Sleep-wake pattern of medical students: early versus late class starting time

Comparison of Chronotypes and their Relationship with Academic Performance and Quality of Life in University Students

Objective  An individual's chronotype affects circadian characteristics associated with bedtime, waking, and other daily activities. It is known that academic achievement is strongly dependent on personality traits. The present study aimed to investigate the relationship regarding chronotype, quality of life, and academic performance of university students by comparing three educational fields: medicine, technology, and art. Materials and Methods  The present cross-sectional study was conducted with 400 medicine, technology, and art students enrolled at universities in Tehran between2018 and 2019, with convenience sampling from January 2020 to January 2021. The students filled out online questionnaires, including a demographics questionnaire, a quality of life assessment questionnaire (the World Health Organization Quality of Life: Brief Version, WHOQOL-BREF), the Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale-21 items (DASS-21). The statistical analysis was performed using the IBM SPSS Statistics for Windows software, version 22.0 ( p  < 0.05). Results  A total of 400 students were enrolled in the present study, including 115 medicine, 153 technology, and 132 art students (67.3% of female and 33.7% of male subjects, with a mean age of 21.06 ± 2.063 years). In spite of the absence of significant differences among the chronotypes of the three groups, there was a significant correlation regarding the chronotypes in all groups and quality of life ( p  = 0.005). Morning-type individuals presented better quality of life and better quality of sleep ( p  < 0.001; r = 0.175). No significant associations were found involving the students' academic performance and their chronotypes ( p  > 0.05; r = 0.026). Conclusion  Considering the chronotype's effect of improving the quality of life of students and, therefore, their academic performance, more studies are essential to effectively improve the academic performance of individuals with different chronotypes.

Sleep Patterns and Influencing Factors in Romanian Medical Students During the COVID-19 Pandemic: A Two-Wave Ecological Study

Introduction Sleep quality among students is variable with sleep disturbances being common worldwide. The coronavirus disease 2019 (COVID-19) pandemic led to major changes, including in the educational system. In this study, we aimed to analyze sleep patterns and screen time of medical students, and the effect of COVID-19. Material and methods We conducted a two-wave questionnaire-based ecological study on Romanian medical students from Târgu Mureș. For data collection, a 43-item questionnaire, structured into six categories, was designed and distributed through social networks and official online teaching platforms. Results Out of 751 answers from both waves, it was seen that most of the responders were female (76.23%, n=571) and in their preclinic years of study (61.33%, n=460). There was a statistically significant association between the form of education and students' general sleep quality (p=0.0010, OR=1.670, 95%CI: 1.228-2.271), their study time (5.5 hours, IQR: 4-7.5 versus five hours, IQR: 2.5-5, p<0.001) and their sleep disturbances (p=0.0008, OR=0.5859, 95%CI: 0.4284-0.8011). Also, there was a statistically significant association between the year of study and their study time (five hours, IQR: 4-7 versus four hours, IQR: 3-6, p<0.001) and their sleep satisfaction (p=0.0027, OR=0.6360, 95%CI: 0.4729-0.8554). Conclusions Students reported better general sleep quality, less trouble sleeping, and less study while studying online full-time. Also, students in clinical years tended to study less and be more satisfied with their sleep compared to students in preclinical years.

The prevalence and associated factors of sleep deprivation among healthy college students in China: a cross-sectional survey

Background

The prevalence of sleep deprivation among college students is increasing and has a few associated factors.

Methods

The present study analyzed 2,142 college students from 28 provinces in China. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. Binary logistic regression was conducted to explore the sleep deprivation related factors. Age and gender were controlled as covariates.

Results

Among the 2,142 college students (27.7% male, 72.3% female), 1,620 (75.6%) reported the average sleep duration was below 7 h per day for one month, 49.3% (1,055/2,142) slept 6∼7 h (contains 6 h), 21.0% (449/2,142) slept 5∼6 h (contains 5 h), and 5.4% (116/2,142) slept <5 h. Age increased the risk of sleep deprivation, the adjusted odds ratio = 1.05 (95% CI [1.01∼1.10]). The adjusted odds ratio (A-OR) for sleep deprivation was higher for students of more than 60 min nap duration per day (A-OR = 2.35, 95% CI [1.45∼3.80]), and age growth (A-OR = 1.05, 95% CI [1.01∼1.10]). In contrast, A-ORs were lower among sleeping inconsistency between work and rest days (A-OR = 0.61, 95% CI [0.49∼0.75]), accustomed to staying up late (A-OR = 0.45, 95% CI [0.36∼0.57]), staying up late to work or study (A-OR = 0.62, 95% CI [0.49∼0.78]), stress (A-OR = 0.75, 95% CI [0.58∼0.98]), and repeated thoughts in bed had (A-OR = 0.79, 95% CI [0.62∼0.99]).

Conclusions

Sleep deprivation is extremely common among healthy college students in China. It is necessary to perform methods maintaining enough sleep due to the current high incidence of sleep deprivation. Controlling the nap duration and getting enough sleep on rest days to replace missing hours of sleep on workdays might improve college students' sleep.

