester.

Hours of sleep per day were measured on a self-perception scale, indicating the number of hours the student sleep per day. The quality of the percipients’ last sleep was measured using a Likert scale, where 1 means very poor sleep quality and 10 means very good sleep quality. Average number of steps per day in the last week was measured on a self-perception scale, indicating the number of steps the student had taken in the last week. Physical activity habits were measured with a questionnaire used in line with previous research. We evaluated the psychophysiological stress response in high psychologically demanding contexts using a questionnaire which included the items: “Did you do any physical activity in the last 7 days?”, “If so, time in minutes of cyclic and/or aerobic activity (cycling, treadmill, Zumba) adding up all the sessions of the 7 days”, “If so, time in minutes of activity with self-loads (sit-ups, push-ups, squats...) or weights (gym machines, weights...) adding up all the sessions of the 7 days.”

The autonomic modulation was assessed through the analysis of heart rate variability (HRV). The HRV data were collected using the EEG for Everybody mobile device (NoviSad, Serbia) following previous procedure(Regueros et al., 2023)(Clemente-Suárez, 2020). The variables analyzed included heart rate (HR), rMSSD (square root of average sum of diff squared between normal r-r), PNN50 (% of diff between normal R–R intervals greater than 50), standard deviation 1 (SD1), standard deviation 2 (SD2), the ratio between SD1 and SD2 (SD1/SD2), low frequency (LF), high frequency (HF), the ratio of low to high frequency (LF/HF), low frequency in normalized units (Lfnu), and high frequency in normalized units (Hfnu).

Statistical analysis

Statistical analyses were analyzed using the Statistical Package for the Social Sciences (SPSS) version 24.0 (SPSS Inc., Chicago, IL., USA). Descriptive statistics (mean and standard deviation) were calculated for each variable. Kolmogorov–Smirnov tests were performed to analyze normality and homogeneity of each variable. To analyze gender differences in sociodemographic, academic, and psychophysiological variables, an independent T test was conducted. A simple linear regression was used to analyze the influence of the study variables on academic performance; the sex and age variables were considered confounding variables. The level of significance was set at p ≤ 0.05.

The academic average (GPA) of the students was 3.94 ± 0.67 on a scale of 1 to 5, where 1 is low academic performance, and 5 is high academic performance; females had a higher average of 3.98 ± 0.64, while males obtained an average of 3.86 ± 0.77. Concerning physical activity, 53.9% of the respondents indicated that they did not engage in any physical activity. The remaining percentage reported an average of 288 minutes per week of cyclical/aerobic activity and 335 minutes per week of weight/abdominal activity. Similarly, for biomedical variables, the students had an average height of 1.63 ± 15.70 cm and a weight of 62.53 ± 13.23 kg. When comparing the study variables by gender, differences in biomedical factors such as age, height, weight, and sleep quality were observed. The analysis revealed that men tend to have better sleep quality, with an average score of 6.53 ± 1.98 on a scale of 0 to 10, where 10 represents the highest quality of sleep.

In terms of personality measured by the BIG-FIVE questionnaire, variations are observed in the agreeableness component, with women scoring higher at 6.09 ± 1.54 compared to men. Additionally, in the neuroticism component, women scored an average of 6.99 ± 1.89, indicating a very high level of this trait, which is linked to increased susceptibility to stress and negative emotions. Women also demonstrate higher scores in state anxiety, psychological inflexibility, and perceived stress compared to men, with averages of 12.53 ± 3.81, 26.38 ± 10.28, and 6.52 ± 3.40, respectively. However, the results of the state anxiety test do not indicate significant anxiety symptoms. Women also exhibit higher levels of psychological inflexibility compared to men, suggesting challenges in accepting and managing negative internal experiences. These findings align with the results of the PSS-4 test, which measures perceived stress and indicates higher levels of stress among women, potentially attributed to feeling overwhelmed by life demands and having difficulty managing stress. In terms of physiological variables measured through heart rate, differences are observed between men and women. Women exhibit higher heart rate levels than men, with an average of 87.39 ± 14.34 beats per minute, indicating a potential response to stress or arousal (Table 1).

