Prevalence of Sleep Disorders and Its Impact on Academic Performance among Medical Students in Port Said University: A Cross-Sectional Study

doi:10.21203/rs.3.rs-4857380/v1

Download PDF

Research Article

Prevalence of Sleep Disorders and Its Impact on Academic Performance among Medical Students in Port Said University: A Cross-Sectional Study

https://doi.org/10.21203/rs.3.rs-4857380/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

Sleep is essential for human health, with significant physiological changes occurring during sleep. Sleep disorders, which are prevalent among university students, can impair various bodily systems and negatively impact academic performance.

Objective

This study aims to estimate the prevalence of sleep disorders, academic performance and assess the relationship between academic performance and sleep quality among medical students at Port Said University.

Methods

This cross-sectional study included 438 medical students from the Colleges of Medicine, Pharmacy, Nursing, and Physical Therapy at Port Said University, conducted from March 2023 to May 2024. Participants completed a self-administered questionnaire, which included the Pittsburgh Sleep Quality Index (PSQI) and the Academic Self-Efficacy (ASE) Scale. The PSQI assessed sleep quality across seven components, and the ASE evaluated academic self-efficacy.

Results

The median global PSQI score among participants was 7 (IQR = 4), indicating poor sleep quality in 67.1% of students. The highest median component scores were for subjective sleep quality, sleep latency, disturbances, and daytime dysfunction. The ASE scores indicated moderate-to-high academic self-efficacy, with notable deficits in time management and exam preparation among poor sleepers. Statistically significant gender differences were observed, with female students exhibiting higher global PSQI scores (p = 0.025) and greater sleep disturbances (p < 0.001). Medication-taking students, particularly those on vitamin/mineral supplements, also reported poorer sleep quality (p = 0.042). Notably, significant differences were found between academic grades, with third and sixth-year students showing higher sleep efficiency issues (p = 0.001). Additionally, specific academic faculties showed significant disparities in sleep disturbances, particularly Pharmacy students (p = 0.001).

Conclusion

The study revealed a high prevalence of poor sleep quality among medical students at Port Said University, affecting their academic performance. Female students and those on medication were particularly at risk. The results highlight the importance of addressing sleep health in academic settings to enhance student well-being and performance.

Sleep Disorders

Academic Performance

Medical Students

Pittsburgh Sleep Quality Index (PSQI)

Academic Self-Efficacy (ASE)

Sleep is the basic function of the life of living organisms, as it constitutes a third of human life every day. Many variable physiological changes occur during the sleep period in all body systems as a result of functional changes in the autonomic and somatic nervous systems. Therefore, cycles of sleep and wakefulness are an example of a circadian rhythm, a daily cycle of biological activity [1].

Inadequate sleep or fewer hours of sleep than normal is a factor associated with a variety of dysfunctions in most body systems, including endocrine, metabolic, cortical function of the brain, and neurological disorders. Sleep disorders can be defined as a group of conditions that disturb normal sleep patterns, so, it will be more complicated with age, stress, and psychological factors increase, and thus they have become one of the most common clinical problems that we face during the recent period [2].

Sleep disorders can affect general health, safety, and quality of life. They are common in both adults and children. However, children with it may have different signs and symptoms than adults. Children with sleep problems may be hyperactive, inattentive, irritable, or oppositional behavior rather than overt sleepiness [3]. There are many different types of sleep disorders. The International Classification of Sleep Disorders (ICSD) helps provide a basic classification and definition of sleep disorders and their effects on human life, work efficiency, and achievement. Specifically, ICSD version 3 (ICSD-3) includes the following categories of sleep disorders: insomnia, uncontrolled breathing during sleep, central disorders of hypersomnolence, sleep-wake cycle disorders, parasomnia, and sleep-related movement disorders [4].

Sleep disorders can arise from various causes and can have a significant impact on an individual's overall health and well-being. Here are some common causes of sleep alterations or sleep disorders: Insomnia, can be caused by factors such as stress, anxiety, depression, chronic pain, medications, or certain medical conditions. It is characterized by difficulty falling asleep, staying asleep, or both [5]. Sleep Apnea, a disorder characterized by pauses in breathing during sleep. It can be caused by physical factors such as obesity or anatomical abnormalities in the airway. Sleep apnea can lead to fragmented sleep and excessive daytime sleepiness [6]. Restless Legs Syndrome (RLS), a neurological disorder characterized by uncomfortable sensations in the legs, often accompanied by an irresistible urge to move them. It can disrupt sleep initiation and maintenance [7]. Narcolepsy, a neurological disorder characterized by excessive daytime sleepiness and sudden, uncontrollable episodes of sleep. It is caused by the loss of cells in the brain that produce hypocretin, a neurotransmitter involved in regulating wakefulness [8].

Prevalence of sleep disorders among university students can vary depending on various factors such as cultural, lifestyle, and academic pressures. Sleep disorders among students worldwide, a study examined the prevalence of sleep problems among university students in 26 countries, found that sleep problems were highly prevalent, with an average global prevalence of 37.4% [9].