The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants

Abstract

Purpose of Review

Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates.

Recent Findings

The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night.

Summary

Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40675-023-00258-5.

Sleep Quality and Social Jetlag in Young Adults During the Social Distancing Caused by COVID-19

Introduction:  This study aimed to evaluate the sleep quality and the Social Jetlag frequency in young adults during social distancing because of COVID-19. Methods:  This is a cross-sectional study with 308 students aged ≥18 years and with Internet access. Questionnaires used: Pittsburgh Sleep Quality Index - Brazil (PSQI-BR), Epworth Sleepiness Scale, and Munich Chronotype Questionnaire. Results:  The mean age of the students was 21 ± 3 years (17 - 42y), with no statistically significant difference between genders. The PSQI-BR indicated that 257 (83.4%) had poor sleep quality. The mean of Social Jetlag for young adults was 02:00 ± 01:49h, and we observed that 16.6% (n = 51) had Social Jetlag. Compared to men in the good sleep quality group, women had higher means for sleep duration on study days and free days, mid-point of sleep on study days and free days and corrected mid-point of sleep on free days. However, when compared to men in the group of poor sleep quality, we observed higher means for women regarding sleep duration on study days, the mid-point of sleep on study days, and the corrected mid-point of sleep on free days. Conclusions:  Thus, the high frequency of young adult students who had poor sleep quality associated with Social Jetlag (2 hours) in the present study may reflect a pattern of sleep irregularity, which may be associated with impairment of environmental synchronizers and stimulation of social synchronizers during the lockdown resulting from the COVID-19 pandemic.

Poor Quality of Sleep is Associated with Lower Academic Performance in Undergraduate Dental Students: A Cross-Sectional Study

Purpose

This study aimed to assess the quality of sleep and associated factors among dental students.

Methods

All dental students regularly enrolled at the Federal University of Pelotas, Brazil, were invited to participate. A structured online questionnaire was applied to collect the independent variables, including academic performance. Quality of sleep was assessed by the validated version of the Pittsburgh Sleep Quality Index. Sample was dichotomized as good sleep quality (total score: ≤ 4) and at least poor quality (total score: ≥ 5). Adjusted analyses were performed using Poisson regression with robust variance to detect the association between sleep quality and independent variables. Independent adjusted models were performed to the whole-sample, only undergraduate and only graduate dental students.

Results

Poor quality of sleep was detected in 266 (65.2%) dental students, of which 228 (68.9%) and 38 (49.4%) were undergraduate and graduate dental students, respectively. Female students presented a prevalence ratio (PR) 19% higher compared to males (95% confidence interval [CI] 1.01-1.41). When only graduate students were considering, those that reported not being the head of the family presented a PR 4.39 higher for poor quality of sleep (95% CI 1.91-10.09). Poor quality of sleep was associated with lower academic performance among undergraduate students (PR: 0.94; 95% CI 0.89-0.99), but not significantly associated when graduate students are considered (PR: 0.99; 95% CI 0.96-1.03).

Conclusion

It was concluded that dental students, mainly female ones, have high prevalence of poor quality of sleep, which is associated with undergraduate student's worst academic performance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41782-022-00223-2.

Social, Biological and Behavioral Factors Associated with Social Jet Lag and Sleep Duration in University Students from a Low Urbanized City

Introduction

Sleep deprivation and social jet lag are observed in college students from highly urbanized cities. However, does these consequences also present in college students from a low urbanization city?

Objective

To evaluate the prevalence and social, biological and behavioral factors associated with sleep deprivation and social jet lag in university students from a low urbanized city of Brazil.

Methods

A total of 298 university students participated in the study through application of the Health and Sleep and the Munich Chronotype Questionnaires. Multiple linear regression with stepwise-forward method was adopted to assess the associations of the factors with the outcome variables.

Results

Doing leisure activities (LA) (B = 23.24) and academic demand (AD) before bedtime (B = 19.51), both on the weekend, and doing household chores (HC) before bedtime (B = 17.61) in the week were associated with an increase in social jet lag, while stimulating drinks (SD) were associated with a decrease (B = −15.17). Shorter sleep duration in the week was related to chronotype (B = −0.56), male (B = −26.51), doing LA (B = −27.63), poor perception about sleeping place (PPSP) (B = −43.02) and daily commute (B = −68.97). The shorter sleep duration in the weekend was associated to male (B = −36.36), PPSP (B = −58.16), have recreational and religious activities (B = −31.11), doing LA (B = −25.10) and AD (B = −23.60). Just chronotype was associated with longer sleep duration in the weekend (B = 0.25).

Conclusion

University students from a low urbanized city present social jet lag, shorter sleep duration on school days and longer sleep duration on free days as a result of biological and social factors, and mostly behavioral factors.

