{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:03:48Z","timestamp":1790075028178,"version":"4.0.1"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clocks &amp; Sleep"],"abstract":"<jats:p>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, \u03b2 = 0.320, p &lt; 0.001, R2 = 0.109), which in turn was strongly associated with uncontrolled eating (Path b: B = 0.4621, \u03b2 = 0.709, p &lt; 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 (\u03b2 = 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\u2019 psychological vulnerability.<\/jats:p>","DOI":"10.3390\/clockssleep8030057","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T09:04:17Z","timestamp":1790067857000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Global Sleep Quality and Uncontrolled Eating Among Romanian Healthcare Students: The Mediating Pathway of Emotional Eating"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9257-8104","authenticated-orcid":false,"given":"Iustina-Gabriela","family":"Mih\u0103ianu","sequence":"first","affiliation":[{"name":"Faculty of Medicine, \u201dGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Andreea-Sabina","family":"Butucaru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201dGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7074-959X","authenticated-orcid":false,"given":"Magdalena","family":"Iorga","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201dGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Faculty of Psychology and Educational Sciences, \u201cAlexandru Ioan Cuza\u201d University of Iasi, 700554 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2953-3842","authenticated-orcid":false,"given":"Raluca Ortensia Cristina","family":"Iurcov","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Pharmacy, University of Oradea, 410087 Bihor, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1038\/s41562-020-00965-x","article-title":"Sleep Characteristics across the Lifespan in 1.1 Million People from the Netherlands, United Kingdom and United States: A Systematic Review and Meta-Analysis","volume":"5","author":"Kocevska","year":"2021","journal-title":"Nat. Hum. Behav."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.sleep.2016.03.008","article-title":"Sleep Quality in the General Population: Psychometric Properties of the Pittsburgh Sleep Quality Index, Derived from a German Community Sample of 9284 People","volume":"30","author":"Hinz","year":"2017","journal-title":"Sleep Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ausserhofer, D., Piccoliori, G., Engl, A., Marino, P., Barbieri, V., Lombardo, S., Mahlknecht, A., and Wiedermann, C.J. (2025). Sleep Problems and Sleep Quality in the General Adult Population Living in South Tyrol (Italy): A Cross-Sectional Survey Study. Clocks Sleep, 7.","DOI":"10.3390\/clockssleep7020023"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Pop, L.M., Iorga, M., Muraru, I.D., and Petrariu, F.D. (2021). Assessment of Dietary Habits, Physical Activity and Lifestyle in Medical University Students. Sustainability, 13.","DOI":"10.3390\/su13063572"},{"key":"ref_5","first-page":"1574","article-title":"Effect of Poor Sleep Quality on Academic Performance among Students at a Public Saudi University","volume":"8","author":"Abdulrahman","year":"2024","journal-title":"Int. J. Med. Dev. Ctries."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"D\u0105browska-Galas, M., Ptaszkowski, K., and D\u0105browska, J. (2021). Physical Activity Level, Insomnia and Related Impact in Medical Students in Poland. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18063081"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.colegn.2020.02.013","article-title":"Associations between Sleep and Lifestyle Behaviours among Australian Nursing Students: A Cross-Sectional Study","volume":"28","author":"Binks","year":"2021","journal-title":"Collegian"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Al-Jawarneh, M., Chauhan, S., Cs\u00f6lle, I., and Lohner, S. (2025). The Association of Unhealthy Eating Behaviors with Sleep Quality Outcomes Among University Students: A Cross-Sectional Study. Nutrients, 17.","DOI":"10.3390\/nu17223580"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"24.","DOI":"10.1186\/s13033-017-0131-9","article-title":"Sleep Disturbances and Mental Strain in University Students: Results from an Online Survey in Luxembourg and Germany","volume":"11","author":"Schlarb","year":"2017","journal-title":"Int. J. Ment. Health Syst."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Grajek, M., Krupa-Kotara, K., Bia\u0142ek-Dratwa, A., Sta\u015bkiewicz, W., Rozmiarek, M., Misterska, E., and Sas-Nowosielski, K. (2022). Prevalence of Emotional Eating in Groups of Students with Varied Diets and Physical Activity in Poland. Nutrients, 14.","DOI":"10.3390\/nu14163289"},{"key":"ref_11","first-page":"1034","article-title":"The Relationship of Sleep Quality with Eating Behavior and Food Intake among Male University Students","volume":"2","author":"Lotfi","year":"2015","journal-title":"J. Sleep Med. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Priede, L., Beitane, I., and Beitane, L. (2025). A Study of Relationships Between Mental Well-Being, Sleep Quality, Eating Behavior, and BMI: A Cross-Sectional Study Among University Students. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22101465"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.amepre.2006.08.009","article-title":"Basic Demographics, Health Practices, and Health Status of US Medical Students","volume":"31","author":"Frank","year":"2006","journal-title":"Am. J. Prev. Med."},{"key":"ref_14","first-page":"415","article-title":"Association Between Indicators of Nutritional Status and Psychological Distress in Medical Students in Slovakia","volume":"127","author":"Belica","year":"2026","journal-title":"Bratisl. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E594","DOI":"10.1017\/S0029665120005431","article-title":"Association between Mental Health and Nutritional Status in University Students Aged 18\u201324 Years","volume":"79","author":"Wilson","year":"2020","journal-title":"Proc. Nutr. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Djunet, N.A. (2023). Night Eating Syndrome and Palatable Eating Motives among Medical Students. Proceedings of the 3rd International Conference on Cardiovascular Diseases (ICCvD 2021), Yogyakarta, Indonesia, 23\u201324 October 2021, Atlantis Press.","DOI":"10.2991\/978-94-6463-048-0_10"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Romero-Blanco, C., Hern\u00e1ndez-Mart\u00ednez, A., Parra-Fern\u00e1ndez, M.L., Onieva-Zafra, M.D., Prado-Laguna, M.D.C., and Rodr\u00edguez-Almagro, J. (2022). Food Preferences in Undergraduate Nursing Students and Its Relationship with Food Addiction and Physical Activity. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19073858"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Serban, D.M., Ursoniu, S., Moleriu, R.D., Banu, A.M., and Serban, C.L. (2024). Mindful Eating, Nutrition Knowledge, and Weight Status among Medical Students: Implications for Health and Counseling Practices. Nutrients, 16.","DOI":"10.3390\/nu16121894"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.appet.2010.08.013","article-title":"Eating Habits, Health Attitudes and Obesity Indices among Medical Students in Northern Greece","volume":"55","author":"Chourdakis","year":"2010","journal-title":"Appetite"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"iii446","DOI":"10.1093\/eurpub\/ckab165.286","article-title":"Evaluation of the Stress and Eating Behaviors of Medical Students after University Entrance Exam","volume":"31","author":"Kara","year":"2021","journal-title":"Eur. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Giannopoulou, I., Kotopoulea-Nikolaidi, M., Daskou, S., Martyn, K., and Patel, A. (2020). Mindfulness in Eating Is Inversely Related to Binge Eating and Mood Disturbances in University Students in Health-Related Disciplines. Nutrients, 12.","DOI":"10.3390\/nu12020396"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11892-018-1000-x","article-title":"Causes of Emotional Eating and Matched Treatment of Obesity","volume":"18","year":"2018","journal-title":"Curr. Diab. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s40519-014-0130-7","article-title":"Eating Behavior and Perception of Body Shape in Japanese University Students","volume":"19","author":"Ohara","year":"2014","journal-title":"Eat. Weight Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1080\/07420528.2021.1903483","article-title":"Chronobiological Traits Predict the Restrained, Uncontrolled, and Emotional Eating Behaviors of Female University Students","volume":"38","author":"Budkevich","year":"2021","journal-title":"Chronobiol. Int."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Alexatou, O., Papadopoulou, S.K., Mentzelou, M., Deligiannidou, G.E., Dakanalis, A., and Giaginis, C. (2025). Exploring the Impact of Emotional Eating Among University Students: A Literature Review. Med. Sci., 13.","DOI":"10.3390\/medsci13020056"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ferrara, M., Bottasso, A., Tempesta, D., Carrieri, M., De Gennaro, L., and Ponti, G. (2015). Gender Differences in Sleep Deprivation Effects on Risk and Inequality Aversion: Evidence from an Economic Experiment. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0120029"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"23806","DOI":"10.1073\/pnas.1914003116","article-title":"Sex Differences in the Circadian Misalignment Effects on Energy Regulation","volume":"116","author":"Qian","year":"2019","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1017\/S0954422423000264","article-title":"Sleep Deprivation in Development of Obesity, Effects on Appetite Regulation, Energy Metabolism, and Dietary Choices","volume":"38","author":"Akhlaghi","year":"2025","journal-title":"Nutr. Res. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Du, C., Adjepong, M., Zan, M.C.H., Cho, M.J., Fenton, J.I., Hsiao, P.Y., and Tucker, R.M. (2022). Gender Differences in the Relationships Between Perceived Stress, Eating Behaviors, Sleep, Dietary Risk, and Body Mass Index. Nutrients, 14.","DOI":"10.3390\/nu14051045"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"020184","DOI":"10.1063\/5.0197436","article-title":"Comparative Analysis for Evaluation and Consumption of Late-Night Snacks Based upon Stress and Sleep Pattern among University Students","volume":"2853","author":"Zameer","year":"2024","journal-title":"AIP Conf. Proc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1278579","DOI":"10.1155\/2019\/1278579","article-title":"Evaluation of Sleep Patterns and Self-Reported Academic Performance among Medical Students at the University of Ghana School of Medicine and Dentistry","volume":"2019","author":"Lawson","year":"2019","journal-title":"Sleep Disord."},{"key":"ref_32","first-page":"1431","article-title":"Examination of Sleep Quality and Factors Affecting Sleep Quality of a Group of University Students","volume":"13","author":"Yildirim","year":"2020","journal-title":"Int. J. Caring Sci."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rossi, A.A. (2025). Tying Food Addiction to Uncontrolled Eating: The Roles of Eating-Related Thoughts and Emotional Eating. Nutrients, 17.","DOI":"10.3390\/nu17030369"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/s40337-025-01473-x","article-title":"Childhood Traumatic Experiences and Addiction-Like Eating Behaviors: The Mediating Roles of Attachment, Mentalization, and Emotional Eating","volume":"13","author":"Rossi","year":"2025","journal-title":"J. Eat. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1038\/ijo.2009.74","article-title":"Psychometric Analysis of the Three-Factor Eating Questionnaire-R21: Results from a Large Diverse Sample of Obese and Non-Obese Participants","volume":"33","author":"Cappelleri","year":"2009","journal-title":"Int. J. Obes."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."}],"container-title":["Clocks &amp; Sleep"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2624-5175\/8\/3\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T10:07:19Z","timestamp":1790071639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2624-5175\/8\/3\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":36,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["clockssleep8030057"],"URL":"https:\/\/doi.org\/10.3390\/clockssleep8030057","relation":{},"ISSN":["2624-5175"],"issn-type":[{"value":"2624-5175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}