While in Egypt, a study conducted in Egypt assessed the prevalence of sleep disorders among a sample of university students, reported that 41.8% of the participants had some form of sleep disorder [10]. Another study conducted about sleep disorders in Egypt assessed the prevalence of sleep disorders among 3143 Egyptian public officials was 20.5% overall, 26.2% in females, and 14.5% in males [11]. There was also a study conducted about the prevalence of sleep disorders among medical students in the middle east and north Africa reported that the prevalence of insomnia disorders ranged between 30.4% in Jordan, 59.1% in Morocco, and 42.1% in Saudi Arabia [12]. Finally, according to another study conducted on 312 participants in UAE, 63.2% of participants had prevalence of sleep problem according to Pittsburgh global score for sleep problem, Insomnia and Restless Leg Syndrome was more common disorders among the participants [13].

3.1. Participants

This study included 438 participants from 4 colleges in Port Said University. This study was conducted from March 2023 to May 2024. A cross-sectional analytical study design was selected to measure the prevalence of sleep disorders, academic performance and to assess the relationship between sleep disorders and academic performance. This study was conducted in four colleges in Port Said University: Faculty of Medicine, Pharmacy, Nursing and Physical Therapy.

Eligibility criteria included all students in colleges of Medicine, Pharmacy, Nursing, and Physical Therapy. Participation was voluntary and students were informed their responses would be confidential. The students did not receive any incentives or rewards for their participation in the study. The questionnaire was distributed in the Arabic language.

3.2. Sample procedure

Data were collected from students at Port Said University by convenient sampling method.

3.3. Data collection tool

Data were collected by self-administered questionnaire to measure the prevalence of sleep disorders, academic performance and to assess the relationship between sleep disorders and academic performance. The questionnaire was filled out privately by medical students themselves at Port Said University after the aim of the study was explained. This questionnaire included 3 sections which are: socio-demographics, Pittsburg Sleep Quality Index (PSQI), and Academic Self-Efficacy (ASE).

Some questions related to socio-demographics were asked during questionnaire including age, gender (male/female), marital status, grade, college, residency (rural/urban), chronic diseases (asthma/ diabetes/ heart disease/ hypertension/ others), job status, medication taking (antidepressant/ vitamin supplementation/ others), smoking (passive/ active/ non-smoker). To assess prevalence of sleep disorders of respondents, a total of 19 questions were structured to be classified into seven components, and to assess academic performance, a total of 8 questions were structured [14][15].

The Pittsburgh Sleep Quality Index (PSQI) is a 19-item self-report questionnaire designed to evaluate sleep quality and disturbances over a 1-month period. It consists of seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored on a scale from 0 to 3, with higher scores indicating worse sleep quality. The component scores are then summed to yield a global PSQI score, ranging from 0 to 21, with higher scores reflecting greater overall sleep disturbance. The PSQI has internal consistency and a reliability coefficient (Cronbach’s alpha) of 0.83 for its seven components. Cronbach's alpha for the Arabic version of the Pittsburgh Sleep Quality Index (PSQI) typically ranges from 0.70 to 0.83, indicating good internal consistency and reliability [14].

The Academic Self-Efficacy Scale (ASE) is an eight-item rapid assessment instrument designed to evaluate respondents' self-efficacy in various academic skills related to academic achievement. These skills include time management, note-taking, test-taking, and general academic ability. The scale provides a quick measure of how confident individuals feel about their capabilities in these areas. Each item is rated to reflect the respondent's perceived competence in performing the specific academic tasks. The ASE has internal consistency and a reliability coefficient (Cronbach’s alpha) of 0.81 for its eight components, and Arabic ASE showed high internal consistency with α = 0.925 in all students [15].

3.4. Data management

The data analysis was performed using Microsoft Excel 2016 and jamovi 2.3.28. Microsoft Excel was used for data cleaning, editing, sorting, and coding. The Excel sheet was then imported into jamovi software. Descriptive statistics will be applied in numerical form; median (inter-quartile range) for non-normally distributed quantitative data and frequency (percentage) for qualitative data. Graphs and tables will be used when appropriate. Associations between the outcome measures and different components of the program were tested for significance by using non-parametric tests (i.e., Mann-Whitney and Kruskal Walis tests).

Mann-Whitney U tests were performed to determine significant relationship between sleep quality groups and academic performance items, and between PSQI components with socio-demographic information. Kruskal Walis was also used PSQI components with socio-demographic information classified into more than 2 groups (i.e., grade, college). Statistical significance is determined at 95% level of confidence (i.e., differences will be considered significant if p-value < 0.05).

3.5. Ethical consideration

An informed consent was obtained from the participants. Participants in the study were informed about the procedure and purpose of the study and confidentiality of information provided. All participants consented willingly to be a part of the study during data collection periods. All data were collected anonymously and analyzed using the coding system. The participants had the right to refuse participation or withdraw at any time without any obligation or stating any reason.

Our study had some limitations: firstly, using convenient sampling strategy might not represent the best picture of study participants. Also, a larger sample sized was preferred to be more representative for the population.

4.1. Demographics

This study included 438 participants from 4 colleges (Fig. 1), and different grades (Fig. 2) in Port Said University, 57.1% of them were females and participants’ median age was 20 years (IQR = 3). Most of them were single (96.8%) and non-smokers (90.2%). 72.4% of them came from urban areas [Table 1].