Prevalence of sleep disorders among medical students of Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia

Background: Sleep disorders are a common medical problem and can affect health and quality of life. There are multiple types of sleep disorders such as obstructive sleep apnea, insomnia, narcolepsy, restless legs/periodic limb movement disorder, circadian rhythm disorders, sleepwalking and nightmares. Medical students appear to be more liable to develop sleep disorders due to their high academic load. Design and Methods: This study seeks to estimate the prevalence of sleep disorders among Umm Al-Qura University medical students and associated risk factors. This cross-sectional study was conducted at the Faculty of Medicine of Umm Al-Qura University in Makkah, Saudi Arabia. A self administrated questionnaire was used to collect the data including socio-demographic data and sleep-50 questionnaire. Four hundred and thirty-eight (438) medical students from the second year to the sixth year were recruited to the study Results: Three hundred and twenty-three participants (73.8%) complained of at least one sleep disorder. The most prevalent sleep disorder among students was narcolepsy at 226 (51.6%). Female students, second year students and students spending significant time watching television or on smartphones were more affected than others with p values of 0.001, 0.005, and 0.004 respectively. Conclusions: Sleep disorders are common among medical students. It is essential to detect and address them before their condition deteriorates.

Long weekend sleep is linked to stronger academic performance in male but not female pharmacy students

Poor sleep hygiene portends loss of physical and mental stamina. Therefore, maintaining a regular sleep/wake schedule on both weekdays and weekends is highly recommended. However, this advice runs contrary to the habits of university students who sleep late on weekends. Pharmacy students at Duquesne University sit for frequent examinations, typically commencing at 7:30 AM, and they complain about mental fatigue. Here, we tested the central hypothesis that longer sleep durations on both weekdays and weekends are linked to stronger academic performance in men and women. Students in their first professional year were administered three surveys to collect data on sleep habits and factors that might influence sleep, such as roommates, long commute times, and sleep interruptions. Grade point averages (GPAs) were collected from the Dean's office, with individual permissions from the students. Longer weekend-but not weekday-sleep durations were significantly correlated with higher cumulative GPAs in men and not in women. Women achieved slightly higher cumulative GPAs than men. Students who fell asleep within 15 min of going to bed had higher professional-phase GPAs than those who fell asleep after an hour or more. Our observations cannot establish causal links, but, given the body of prior evidence on the salutary properties of sleep, men may reap more benefit from recovery sleep on weekends. Rather than recommending that students force themselves awake early on weekends in an attempt to maintain a consistent sleep routine, the real-life habits of students should also be given consideration.

Relationship between temporomandibular dysfunctions, sleep disorders, and anxiety among dentistry students

Introduction: This study aimed to evaluate the relationship between temporomandibular dysfunction (TMD), anxiety, and sleep disorder (DS) among dentistry students, relating the periods in which they are enrolled.Methods: The study consisted of 90 students: Group 1: 30 first-period students; Group 2: 30 fifth-period students; Group 3: 30 students from the ninth period. The participants responded to the RDC/TMD, Fletcher & Luckett questionnaires, and the Beck Anxiety Inventory to analyze symptoms of TMD, DS, and anxiety.Results: There was an association between TMD, DS, and the period studied. When related to moderate and severe anxiety, the group that had the highest incidence was Group 1 (first period students).Conclusion: The apprehension for what is new can influence the TMD and DS indices, while the greater concern for academic/professional performance can generate higher levels of anxiety.

Students’ decision making in class selection and enrolment

Purpose

The purpose of this paper is to propose a theoretical model that integrates various dimensional factors which influence decision-making process of class selection and enrolment, analysing different angles of this process and explaining those factors which determine students’ decision.

Design/methodology/approach

This study uses quantitative design to determine and explore students’ decision making in class selection and enrolment. There were 396 students who participated in this study. The data were analysed using principle component analysis to determine the dominant factor for class selection and enrolment.

Findings

The study has analysed different factors that can influence students’ decision for class selection and enrolment. Five important underlying factors have been identified which includes the class and lecturer factor, time-space factor, ease and comfort factor, course mate factor and commitment factor. Moreover, the Kruskal–Wallis test shows that there is a significant mean difference in choice and selection behaviour between genders and students’ personal attitudes.

Research limitations/implications

This study is an early attempt to explore the wide fields of decision making in class selection and enrolment. It is hoped that follow-up studies would provide more coverage relative to the findings of this research.

Practical implications

One particular dimension of micro decision making faced by students is class (course) selection in the beginning of every academic semester/term. Class selection is very critical decision for students as it would reflect students expected outcome for their future career directions. More importantly, the decision made by the students may also affect their academic performance throughout their study.

Social implications

From the perspective of the university’s administrators, this issue is very critical for planning purposes. Understanding the students’ behaviour in class selection could improve the cost effectiveness as well as the scheduling of course offering to enhance students’ and instructors’ teaching and learning experience.

Originality/value

While many studies try to explore the questions of what makes a student choose a specific college/university or a specific field, limited number have investigated the behaviour of students in class selection and enrolment. This paper contributes to bridging that gap.

