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Abstract This study investigated temporal changes in sleep quality among Chinese boarding high school students across four phases (2019:pre-pandemic baseline, 2020:outbreak containment, 2021:dynamic mitigation, and 2024:post-pandemic adaptation), aiming to identify optimal PSQI cutoffs and key predictors using machine learning. A total of 4,592 Grade 11 students from Hebei Province were surveyed using a four-wave repeated cross-sectional design.
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