Table 1

General characteristics of the studied participants. (n = 438)
General Characteristics		Frequency	Percentage (%)
Age (n = 438)	Median (IQR)	20 (3)
Gender (n = 438)	Male	188	42.9
Gender (n = 438)	Female	250	57.1
Marital Status (n = 438)	Single	424	96.8
	Married	12	2.7
	Divorced	1	0.2
	Widowed	1	0.2
Residency (n = 438)	Urban	317	72.4
Residency (n = 438)	Rural	121	27.6
Chronic disease or any serious medical condition (n = 437)	Asthma	10	2.3
	Diabetes Mellitus	4	0.9
	Heart Diseases	1	0.2
	Hypertension	2	0.5
	Others	11	2.5
	More than One Condition	3	0.7
	No	377	86.3
	Do not Know	29	6.6
Occupation (n = 435)	Jobless	387	89
	Part-time Job	41	9.4
	Full-time Job	7	1.6
Medication (n = 435)	Antidepressant	5	1.1
	Vitamin/Mineral Supplements	143	32.9
	Others	20	4.6
	More than One Medication	5	1.1
	No	262	60.2
Smoking Status (n = 407)	Active Smoker	14	3.4
	Passive Smoker	26	6.4
	Non-Smoker	367	90.2

It was observed that most of the study participants (86.3%) do not have any serious medical conditions. Additionally, 32.9% of them take vitamin and/or mineral supplements and 60.2% of them does not take any medication at all.

4.2. Pittsburg Sleep Quality Index

During the past month, median time of the study participants would usually be in bed by was 3:00 AM (IQR = 5), and the median time they usually would be awake by in the morning was 10:00 AM (IQR = 4.5). Moreover, about 20 minutes (IQR = 20) were taken by them to fall asleep, and the actual amount of sleep they would have been 8 hours (IQR = 3) [Table 2] PSQI questions’ frequencies are shown in [Table 3] and [Table 4].

Table 2

Pittsburg sleep quality index first 4 questions.
Questions	Median (IQR)
During the past month, what time have you usually gone to bed at night? (n = 413)	3.00 (5)
During the past month, how long (in minutes) has it usually takes you to fall asleep each night? (n = 420)	20.00 (20)
During the past month, what time have you usually gotten up in the morning? (n = 412)	10.00 (4.5)
During the past month, how many hours of actual sleep did you get at night? (n = 420)	8.00 (3)

Table 3

Pittsburg sleep quality index 5th to 7th questions.
Question; “During the past month, how often have you had trouble sleeping because you….”	Frequency (Percentage)
	Not during the past month	Less than once a week	Once or twice a week	Three or more times a week
Cannot get to sleep within 30 minutes. (n = 431)	103 (23.9)	87 (20.2)	87 (20.2)	154 (35.7)
Wake up in the middle of the night or early morning. (n = 430)	95 (22.1)	81 (18.8)	117 (27.2)	137 (31.9)
Have to get up to use the bathroom. (n = 430)	155 (36)	113 (26.3)	89 (20.7)	72 (16.7)
Cannot breathe comfortably. (n = 429)	237 (55.2)	82 (19.1)	49 (11.4)	61 (14.2)
Cough or snore loudly. (n = 428)	334 (78)	50 (11.7)	19 (4.4)	25 (5.8)
Feel too hot. (n = 429)	139 (32.4)	87 (20.3)	98 (22.8)	105 (24.5)
Have bad dreams. (n = 432)	176 (40.7)	99 (22.9)	91 (21.1)	66 (15.3)
Have pain. (n = 431)	221 (51.3)	87 (20.2)	59 (13.7)	64 (14.8)
Question
During the past month, how often have you taken medicine to help you sleep (prescribed or over the counter)? (n = 423)	347 (82)	38 (9)	25 (5.9)	13 (3.1)
During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? (n = 425)	216 (50.8)	81 (19.1)	72 (16.9)	56 (13.2)

Table 4

Pittsburg sleep quality index 8th and 9th questions.
Question	Frequency (Percentage)
Question	No problem at all	Only a very slight problem	Somewhat of a problem	Very big problem
During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? (n = 429)	52 (12.1)	142 (33.1)	172 (40.1)	63 (14.7)
	Very good	Fairly good	Fairly bad	Very bad
During the past month, how would you rate your sleep quality overall? (n = 426)	34 (8)	198 (46.5)	149 (35)	45 (10.6)

Participants’ PSQI scores for each component and global PSQI scores are shown in [Table 5]. The median global PSQI score was 7 (IQR = 4), which indicates poor sleep quality. With regard to each component, subjective sleep quality, sleep latency, disturbance and daytime dysfunction showed the highest median scores. The lowest scores were found in sleep duration, efficiency, and use of sleep medications, which indicating that the most participants did not use sleeping medication. According to global PSQI scores, study participants were classified into good sleep quality (32.9%) if global PSQI ≤ 5, and to poor sleep quality (67.1%) if global PSQI > 5 (Fig. 3).