Exposure to lead and its effect on sleep quality and digestive problems in soldering workers

Some studies show that exposure to lead affects sleep quality and causes digestive disorders. The aim of this study was to evaluate the quality of sleep and digestive disorders in solderers exposed to lead. In a cross-sectional study, the occupational exposure of 40 soldering workers to lead fume and their blood lead levels were measured in the electronics industry of Neyshabur city, according to standard methods. The sleep quality of workers was measured by the Pittsburgh Sleep Quality Index (PSQI) questionnaire and their digestive disorders were recorded in a checklist. This study showed that 67.5% of subjects had poor sleep quality. There was a significant relation between sleep quality, air lead (p = 0.02), and blood lead (p = 0.03). Bad sleep quality was 2.4 times higher in subjects exposed to lead above the threshold (p = 0.03). 92.5% of the population under study suffered from at least one digestive disorder. Digestive disorders such as hiccupping (85%) and nausea (67%) were more common among the workers, and their odds was 3.09 and 2.00 times higher in workers exposed to lead above the threshold, compared with others. Bad sleep quality and gastrointestinal disorders were prevalent among workers exposed to lead. The results of this study confirm the need for further research about the side effects of lead on humans. It also clarifies the need for a revision in the recommended occupational exposure level for lead.

Sleep quality in medical students: a comparison across the various phases of the medical course

OBJECTIVE

To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course.

METHODS

This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups.

RESULTS

Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C.

CONCLUSIONS

Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students.

Post-class naps boost declarative learning in a naturalistic school setting

Laboratory evidence of a positive effect of sleep on declarative memory consolidation suggests that naps can be used to boost school learning in a scalable, low-cost manner. The few direct investigations of this hypothesis have so far upheld it, but departed from the naturalistic setting by testing non-curricular contents presented by experimenters instead of teachers. Furthermore, nap and non-nap groups were composed of different children. Here we assessed the effect of post-class naps on the retention of Science and History curricular contents presented by the regular class teacher to 24 students from 5th grade. Retention was repeatedly measured 3-4 days after content learning, with weekly group randomization over 6 consecutive weeks. Contents followed by long naps (>30 min), but not short naps (<30 min), were significantly more retained than contents followed by waking (Cohen's d = 0.7962). The results support the use of post-class morning naps to enhance formal education.

Association between sleep quality and quality of life among students: a cross sectional study

Background Lack of sleep and on going sleep disorder can affect family health and interpersonal relationships. Objective The aim of study was to investigate the association between sleep quality and the probable determinants of quality of life among students of a public health faculty at Shahid Beheshti University of Medical Sciences (SBMU) in the 2015 academic year. Methods The data from a cross-sectional study of 275 students that randomly stratified sampling between different classes of college students of a public health faculty of Shahid Beheshti University of Medical Sciences were used in this study. The data were collected using a structured questionnaire consisted of modules on socio-demographic characteristics, the Petersburg Standardized Sleep Quality Questionnaire(PSQL) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Data analysis was done with descriptive and logistic regression. All analyses were carried out using SPSS software V.19. Results A total of 275 students participated in this study. The mean age ± standard deviation (SD) was 22.1 ± 3.6 years. In the univariable model, students that were living in their own homes had the odds of 2.18 times more than the others to have a higher quality of life level [95% confidence interval (CI): 1.07-4.45]. Moreover, sleep disorder was negatively associated with the quality of life [odds ratio (OR) = 0.23; 95% CI: 0.12-0.46]. Conclusion These results will help university administrators and policy makers to identify factors associated with poor sleep and provide approaches to enhance sleep hygiene and relevant knowledge in university students. Living in a dormitoy while also suffering from sleep problems could significantly reduce the quality of life.

Does Elite Sport Degrade Sleep Quality? A Systematic Review

BACKGROUND

Information on sleep quality and insomnia symptomatology among elite athletes remains poorly systematised in the sports science and medicine literature. The extent to which performance in elite sport represents a risk for chronic insomnia is unknown.

OBJECTIVES

The purpose of this systematic review was to profile the objective and experienced characteristics of sleep among elite athletes, and to consider relationships between elite sport and insomnia symptomatology.

METHODS

Studies relating to sleep involving participants described on a pre-defined continuum of 'eliteness' were located through a systematic search of four research databases: SPORTDiscus, PubMed, Science Direct and Google Scholar, up to April 2016. Once extracted, studies were categorised as (1) those mainly describing sleep structure/patterns, (2) those mainly describing sleep quality and insomnia symptomatology and (3) those exploring associations between aspects of elite sport and sleep outcomes.

RESULTS

The search returned 1676 records. Following screening against set criteria, a total of 37 studies were identified. The quality of evidence reviewed was generally low. Pooled sleep quality data revealed high levels of sleep complaints in elite athletes. Three risk factors for sleep disturbance were broadly identified: (1) training, (2) travel and (3) competition.

CONCLUSION

While acknowledging the limited number of high-quality evidence reviewed, athletes show a high overall prevalence of insomnia symptoms characterised by longer sleep latencies, greater sleep fragmentation, non-restorative sleep, and excessive daytime fatigue. These symptoms show marked inter-sport differences. Two underlying mechanisms are implicated in the mediation of sport-related insomnia symptoms: pre-sleep cognitive arousal and sleep restriction.

Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study

INTRODUCTION

Studies show that 9.4% to 38.2% of university students are suffering from insomnia. However, research data in developing countries is limited. Thus, the aim of the study was to assess insomnia and its temporal association with academic performance.

METHODS AND MATERIALS

Institution based cross-sectional study was conducted with 388 students at Debre Berhan University. Data were collected at the nine colleges. Logistic and linear regression analysis was performed for modeling insomnia and academic performance with a p value threshold of 0.05, respectively. Data were entered using EPI-data version 3.1 and analyzed using SPSS version 20.

RESULTS

The prevalence of insomnia was 61.6%. Field of study (p value = 0.01), worshiping frequency (p value = 0.048), marital status (p value = 0.03), and common mental disorder (p value < 0.001) were identified associated factors of insomnia. There was no significant association between insomnia and academic performance (p value = 0.53, β = -0.04). Insomnia explained 1.2% (r² = 0.012) of the difference in academic performance between students.

CONCLUSIONS

Nearly 3 out of 5 students had insomnia. We recommended that universities would endorse sleep quality and mental health illness screening programs for students.

Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Relationship with stress and academic performance

Objectives:

To determine sleep habits and sleep quality in medical students during their clinical years using validated measures; and to investigate associations with academic performance and psychological stress.

Methods:

In this cross-sectional study, medical students (n=320) were randomly selected from a list of all enrolled clinical-year students in a Saudi medical school from 2011-2012. Students filled a questionnaire including demographic and lifestyle factors, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Perceived Stress Scale.

Results:

Students acquired on average, 5.8 hours of sleep each night, with an average bedtime at 01:53. Approximately 8% reported acquiring sleep during the day, and not during nighttime. Poor sleep quality was present in 30%, excessive daytime sleepiness (EDS) in 40%, and insomnia symptoms in 33% of students. Multivariable regression models revealed significant associations between stress, poor sleep quality, and EDS. Poorer academic performance and stress were associated with symptoms of insomnia.

Conclusion:

Sleep deprivation, poor sleep quality, and EDS are common among clinical years medical students. High levels of stress and the pressure of maintaining grade point averages may be influencing their quality of sleep.

Investigation of the Relationship between Psychological Variables and Sleep Quality in Students of Medical Sciences

OBJECTIVES

Students of medical sciences are exposed to many emotional and mental problems. In light of the importance of sleep quality in learning and liveliness, this study was conducted to examine the relationship between psychological variables (stress, anxiety, and depression) and sleep quality of students.

DESIGN

This research is a cross-sectional analytical study, where all students studying at Fasa University of Medical Sciences in 2012-2013 year were selected. To examine the students' stress, anxiety, and depression values, the standardized 21-item DASS-21 was used, and to examine their sleep quality, Pittsburgh Sleep Quality Index (PSQI) was used.

RESULTS

The results of the study demonstrated that 73% of the students have moderate and severe stress, and 46.4% of them have PSQ scores ≥ 5. The students' mean sleep quality score was 4.65 ± 2.37, and their stress score was 8.09 ± 5.14. A statistically significant relationship was found between the students' stress levels and sleep quality (P < 0.001).

CONCLUSION

The high stress levels decrease students' sleep quality. High stress levels and also the significant relationship between stress value and decrease in students' sleep quality call for more attention to and care for students' emotional and mental issues and timely proper interference on the part of authorities.

Impact of a modest delay in school start time in Hong Kong school adolescents

OBJECTIVE

To examine the effects of a modest delay (15 min) in school start time (SST) on adolescent sleep patterns, mood, and behaviors.

METHODS

Two secondary schools in Hong Kong with a total of 1173 students (intervention: n = 617; comparison school n = 556) completed both baseline and follow-up questionnaires. School start time was delayed by 15 min, from 7:45 a.m. to 8:00 a.m., in the intervention school. The comparison school maintained their regular SST at 7:55 a.m. Students' sleep-wake patterns, daytime sleepiness, and mental and behavioral aspects were assessed by validated questionnaires before and after the intervention.

RESULTS

Students in the intervention school significantly delayed their weekday wake-up time (p < 0.001) and increased their total time in bed (p < 0.001) when compared to students in the comparison school. Both groups experienced a delay in their weekday bedtime. The students in the intervention school showed improved mental health [General Health Questionnaire (GHQ) score, p = 0.015], better prosocial behaviors (p = 0.009), better peer relationships (p < 0.001), greater attentiveness (p < 0.001), less emotional problems (p = 0.002), and less behavioral difficulties (p < 0.001) as measured by Strengths and Difficulties Questionnaire (SDQ).

CONCLUSIONS

A modest delay (15 min) in school start time can increase adolescent sleep with corresponding improvement in mood and behaviors. Current findings have significant implications for education policy, suggesting that school administrators and policy makers should systematically consider delaying school start time to promote sleep and health among school-aged adolescents.

CLINICAL TRIAL REGISTRATION

ChiCTR-TRC-12002798. The trial protocol can be accessed at: http://www.chictr.org/en/proj/show.aspx?proj=3955.