Table 1

Psychophysiological gender differences in university students
Variables			n	Media	SD	t-student
Biomedical	Age	Woman	449	19.22	2.97	0.01
	Age	Man	152	20.26	3.95	0.01
	Height (in cm)	Woman	446	159.45	15.89	0.01
	Height (in cm)	Man	151	174.97	6.99	0.01
	Weight (in kg)	Woman	436	59.93	12.17	0.01
	Weight (in kg)	Man	150	70.09	13.35	0.01
	Quality of sleep	Woman	449	6.11	2.12	0.03
	Quality of sleep	Man	152	6.53	1.98	0.03
Personality	BIG-FIVE Extraversion	Woman	449	4.74	1.60	0.26
	BIG-FIVE Extraversion	Man	152	4.91	1.65	0.26
	BIG-FIVE Agradable	Woman	449	6.09	1.54	0.01
	BIG-FIVE Agradable	Man	152	5.70	1.54	0.01
	BIG-FIVE Scrupulous	Woman	449	6.27	1.81	0.30
	BIG-FIVE Scrupulous	Man	152	6.44	1.81	0.30
	BIG-FIVE Neuroticism	Woman	449	6.99	1.89	0.01
	BIG-FIVE Neuroticism	Man	152	5.63	1.85	0.01
	BIG-FIVE Open to Experience	Woman	449	7.68	1.66	0.35
	BIG-FIVE Open to Experience	Man	152	7.53	1.62	0.35
Anxiety	STAI	Woman	449	12.53	3.81	0.01
Anxiety	STAI	Man	152	11.16	3.33	0.01
Psychological flexibility	AAQII	Woman	449	26.38	10.28	0.01
Psychological flexibility	AAQII	Man	152	23.17	9.95	0.01
Solitude	Soledad UCLA	Woman	449	5.27	1.87	0.20
Solitude	Soledad UCLA	Man	152	5.05	1.74	0.20
Perceived stress	PSS-4	Woman	449	6.52	3.40	0.01
Perceived stress	PSS-4	Man	152	5.34	2.82	0.01
Symptoms of depression	ZUNG Scale	Woman	449	45.53	6.46	0.06
Symptoms of depression	ZUNG Scale	Man	152	44.43	6.36	0.06
Physical activity	Steps	Woman	161	10009.17	57249.52	0.59
	Steps	Man	66	6231.98	12406.43	0.59
	Cyclical/aerobic activity	Woman	104	325.12	820.58	0.36
	Cyclical/aerobic activity	Man	56	220.77	298.21	0.36
	Weight/abs activity	Woman	93	329.03	479.80	0.82
	Weight/abs activity	Man	63	344.46	367.01	0.82
Heart Rate Variability	HR	Woman	389	87.39	14.84	0.02
	HR	Man	140	84.23	14.17	0.02
	rMSSD	Woman	389	47.12	22.92	0.63
	rMSSD	Man	140	48.20	24.43	0.63
	PNN50	Woman	389	26.75	18.30	0.83
	PNN50	Man	140	27.14	20.68	0.83
	SD1	Woman	389	32.83	16.27	0.93
	SD1	Man	140	32.96	17.22	0.93
	SD2	Woman	389	53.95	28.65	0.95
	SD2	Man	140	54.11	26.57	0.95
	LFnu	Woman	389	56.61	20.96	0.66
	LFnu	Man	140	55.73	21.04	0.66
	HFnu	Woman	389	41.89	20.03	0.77
	HFnu	Man	140	42.45	20.87	0.77
GPA	Grade point average (0–5)	Woman	444	3.98	0.64	0.05
GPA	Grade point average (0–5)	Man	146	3.86	0.77	0.05
Note: SD: Standard deviation; STAI: State anxiety questionnaire; AAQII: Acceptance and Action Questionnaire; PSS-4: Perceived Stress Scale 4; HR: Heart rate; rMSSD: square root of average sum of diff squared between normal r-r; PNN50:% of diff between normal R–R intervals greater than 50; SD1: Sensitivity of short-term variability of HRV; SD2: Long-term variability of the HRV spectrum; LFnu: Low frequency; HFnu: High frequency; Height measured in centimeters; Weight measured in kilograms.