Table 5

Pittsburgh sleep quality index scores.
Categories	Median (IQR)	Min ~ Max
Component 1: Subjective Sleep Quality (n = 426)	1 (1)	0 ~ 3
Component 2: Sleep Latency (n = 421)	1 (1)	0 ~ 3
Component 3: Sleep Duration (n = 420)	0 (1)	0 ~ 3
Component 4: Sleep Efficiency (n = 408)	0 (1)	0 ~ 2
Component 5: Sleep Disturbance (n = 434)	1 (1)	0 ~ 3
Component 6: Use of Sleep Medication (n = 423)	0 (0)	0 ~ 3
Component 7: Daytime Dysfunction (n = 438)	1 (1)	0 ~ 3
Global PSQI score (total score) (n = 395)	7 (4)	1 ~ 15
	Frequency (Percentage)
Good Sleep Quality (Global PSQI ≤ 5)	130 (32.9)
Poor Sleep Quality (Global PSQI > 5)	265 (67.1)

4.3. Academic Self-Efficacy Questionnaire

Participants’ ASE frequencies and scores are shown in [Table 6] and [Table 7] respectively. The median full-scale total was 39 (IQR = 15), which indicates average-to-high academic performance. With regard to each item, 8th item showed the highest median scores, indicating the capability of study participants to succeed at the university, and 7th item showed the lowest median scores, indicating participants’ low interest in university academic work.

Table 6

Frequencies of academic self-efficacy assessment.
Items	Frequency (Percentage)
Items	Strongly Disagree	Disagree	More or less disagree	Undecided	More or less agree	Agree	Strongly Agree
Item 1: I know how to schedule my time to accomplish my tasks. (n = 430)	52 (12.1)	32 (7.4)	102 (23.7)	102 (23.7)	65 (15.1)	30 (7)	47 (10.9)
Item 2: I know how to take notes. (n = 430)	49 (11.4)	53 (12.3)	49 (11.4)	83 (19.3)	68 (15.8)	68 (15.8)	60 (14)
Item 3: I know how to study to perform well on tests. (n = 426)	35 (8.2)	27 (6.3)	65 (15.3)	91 (21.4)	93 (21.8)	68 (16)	47 (11)

Items	Frequency (Percentage)
Items	Strongly Disagree	Disagree	More or less disagree	Undecided	More or less agree	Agree	Strongly Agree
Item 4: I am good at research and writing papers. (n = 426)	60 (14.1)	48 (11.3)	66 (15.5)	86 (20.2)	69 (16.2)	45 (10.6)	52 (12.2)
Item 5: I am a very good student. (n = 429)	28 (6.5)	24 (5.6)	43 (10)	98 (22.8)	90 (21)	68 (15.9)	78 (18.2)
Item 6: I usually do very well in school and at academic tasks.	33 (7.7)	28 (6.5)	59 (13.8)	99 (23.1)	78 (18.2)	71 (16.6)	60 (14)
	21 (4.9)	24 (5.6)	45 (10.5)	99 (23.1)	94 (21.9)	80 (18.6)	66 (15.4)
Item 7: I find my university academic work interesting. (n = 430)	131 (30.5)	42 (9.8)	55 (12.8)	75 (17.4)	47 (10.9)	35 (8.1)	45 (10.5)
Item 8: I am very capable of succeeding at the university. (n = 429)	27 (6.3)	19 (4.4)	29 (6.8)	65 (15.2)	62 (14.5)	107 (24.9)	120 (28)

Table 7

Scores of academic self-efficacy assessment.
Items	Median (IQR)	Min ~ Max
Item 1: I know how to schedule my time to accomplish my tasks. (n = 430)	4 (2)	1 ~ 7
Item 2: I know how to take notes. (n = 430)	4 (3)
Item 3: I know how to study to perform well on tests. (n = 426)	4 (3)
Item 4: I am good at research and writing papers. (n = 426)	4 (3)
Item 5: I am a very good student. (n = 429)	5 (2)
Item 6: I usually do very well in school and at academic tasks.	4 (3)
	5 (2)
Item 7: I find my university academic work interesting. (n = 430)	3 (4)
Item 8: I am very capable of succeeding at the university. (n = 429)	6 (3)
	Median (IQR)
Full Scale Total (n = 422)	39 (15)

4.4. Inter-relationship between PSQI and Academic Performance

Regarding the relation between sleep quality and academic performance, Mann-Whitney U test is statistically significant at 1st and 3rd items of ASE (p = 0.015 and 0.039 respectively) compared between two groups according to sleep quality [Table 8]. Regarding the differences in PSQI scores according to participants’ general characteristics are presented in [Table 9].