Sono e adolescência: quantas horas os adolescentes precisam dormir?

Objetivo Determinar a especificidade e a sensibilidade de uma medida para apontar o melhor ponto de corte para a duração de sono como preditor da sonolência diurna excessiva em adolescentes. Métodos Participaram do estudo 1.359 adolescentes, com idades de 14 a 21 anos, de duas cidades do sul do Brasil, que responderam a questionário de hábitos de sono e sonolência diurna. Utilizou-se a Receiver Operating Characteristic para estimar a capacidade preditiva da duração de sono para a sonolência diurna excessiva. Resultados A média de duração do sono para os adolescentes com sonolência diurna excessiva foi de 7,9 horas e para aqueles sem sonolência diurna excessiva foi de 8,33 horas (p < 0,001). A prevalência de sonolência diurna excessiva foi de 35,7%. Foi observada correlação significativa e negativa entre a duração do sono e as idades analisadas (p < 0,001). A análise de Receiver Operating Characteristic indicou duração mínima de 8,33 horas como proteção para a sonolência diurna excessiva. Conclusão Foi observada alta prevalência de sonolência diurna excessiva e propõe-se como possível duração de sono um mínimo de 8,33 horas nos dias com aula para que os adolescentes evitem esse desfecho.

Sleep disturbances among medical students: a global perspective

Medical students carry a large academic load which could potentially contribute to poor sleep quality above and beyond that already experienced by modern society. In this global literature review of the medical students' sleep experience, we find that poor sleep is not only common among medical students, but its prevalence is also higher than in non-medical students and the general population. Several factors including medical students' attitudes, knowledge of sleep, and academic demands have been identified as causative factors, but other potential mechanisms are incompletely understood. A better understanding about the etiology of sleep problems in medical trainees is essential if we hope to improve the overall quality of medical students' lives, including their academic performance. Sleep self-awareness and general knowledge appear insufficient in many studied cohorts, so increasing education for students might be one beneficial intervention. We conclude that there is ample evidence for a high prevalence of the problem, and research in this area should now expand towards initiatives to improve general sleep education for medical students, identify students at risk, and target them with programs to improve sleep.

Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS): reliability, initial validity and normative scores in higher education students

Based on successive samples totaling more than 5000 higher education students, we scrutinized the reliability, structure, initial validity and normative scores of a brief self-report seven-item scale to screen for the continuum of nighttime insomnia complaints/perceived sleep quality, used by our team for more than a decade, henceforth labeled the Basic Scale on Insomnia complaints and Quality of Sleep (BaSIQS). In study/sample 1 (n = 1654), the items were developed based on part of a larger survey on higher education sleep-wake patterns. The test-retest study was conducted in an independent small group (n = 33) with a 2-8 week gap. In study/sample 2 (n = 360), focused mainly on validity, the BaSIQS was completed together with the Pittsburgh Sleep Quality Index (PSQI). In study 3, a large recent sample of students from universities all over the country (n = 2995) answered the BaSIQS items, based on which normative scores were determined, and an additional question on perceived sleep problems in order to further analyze the scale's validity. Regarding reliability, Cronbach alpha coefficients were systematically higher than 0.7, and the test-retest correlation coefficient was greater than 0.8. Structure analyses revealed consistently satisfactory two-factor and single-factor solutions. Concerning validity analyses, BaSIQS scores were significantly correlated with PSQI component scores and overall score (r = 0.652 corresponding to a large association); mean scores were significantly higher in those students classifying themselves as having sleep problems (p < 0.0001, d = 0.99 corresponding to a large effect size). In conclusion, the BaSIQS is very easy to administer, and appears to be a reliable and valid scale in higher education students. It might be a convenient short tool in research and applied settings to rapidly assess sleep quality or screen for insomnia complaints, and it may be easily used in other populations with minor adaptations.

Homework schedule: an important factor associated with shorter sleep duration among Chinese school-aged children

This study was designed to examine the hypothesis that homework schedule has adverse impacts on Chinese children's sleep-wake habits and sleep duration. A random sample of 19,299 children aged 5.08 to 11.99 years old participated in a large, cross-sectional survey. A parent-administered questionnaire was completed to quantify children's homework schedule and sleep behaviors. Generally, it was demonstrated that more homework schedule was significantly associated with later bedtime, later wake time, and shorter sleep duration. Among all sleep variables, bedtime and sleep duration during weekdays appeared to be most affected by homework schedule, especially homework schedule during weekdays.