Simple linear regression was performed with all study variables included. The dependent variable was the grade point average, reflecting the academic performance of university students. The model's coefficient of determination (r2) was found to be 0.56, meaning that 56% of the variability in academic averages is explained by this linear model. Upon closer examination (Table 2), certain variables were found to have statistically significant values. For instance, an increase of one unit in hours of sleep was associated with a 0.21 point increase in academic average (95%CI: 0.03–0.39). Additionally, a similar trend was observed for HR (0.01, 95%CI: 0.00-0.03) and rMSSD (0.03, 95%CI: 0.01–0.05), suggesting that increased stress might be linked to improved stress management capacity and healthier autonomic function.

Table 2

Simple linear regression model of academic stress.
Variables	Estimate	95% CI		P-value
(Constant)	0.93	-5.36	7.21	0.76
Hours of sleep	0.21	0.03	0.39	0.02
HR	0.01	0.00	0.03	0.04
rMSSD	0.03	0.01	0.05	0.02
Note: Dependent variable: Grade point Average (GPA). The variables age and sex were included in the model as they were considered confounding variables. HR: Heart rate; rMSSD: square root of average sum of diff squared between normal r-r.

The purpose of this study was to investigate gender differences in the psychophysiological aspects of stress and academic performance among university students and to examine how these variables relate to academic performance. The initial hypothesis, which proposed that female students would experience higher psychophysiological stress levels and lower academic performance, was partially confirmed, despite reporting higher levels of psychophysiological stress in factors such as neuroticism, anxiety, psychological inflexibility, perceived stress, and heart rate variability, female university students demonstrated better academic performance compared to their male counterparts. This suggests that women might employ more effective emotional regulation strategies, enabling them to manage stressors without a significant detriment to their academic outcomes. The secondary hypothesis, which predicted that heightened levels of perceived stress, anxiety, depression symptoms, and loneliness would be associated with lower academic performance, was rejected. Contrary to expectations, these variables did not show a significant relationship with academic achievement, indicating that factors beyond psychophysiological stress might play a more critical role in determining academic success.

As for the psychological variables of the university students, personality differences were observed. Female university students tended to exhibit more warm, trusting, and cooperative traits, while males tended to exhibit skepticism, openness, and competitiveness. These results are consistent with research suggesting that social expectations lead women to embrace cooperation and empathy, whereas men tend to display more competitive and skeptical traits (Khan et al., 2020). These differences may influence how each sex copes with stress, which is relevant in the context of academic performance. Furthermore, in the present study, it was observed that women showed higher levels of neuroticism, a trait associated with emotional instability and worry. The literature suggests that neuroticism is linked to greater susceptibility to stress and negative emotions, which is consistent with our findings, in which women reported higher levels of psychophysiological stress compared to men(Djudiyah et al., 2016). Other studies suggest that the impact of neuroticism in women may be moderated by negative cognitive bias. This suggests that gender roles and psychological and physical characteristics may influence how personality traits affect individuals(Hou et al., 2024).

Regarding emotional variables, although the study sample did not present clinical levels of depression or anxiety, women reported higher levels of state anxiety; our results suggest that, although women may experience anxiety, it does not reach clinical levels, which would have an impact on their academic performance. This may be due to a higher perception of academic stress, reflecting differences in the cognitive interpretation of stress(Augusto-Landa et al., 2024), and is in contrast to other research that has found higher rates of anxiety in women in various contexts(Haro et al., 2006). In terms of psychological inflexibility, the study sample exhibited low levels, indicating an ability to accept difficult internal experiences without allowing them to interfere with behavior and decisions. However, when broken down by gender, women showed higher levels of inflexibility, which may be related to challenges in accepting and managing negative internal experiences(Peris-Ramos et al., 2024). This pattern is consistent with studies linking psychological inflexibility to higher levels of anxiety and depression, especially in women(Eisenbeck et al., 2019)(Gilbert et al., 2019).