Table 8

Relation between sleep quality and academic performance.
Variable	Categories	Median ¹ (IQR)
Variable	Categories	Item 1	Item 2	Item 3	Item 4	Item 5	Item 6.1	Item 6.2	Item 7	Item 8	Full Scale Total
Global PSQI	Global PSQI ≤ 5	4 (2)	4 (4)	5 (2)	4 (2.25)	5 (2)	5 (3)	5 (2)	3.5 (4)	6 (2)	39 (13)
	Global PSQI > 5	4 (2)	4 (3)	4(3)	4 (3)	5 (2)	4 (3)	5 (2)	3 (4)	6 (3)	39 (14)
	p ²*	0.015	0.892	0.039	0.737	0.382	0.346	0.445	0.616	1.000	0.158
* Mann Whitney U test

Table 9

Differences between PSQI and general characteristics.
Variable	Categories	Median (IQR)
Variable	Categories	Global PSQI	Comp. 1	Comp. 2	Comp. 3	Comp. 4	Comp. 5	Comp. 6	Comp. 7
Gender	Male	6 (3)	1 (1)	1 (1)	0 (1)	0 (1)	1 (1)	0 (1)	1 (1)
	Female	7 (4)	1 (1)	2 (1)	0 (1)	0 (0)	1 (1)	0 (1)	1 (1)
	p ¹*	0.025	0.906	0.031	0.997	0.419	< .001	0.102	0.609
Grade	First	7 (4.5)	1.5 (1)	1 (1)	1 (1)	0 (0)	2 (1)	0 (0)	1.5 (1)
	Second	7 (3.25)	1 (1)	1 (1)	0 (1)	0 (1)	1 (1)	0 (0)	1 (1)
	Third	7 (3)	2 (1)	1 (1)	0 (1)	0.5 (2)	1 (0.75)	0 (0)	1 (1)
	Forth	7 (4)	1 (1)	1.5 (1)	0 (1)	0 (0)	1 (1)	0 (1)	2 (1)
	Fifth	6 (3)	1 (1)	2 (2)	0 (1)	0 (0)	1 (1)	0 (0)	1 (1)
	Sixth	6.5 (1.5)	1.5 (0.5)	2.5 (0.5)	0 (0)	1 (1)	1 (0)	0 (0)	0.5 (0.5)
	p ¹†	0.702	0.544	0.111	0.443	0.001	0.025	0.086	0.059
College	Medicine	7 (3)	1 (1)	1 (1)	0 (1)	0 (1)	1 (1)	0 (0)	1 (1)
	Pharmacy	7 (5)	2 (1)	2 (1)	0 (1)	0 (0)	1.5 (1)	0 (1)	1 (1)
	Nursing	7 (4.5)	1 (0.75)	1 (1)	0 (1)	0 (0)	1 (1)	0 (0)	1 (1)
	Physical Therapy	7 (4)	2 (1)	1 (1)	1 (1)	0 (0)	1 (1)	0 (0)	1 (1)
	p ¹†	0.086	0.071	0.122	0.152	0.020	0.001	0.066	0.249
Residency	Urban	7 (4)	1 (1)	1 (1)	0 (1)	0 (1)	1 (1)	0 (0)	1 (1)
	Rural	6 (3)	1 (1)	2 (1)	0 (1)	0 (0)	1 (1)	0 (0)	1 (1)
	p ¹*	0.124	0.269	0.33	0.058	0.327	0.209	0.051	0.076
Medication	Yes	7 (4)	1 (1)	2 (1)	0 (1)	0 (0)	1 (1)	0 (0)	1 (1)
	No	7 (3)	1 (1)	1 (1)	0 (1)	0 (1)	1 (1)	0 (0)	1 (1)
	p ¹*	0.042	0.612	0.007	0.906	0.449	< .001	0.004	0.367
* Mann Whitney U test, † Kruskal Walis test

4.5. Inter-relationship between Demographics and PSQI Scores

Mann-Whitney U test is statistically significant at gender and medication differences, and Kruskal Walis test is statistically significant for grade level and college (for 4th and 5th components). Females had higher scores for global PSQI (p = 0.025), sleep latency (component 2; p = 0.031) and sleep disturbance (component 5; p < .001). Post-hoc analysis, Dwass-Steel-Critchlow-Fligner (DSCF) pairwise comparisons, were applied in statistically significant variables only [Table 10].

Table 10

Pairwise comparisons between grade levels/ colleges in regard of PSQI.
Pairwise comparisons between grade levels in regard of PSQI component 4
Groups		W	p
First-year students	Second-year students	4.1464	0.040
First-year students	Third-year students	4.3704	0.025
Pairwise comparisons between grade levels in regard of PSQI component 5
Groups		W	p
First-year students	Second-year students	− 4.326	0.027
Pairwise comparisons between college in regard of PSQI component 4
Groups		W	p
Medicine students	Physical Therapy students	− 3.800	0.036
Pairwise comparisons between college in regard of PSQI component 5
Groups		W	p
Medicine students	Pharmacy students	5.467	< 0.001
W = Wilcoxon rank sum test statistics, p < 0.05 values are considered as statistically different. Only statistically different results are listed.

Third-year and sixth-year students had higher scores for sleep efficiency (component 4; p = 0.001), which means that they do not get that much rest they need. Post-hoc tests were used to compare all pairs of groups. The difference between first-year and second-year, and first-year and third-year were significant (p = 0.040 and p = 0.025, respectively). None of the other comparisons were significant (all ps > 0.071). First-year students had higher scores for sleep disturbance (component 5; p = 0.025), which means irregularity of their sleep pattern. The difference between first-year and second-year was significant (p = 0.027). None of the other comparisons were significant (all ps > 0.162).