Association between Physical Activity and Insomnia among Saudi Female College Students

[Purpose] Insomnia is quite common and it can affect the quality of life of an individual. Students undergo stress due to various academic demands leading to sleeplessness and daytime sleepiness. This study was conducted to investigate the association between physical activity and insomnia among female Saudi students. [Subjects] 62 female students with a mean age of 21 ± 1.5 years took part in a motivational program to increase the number of steps taken per day for three weeks. [Methods] After obtaining subject’s informed consent all the subjects were assessed for insomnia using the insomnia severity index (ISI), They were then given pedometers to calculate the number of steps they took per day. A physical activity log was kept for three weeks. Pre- and post -intervention ISI scores were calculated and correlated with the 3-week physical activity log. [Results] 50% of the subjects had no clinically significant insomnia (NCSI), 42% had sub threshold (STI), and 8% had moderate clinical (MCI) insomnia. There was a moderate negative correlation between physical activity and ISI scores after the 3-week motivation program. [Conclusion] Prevalence of insomnia was common among female Saudi students and increase in physical activity appears to improve the sleep pattern.

Sleep timing is more important than sleep length or quality for medical school performance

Overwhelming evidence supports the importance of sleep for memory consolidation. Medical students are often deprived of sufficient sleep due to large amounts of clinical duties and university load, we therefore investigated how study and sleep habits influence university performance. We performed a questionnaire-based study with 31 medical students of the University of Munich (second and third clinical semesters; surgery and internal medicine). The students kept a diary (in 30-min bins) on their daily schedules (times when they studied by themselves, attended classes, slept, worked on their thesis, or worked to earn money). The project design involved three 2-wk periods (A: during the semester; B: directly before the exam period--pre-exam; C: during the subsequent semester break). Besides the diaries, students completed once questionnaires about their sleep quality (Pittsburgh Sleep Quality Index [PSQI]), their chronotype (Munich Chronotype Questionnaire [MCTQ]), and their academic history (previous grades, including the previously achieved preclinical board exam [PBE]). Analysis revealed significant correlations between the actual sleep behavior during the semester (MS(diary); mid-sleep point averaged from the sleep diaries) during the pre-exam period and the achieved grade (p = 0.002) as well as between the grades of the currently taken exam and the PBE (p = 0.002). A regression analysis with MS(diary) pre-exam and PBE as predictors in a model explained 42.7% of the variance of the exam grade (effect size 0.745). Interestingly, MS(diary)--especially during the pre-exam period-was the strongest predictor for the currently achieved grade, along with the preclinical board exam as a covariate, whereas the chronotype did not significantly influence the exam grade.

Avaliação da qualidade do sono de estudantes universitários de Fortaleza-CE

O objetivo desta pesquisa foi avaliar a qualidade do sono de estudantes universitários de Fortaleza, Ceará, Brasil. Estudo transversal foi realizado com 701 alunos da Universidade Federal do Ceará, entre março e junho de 2011. Foi aplicado o Índice de Qualidade do Sono de Pittsburgh. A maioria dos universitários tinha uma qualidade subjetiva do sono ruim (54%), latência e eficiência do sono inferior a 15 minutos (60, 1%) e a 65% (99%), respectivamente. A duração do sono da amostra foi de 6, 3 horas diárias (DP±1, 4 horas) (p<0.001). A análise dos dados evidenciou que parcela substancial dos universitários investigados (95, 3%) possui má qualidade do sono. É determinante operacionalizar ações de promoção da saúde nas universidades para que o próprio acadêmico atue na construção da sua qualidade de sono.

Avaliação da sonolência em estudantes universitários de turnos distintos

Estudantes de graduação possuem altas chances de apresentar Sonolência Diurna Excessiva, devido aos horários escolares e às demandas acadêmicas. Por isso, pretendeu-se analisar níveis de sonolência de estudantes de turnos distintos. O universo foi constituído por 109 graduandos do turno matutino e 125 do noturno. Utilizou-se a Escala de Sonolência de Epworth. A amostra apresentou média total de 9,38 (DP=4,03), sendo 9,03 (DP=4,01) para o turno matutino e 9,7 (DP=3,93) para o noturno. Foram detectadas diferenças significativas nos níveis de sonolência entre turnos (η² =0,10;p < 0,00), e entre os indivíduos do gênero masculino e feminino nos dois turnos (η²=0,45; p<0,00). Assim, deve ser considerado o papel das demandas acadêmicas em cada turno, já que elas afetam diretamente a qualidade do sono.

Sleep disorder among medical students: relationship to their academic performance

BACKGROUND

Medical students are exposed to a significant level of pressure due to academic demands. Their sleep pattern is characterized by insufficient sleep duration, delayed sleep onset, and occurrence of napping episodes during the day.

OBJECTIVE

To examine the prevalence of sleep disorder among medical students and investigate any relationship between sleep disorder and academic performance.

METHODS

This is a cross-sectional self-administered questionnaire-based study. The participants were medical students of the first, second, and third academic years. The Epworth Sleepiness Scale (ESS) was also included to identify sleep disorder and grade point average was recorded for academic performance.

RESULTS

There were 491 responses with a response rate of 55%. The ESS score demonstrated that 36.6% of participants were considered to have abnormal sleep habits, with a statistically significant increase in female students (p = 0.000). Sleeping between 6-10 h per day was associated with normal ESS scores (p = 0.019) as well as the academic grades ≥ 3.75. Abnormal ESS scores were associated with lower academic achievement (p = 0.002).