In examining heart rate variability (HRV), the study identified significant gender-based differences in time-domain variables, including HR, rMSSD, and PNN50, supporting the notion that men experience greater sympathetic modulation compared to women. Similarly, male university students in the sample showed higher HR and lower rMSSD than their female counterparts, indicating the predominance of sympathetic activity in stressful contexts. These findings corroborate previous research demonstrating that men tend to exhibit greater sympathetic activity, as evidenced by elevated HR values and greater sympathetic modulation during academic stress(Hammoud et al., 2019)(36). The observed gender disparity in stress response may have its roots in evolutionary biology; some studies suggest that males have evolved more pronounced “fight or flight” responses, whereas females are more likely to adopt a “tend and befriend” strategy. This divergence likely influences autonomic modulation and reactions to academic stressors(Taylor et al., 2000). Additionally, hormones such as estrogen and progesterone play a critical role in stress modulation, particularly through their effects on the parasympathetic nervous system, thereby contributing to enhanced physiological flexibility under stress(Kajantie & Phillips, 2006).

Concerning academic performance, test results indicate that students who get more sleep tend to perform better academically. These findings align with previous research emphasizing the pivotal role of sleep in memory consolidation and learning(Curcio et al., 2006). Sleep, particularly during the REM phase, is instrumental in consolidating both declarative and non-declarative memories, which are fundamental for academic and cognitive performance(Curcio et al., 2006). Furthermore, the quality and quantity of sleep are closely linked to enhanced cognitive functioning, as they support neuroplasticity, a critical process for long-term memory consolidation and retention of newly acquired information(Walker & Stickgold, 2006). Additionally, autonomic modulation, measured in the study sample through HRV variables such as HR and rMSSD, suggests that their increase in these variables is indicative of enhanced parasympathetic modulation. This increased in parasympathetic activity correlates with an improved capacity to manage stress, which in turn facilitates better academic performance in high-pressure contexts(Thayer et al., 2012). Prior research has also demonstrated that individuals exhibiting higher HRV tend to regulate stress more effectively, thus performing better in both academic and cognitive tasks(Forte et al., 2019). This evidence underscores the importance of emotional regulation and physiological stress coping mechanisms as essential factors for academic success, particularly in high-demand environments(Porges, 2007).

The findings of this study underscore the importance of implementing gender-sensitive stress management and sleep hygiene programs in university settings. By recognizing the distinct psychophysiological stress responses of male and female students, universities can tailor interventions that promote effective emotional regulation strategies. Workshops that focus on stress management techniques, such as mindfulness and relaxation exercises, alongside education on the significance of sleep quality, can enhance overall student well-being and academic performance. Additionally, fostering an environment that encourages open discussions about mental health and stress may empower students to seek help, ultimately leading to improved academic outcomes.

The study has some limitations, that should be considered when interpreting the results. First, the use of a cross-sectional design restricts the ability to infer causal relationships. Furthermore, the study did not account for certain confounding variables such as coping strategy quality, social support, menstrual cycle, and contraceptive use, which could have influenced both academic performance and stress regulation. Future research should employ longitudinal designs to capture temporal dynamics and explore interventions aimed at enhancing stress regulation, considering gender-specific differences. The current findings offer practical implications for developing targeted stress management programs and improving sleep habits among university students, with a focus on gender-sensitive approaches.

As conclusion, while female university students exhibited higher levels of psychophysiological stress, their academic performance was not adversely affected, indicating a greater ability to employ effective emotional regulation strategies compared to their male counterparts. Additionally, sleep quality and autonomic modulation were identified as crucial factors for academic success, corroborating existing literature on the relationship between these elements and cognitive performance. These findings underscore the need to develop stress management programs and improve sleep habits, taking gender differences into account to optimize student well-being and academic outcomes.

The authors declare that they have no conflict of interest and did not receive support from any organization for the submitted work.

Author Contribution

J.C.B.-A. and V.J.C-S. conceptualized the study and designed the methodology. J.C.B.-A. conducted the statistical analysis and prepared the initial draft of the manuscript. D.R.-C. contributed to data collection and interpretation of results. V.J.C.-S. provided critical revisions and contributed to the theoretical framework. All authors reviewed and approved the final version of the manuscript.

Data Availability

Data is provided within the manuscript or supplementary information files

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Gender Differences in the Relationship between Sleep, Autonomic Function and Academic Performance: The Role of Sleep and HRV

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