Hongwei Wang

Background Sleep problems are common among university students due to academic stress, lifestyle factors, and psychological distress and may adversely affect physical and mental health, academic performance, and social functioning. Mindfulness-based interventions (MBIs) have increasingly been used as a non-pharmacological approach to improve sleep health; however, previous findings remain inconsistent, and evidence specifically addressing sleep quality in university students remains limited. This study aimed to systematically evaluate the effects of MBIs on sleep quality in university students and explore factors that may account for variations in intervention effects. Methods We searched seven databases—PubMed, Web of Science, EBSCO, the Cochrane Library, Scopus, Embase, and ScienceDirect—from inception to June 26, 2026. Randomized controlled trials (RCTs) evaluating MBIs for sleep quality in university students were included. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment using the RoB 2 tool. Meta-analysis was conducted in Stata 17.0 using a random-effects model. Subgroup analyses, sensitivity analyses, publication bias assessment, and GRADE assessment were also performed. Results Ten RCTs involving 638 university students were included, with 335 participants in the intervention groups and 303 in the control groups. MBIs significantly improved sleep quality [SMD = −0.97, 95% CI (−1.43, −0.51), p < 0.001], although substantial heterogeneity was observed ( I 2 = 85.1%). Subgroup analyses revealed statistically significant between-group differences with respect to sleep-outcome measurement instrument ( p = 0.001), intervention type ( p = 0.009), and session duration ( p = 0.030), indicating that these variables may partially account for the observed heterogeneity. Sensitivity analyses supported the robustness of the pooled results. Egger’s test revealed no evidence of significant publication bias ( p = 0.270). The certainty of the evidence was rated as low according to the GRADE framework. Conclusion MBIs may improve sleep quality in university students. However, given the substantial heterogeneity and low certainty of evidence, further high-quality RCTs are needed to confirm these findings. Systematic review registration CRD420261458068, https://www.crd.york.ac.uk/PROSPERO/view/CRD420261458068 .