CONCLUSION

A high prevalence of sleep disorder was found in this group of students, specifically female students. Analysis of the relationship between sleep disorder and academic performance indicates a significant relationship between abnormal ESS scores, total sleeping hours, and academic performance.

Morningness-eveningness preferences and academic achievement of university students

The present study investigates whether the circadian preferences of students are related to their academic achievements. This study explores whether different class times affect students' achievement and examines the performance of students on final exams administered at 09:30 h for differences according to chronotype. A total of 1471 university students between 18 and 25 yrs of age responded to a morningness-eveningness questionnaire (MEQ), and data on their cumulative grade point averages (CGPA) were also collected from their transcripts. Some of the students in the sample attended classes during the first teaching period, which started at 08:00 h and ended at 14:50 h, and the remaining students followed the second schedule, which started at 15:00 h and ended at 21:50 h. MEQ scores were found to differ by sex. MEQ scores partially predicted academic success and that students' academic achievements differed according to the time of the teaching period. Moreover, final exam (administered at 09:30 h) scores differed with respect to their circadian preferences; students with a morning preference achieved higher scores than either those with an evening or intermediate preference. Both teaching and test start times thus impact academic performance.

Influence of gender on psychomotor vigilance task performance by adolescents

During adolescence, the sleep phase delay associated with early school times increases daytime sleepiness and reduces psychomotor performance. Some studies have shown an effect of gender on psychomotor performance in adults and children. Males present faster reaction times (RT) compared with females. The aim of the present study was to evaluate the influence of gender on Palm psychomotor vigilance task (PVT) performance in adolescents. Thirty-four adolescents (19 girls, 13 to 16 years old) attending morning school classes of a public school in Curitiba, PR, Brazil, participated in the study. Sleep patterns were measured using actigraphy and sleepiness data were accessed with the Karolinska Sleepiness Scale (KSS). KSS and PVT measurements were collected at two times in the morning (8:00 and 11:00 h). The data were compared using one-way ANOVA, considering gender as a factor. ANOVA indicated that gender did not affect sleep patterns and subjective somnolence; however, a statistically significant effect of gender was detected for PVT performance. Boys presented faster RT (RT-PVT1: 345.51 ms, F = 6.08, P < 0.05; RT-PVT2: 343.30 ms, F = 6.35, P < 0.05) and fewer lapses (lapses-PVT1: 8.71, F = 4.45, P < 0.05; lapses-PVT2: 7.82, F = 7.06, P < 0.05) compared with girls (RT-PVT1: 402.96; RT-PVT2: 415.70; lapses-PVT1: 16.33; lapses-PVT2: 17.80). These results showed that this effect of gender, already reported in adults and children, is also observed in adolescents. The influence of gender should be taken into account in studies that use Palm PVT to evaluate psychomotor performance in this age range.

Influence of chronotype, season, and sex of subject on sleep behavior of young adults

The aim of this study was to investigate whether sex, season, and/or chronotype influence the sleep behavior of university students. Detailed data were collected on activity/rest patterns by wrist actigraphy combined with diaries. Thirty-four medical students (19 female and 15 male) were monitored by Actiwatch actometers for 15 consecutive days in May and again in November. The data of a modified Horne and Ostberg chronotype questionnaire, which were collected from 1573 female and 1124 male medical school students surveyed in the spring and autumn over an eight-year period, were evaluated. Actiwatch sleep analysis software was used to process the activity data with statistical analyses performed with ANOVA. We found no significant sex-specific differences in sleep efficiency, sleep onset latency, or actual sleep-time duration. However, we did find a difference in sleep efficiency between morning and evening types, with morning types having a higher sleep efficiency (87.9%, SD=1.3) than evening types (84.3%, SD=0.87%; p=0.007). Seasonal differences were also detected: the actual sleep-time duration in autumn was significantly longer (mean 6.9 h, SD=0.13 h) than in spring (6.6 h, SD=0.1 h; p=0.013). Evaluation of the chronotype questionnaire data showed that individuals with no special preference for morningness or eveningness (i.e., so-called intermediates) were most common. The distribution of chronotypes was related to the sex of subject. Men displayed eveningness significantly more often than women (28.9% males vs. 20.8% females; p<0.001), while females exhibited greater morningness (20.3% females vs.15.6% males; p<0.001). Sex influences chronotype distribution, but not actual sleep time-duration, sleep onset latency, or sleep efficiency. The latter, however, differed among chronotypes, while actual sleep-time duration was affected by season.

[Sleep patterns of first-year nursing students]

This exploratory and descriptive study aimed at describing sleep patterns of first-year university students at the beginning of their course. The study was conducted at Campinas State University, Brazil. Data were collected in two points of time using Pittsburgh Sleep Quality Index. Results showed that students report sleep of better quality and increased length during vacations, when they kept sleep habits in conformity to chronotype. After classes started a greater number of subjects reported poor sleep quality and daytime lack of enthusiasm. Those changes could be due to the submission of subjects to schedules imposed by the university or to the irregularity of sleep habits assumed. Possible relationship between those sleep-changes and academic performance stresses the importance of ongoing studies on this issue.