Medicine students had higher scores for sleep efficiency (component 4; p = 0.02). The difference between Medicine and Physical Therapy was significant (p = 0.036). None of the other comparisons were significant (all ps > 0.246). Pharmacy students had higher scores for sleep disturbance (component 5; p = 0.001). Post-hoc tests were used to compare all pairs of groups. The different between Medicine and Pharmacy was significant (p < 0.001). None of the other comparisons were significant (all ps > 0.243).

Medication-taking students had higher scores for global PSQI (p = 0.042), sleep latency (component 2; p = 0.007), sleep disturbance (component 5; p < .001), and use of sleep medication (component 6; p = 0.004).

Sleep is essential to health and day-to-day activities; it significantly affects cognitive and physical health. Sleep disorders are widespread among medical students due to various factors such as academic workload, irregular sleep patterns and anxiety. Hence, this study aims to tackle sleep disorders by measuring their prevalence and students’ academic performance and then assessing the relationship between both among medical students at Port Said University.

The majority of students (67.1%) had poor sleep quality, which is in line with 2 studies conducted on medical students. One done in Riyadh, revealing that 77% of students have poor sleep quality [56], while the second took place in Pakistan (64.24%) [16]. This implies that medical students have relatively poor sleep quality, which can be due to the stressful environment of medical school; as another study in Pakistan compared medical and non-medical students' sleep quality and found medical students to have poorer sleep quality (67.3%) compared to non-medical students (50.4%) [17].

Female students in this study had slightly poorer sleep quality than male students, which is statistically significant (p = 0.025), which conflicts with another study in Riyadh stating that there is no statistical significance regarding gender difference (p = 0.25) [18]. A study in Jeddah supports current study findings (statistically significant at p = 0.02) found that female students have poorer sleep quality (73.8%) than male students (64.6%) [19]. The reason behind this difference is not apparent. Still, it may be due to biological differences between genders and psychological problems that may be more prevalent in females, as some studies suggested [20][21].

Sleep latency was longer in female students compared to male students, which is statistically significant (p = 0.031). Similar findings were found by studies conducted in Jordon and China with statistically significant difference (p < 0.001) [22][23].

Sleep disturbances between both genders were statistically significant (p < 0.01). This is consistent with the study done in China [23]. Despite being statistically significant, the difference is very narrow and practically not meaningful.

Students taking medication in this study (39.8%), mainly vitamin/mineral supplements (32.9%), had higher global PSQI score than students not taking medication, which is statistically significant (p = 0.042). Vitamin supplementation may affect sleep quality such as vitamin D which have significant benefit on subjective sleep quality among different age groups [24]. Another study also suggested that vitamin D supplementation has a beneficial role in enhancing the sleep quality of individuals with a significant decrease of 2.33 in PSQI score compared with placebo (p < 0.001) [25]. Both studies suggested that supplements have a beneficial role in enhancing sleep quality, which is inconsistent with current findings.

Students taking medication in this study had a higher sleep latency score than that of students not taking medication, which is statistically significant (p = 0.007). They also had statistically significant sleep disturbance scores (p = 0.001), but clinically similar. Further investigation is required to assess the inter-relationship between supplementation and sleep quality.

Grade differences were statistically significant for sleep efficiency and disturbance (p = 0.001 and p = 0.025, respectively), emphasizing the disparity between grades. A study in Karachi showed the difference in sleep quality between basic and clinical sciences students [26]. Clinical sciences students were significantly affected by sleep disturbances and had higher sleep latency, shorter duration, less efficiency, and more frequent daytime dysfunction. This may be due to more sessions and prolonged practice hours than students of basic medical sciences.

Different colleges/specialties among students in the medical field may affect their sleep. This study found that Medical and Pharmacy colleges have higher scores in sleep efficiency and disturbance, which are statistically significant (p = 0.020 and p = 0.001, respectively). This study found higher sleep disturbance scores among pharmacy students compared to a study conducted on 253 students at an USA Pharmacy school [27]. Another study conducted on 105 nursing students also in USA found that higher sleep disturbance scores compared to this study, but this study was conducted on a larger sample of 435 students [28]. This may be owing to the challenges faced by students in different specialties in the medical field, such as more study hours, more practice hours and frequent exam periods throughout the academic year.

Sleep quality can affect the academic performance of medical students; a study conducted in Saudi Arabia found that poor sleepers were 60% high achievers, and high achievers were 42% likely to be poor sleepers compared to low achievers [29]. Another study in Yemen stated that those who reported “yes” (27.3%) and those who reported “to some extent” (38.7%) were more than those who reported “no” (34%) to the effect of sleep quality on academic performance [30]. Other studies do not support such claims; a study at the University of Ghana that showed statistical significance (p = 0.019) regarding sleep quality and academic performance found that 63.3% of students with good sleep quality had excellent academic performance, and none of them reported poor academic performance [31]. In this study, there is only statistical significance for differences between students with good and poor sleep quality for item 1 (scheduling time to accomplish tasks) and item 3 (studying to perform well on tests) of ASE.

