Subjective sleep quality and academic outcomes in nursing students through a cognitive-behavioral therapy for insomnia based educational program: a pilot study

Poor sleep quality is highly prevalent among nursing students and has been associated with reduced cognitive functioning and academic performance. Although cognitive behavioral therapy for insomnia (CBT-I) is effective in improving sleep outcomes in individuals with insomnia, evidence on preventive sleep education incorporating selected CBT-I principles in healthy university populations remains limited. A two-arm pilot randomized clinical trial was conducted among 32 first-year nursing students (mean age 19.9 ± 1.95 years) from a Spanish university. Participants were randomly allocated to an intervention group (IG, n = 14) or a control group (CG, n = 18) to evaluate the effectiveness of a CBT-I-informed educational intervention on subjective sleep quality, academic performance, and attention. The intervention consisted of a CBT-I-informed educational program delivered through active-constructive learning. Participants completed the Pittsburgh Subjective Sleep Quality Index (PSQI), and the d2 Test of Attention both before and after the intervention. Cognitive performance was assessed by primary attention outcomes, including Concentration Performance (CON), Total Responses (TR), Total Correct Responses (TC), and Correct Responses in Sequence (TR⁺) among others. Academic performance was evaluated by comparing final course grades before and after intervention. No statistically significant between-group differences were observed for sleep outcomes, although the IG showed descriptive reductions in sleep latency and modest changes in sleep duration and global PSQI scores. The IG demonstrated greater improvements in attentional performance than the CG across several principal attention outcomes, including TOT, CON, TC and TR+, with large effect sizes (Hedges’ g = 1.38–1.9). Final course grades improved significantly within the IG ( p = 0.015), although between-group differences were not statistically significant. This pilot study provides preliminary signals of improvements in attentional performance following a preventive CBT-I-informed educational intervention, while changes in subjective sleep outcomes were modest and did not demonstrate a significant between-group effect. Although these results do not establish efficacy, these preliminary signals justify further investigation, particularly regarding attentional outcomes. Overall, these findings support further investigation of structured sleep education within nursing curricula and warrant confirmation in larger randomized trials. ClinicalTrials.gov Identifier: NCT05273086. Registered: 2023-07-12.