This study found that students’ knowledge of how to schedule time to accomplish tasks was statistically significant (p = 0.015), which was represented with higher scores in good sleep quality group. The limited literature on the effect of sleep quality on time management and task accomplishment has opposed further comparisons between the results of other studies. This difference may be due to a disturbed sleep schedule and daytime dysfunction of students with poor sleep quality.

The ability to perform well on tests was higher in students with good sleep quality being 5 (IQR = 2) and lower in students with poor sleep quality being 4 (IQR = 2). A study conducted in Norway on higher education students suggested a strong correlation between difficulties initiating and maintaining sleep (DIMS) and students reporting having failed one or more examinations [32]. This may be owing to the stress related to the exam period, which is aggravated by poor sleep. Another study in Saudi Arabia stated no significant association exists between current GPA and poor sleep quality or distress level [33].

This study was limited by the scarcity of literature with ASE as an assessment tool for academic performance which made comparing current findings with previous ones more difficult; implementing self-efficacy tools in studies targeting university students (especially medical school) can help make accurate predictions of academic performance as GPA [34]. The availability of studies discussing the effect of medication as supplements was rare, and most students didn’t take any sleep medication, which limited the chance of exploring their impact on sleep quality. This indicates that the novel data provided in the current study can help understand such differences, but further research on different medications and their implications for affecting medical students’ sleep quality is required. A detailed breakdown of PSQI results comparing different variables (as sociodemographic characteristics) regarding their effect on a single component of sleep quality, such as sleep latency and sleep disturbances among medical students, should be considered to understand their impact better.

This study highlights the importance of addressing sleep disorders among medical students in Port Said University, as the majority (67.1%) were found to have poor sleep quality. The findings also successfully measured academic performance among these students, indicating that poor sleep quality can negatively impact specific aspects of their academic performance, such as the ability to schedule time effectively and perform well on tests.

Furthermore, the study assessed the relationship between sleep disorders and academic performance, uncovering statistically significant correlations. Notably, the study also identified various sociodemographic risk factors associated with sleep disorders, such as gender and medication use, fulfilling the secondary objective. Female students and those taking medication, particularly vitamin/mineral supplements, reported poorer sleep quality.

However, the limited literature on the relationship between sleep quality and self-efficacy measures warrants further investigation. To improve the academic well-being of medical students, universities should consider implementing comprehensive sleep health programs that address the unique challenges faced, including stress management and time management strategies.

ADHD

Attention Deficit Hyperactivity Disorder

AHI

Apnea–Hypopnea Index

AIS

Athens Insomnia Scale

ARAS

Ascending Reticular Activating System

ASE

Academic Self–Efficacy

CGPA

Cumulative Grade Point Average

COVID

19–Coronavirus Disease of 2019

GSQS

Groningen Sleep Quality Scale

ICSD

International Classification of Sleep Disorders

NREM

Non–Rapid Eye Movement

PER

3–Period Circadian Regulator 3

PSQI

Pittsburgh Sleep Quality Index

REM

Rapid Eye Movement

RLS

Restless Leg Syndrome

SDB

Sleep–Disordered Breathing

Sleep Restriction

Ethical Approval and Consent to Participate

This study received ethics approval from Port Said University Review Board. All participants were provided with detailed information about the study's purpose, procedures, potential risks, and benefits. Informed consent was obtained from each participant prior to data collection, ensuring that participation was voluntary and that they had the right to withdraw at any time. Participants' responses were anonymized to maintain confidentiality.

Consent for Publication: Not Applicable.

Availability of Data and Material: All data generated or analyzed during this study are included in this published article.

Competing Interest: The authors declare that they have no competing interests

Funding: No funding was received for this research.

Authors’ Contributions

Y.I. led the study's conceptualization, methodology, and supervision. A.M.E. and N.M.A. managed data collection and analysis, with A.M.E. drafting the manuscript. H.A.A., H.S.M., and Y.A. contributed to literature review, validation, and manuscript editing. S.A.S. and H.A. handled statistical analysis and interpretation. M.B. managed software and visualization. A.S. and S.T. provided resources and data support. All authors approved the final manuscript.

Acknowledgments

We would like to express my sincere gratitude to all those who contributed to the completion of this research paper. The corresponding author would like to acknowledge the researchers and authors whose studies formed the foundation of this cross-sectional studies. We would like to show our greatest appreciation to Assoc. Prof. Nesrine Saad Farrag and Dr. Nihal Sharaf El-Din as the thesis supervisor. we can’t say thank you enough for her tremendous support and help. Without their encouragement and guidance this thesis would not have materialized. We would like to express the most profound gratitude to all of the students at Port-Said University who participated in this study.

Maier JG, Nissen C. Sleep and memory: mechanisms and implications for psychiatry. Curr Opin Psychiatry. 2017;30(6):480–4. 10.1097/YCO.0000000000000365.
Wong ML, Lau EY, Wan JH, Cheung SF, Hui CH, Mok DS. The interplay between sleep and mood in predicting academic functioning, physical health and psychological health: a longitudinal study. J Psychosom Res. 2013;74(4):271–7. 10.1016/j.jpsychores.2012.08.014.
O'Brien LM. The neurocognitive effects of sleep disruption in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):813–23. 10.1016/j.chc.2009.04.008.
Alhola P, Polo-Kantola P. Sleep deprivation: Impact on cognitive performance. Neuropsychiatr Dis Treat. 2007;3(5):553–67.
Chung KF. Insomnia subtypes and their relationships to daytime sleepiness in patients with obstructive sleep apnea. Res Nurs Health. 2018;41(5):461–469. https://pubmed.ncbi.nlm.nih.gov/29972795/
Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G, Ayas N. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2018;15(11):e1002642. https://pubmed.ncbi.nlm.nih.gov/30444963/
Cho YW, Lee JH, Lee JY, Moon HJ, Kim H. Restless legs syndrome and quality of sleep in type 2 diabetes. J Clin Sleep Med. 2017;13(6):733–739. https://pubmed.ncbi.nlm.nih.gov/28356188/
Pizza F, Vandi S, Iloti M, Franceschini C, Liguori R, Mignot E, Plazzi G. The clinical spectrum of childhood narcolepsy. Sleep. 2020;43(11):zsz280. https://pubmed.ncbi.nlm.nih.gov/32040140/
Lund HG, et al. Sleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health. 2010;46(2):124–32.
Gadallah M, et al. Sleep disorders among medical students in Sohag University, Egypt. J Sleep Disord Ther. 2015;4(2):1–4.
Eshak ES. The prevalence and determining factors of sleep disorders vary by gender in the Egyptian public officials: a large cross-sectional study. Bull Natl Res Cent. 2022;46:240.
Chaabane S, Chaabna K, Khawaja S, et al. Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis. Sci Rep. 2024;14:4656.
KhaderAA. KoolippuilakkalS,Stuarbaris(2022)SleepDisorderamongAdalescenssinAjman,UAE.JShpDisordTher.52:003.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. https://doi.org/10.1016/0165-1781(89)90047-4.
Chemers MM, Hu L, Garcia BF. Academic self-efficacy and first year college student performance and adjustment. J Educ Psychol. 2001;93(1):55–64. https://doi.org/10.1037/0022-0663.93.1.55.
Maheshwari G, Shaukat F. Impact of poor sleep quality on the academic performance of medical students. Cureus. 2019;11(4).
Nadeem A, Cheema MK, Naseer M, Javed H. Comparison of quality of sleep between medical and non-medical undergraduate Pakistani students. J Pak Med Assoc. 2018;68(10):1465–70.
Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK. The prevalence and association of stress with sleep quality among medical students. J Epidemiol global health. 2017;7(3):169–74.
Ibrahim NK, Badawi F, Mansouri Y, Ainousa A, Jambi S, Fatani AN. Sleep quality among medical students at King Abdulaziz University: a cross-sectional study. J Community Med Health Educ. 2017;7(561):2161–711.
Van Reen E, Sharkey KM, Roane BM, Barker D, Seifer R, Raffray T, Bond TL, Carskadon MA. Sex of college students moderates associations among bedtime, time in bed, and circadian phase angle. J Biol Rhythm. 2013;28(6):425–31.
Fatima Y, Doi SA, Najman JM, Al Mamun A. Exploring gender difference in sleep quality of young adults: findings from a large population study. Clin Med Res. 2016;14(3–4):138–44.
Alosta MR, Oweidat I, Alsadi M, Alsaraireh MM, Oleimat B, Othman EH. Predictors and disturbances of sleep quality between men and women: results from a cross-sectional study in Jordan. BMC Psychiatry. 2024;24(1):200.
Tang J, Liao Y, Kelly BC, Xie L, Xiang YT, Qi C, Pan C, Hao W, Liu T, Zhang F, Chen X. Gender and regional differences in sleep quality and insomnia: a general population-based study in Hunan Province of China. Sci Rep. 2017;7(1):43690.
Chan V, Lo K. Efficacy of dietary supplements on improving sleep quality: a systematic review and meta-analysis. Postgrad Med J. 2022;98(1158):285–93.
Abboud M. Vitamin D supplementation and sleep: A systematic review and meta-analysis of intervention studies. Nutrients. 2022;14(5):1076.
Al-Khani AM, Sarhandi MI, Zaghloul MS, Ewid M, Saquib N. A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia. BMC Res Notes. 2019;12(1):665.
Cates ME, Clark A, Woolley TW, Saunders A. Sleep quality among pharmacy students. Am J Pharm Educ. 2015;79(1):09.
Cox SD, Benoit JS, Brohard CL, McIntyre TM. Evaluation of sleep quality among nursing faculty: Application of the Pittsburgh Sleep Quality Index—A descriptive correlational study. Nurs Open. 2022;9(1):339–48.
Khero M, Fatima M, Shah MA, Tahir A. Comparison of the status of sleep quality in basic and clinical medical students. Cureus. 2019;11(3).
Attal BA, Bezdan M, Abdulqader A. Quality of Sleep and Its Correlates among Yemeni Medical Students: A Cross-Sectional Study. Sleep disorders. 2021;2021(1):8887870.
Lawson HJ, Wellens-Mensah JT, Attah Nantogma S. Evaluation of sleep patterns and self-reported academic performance among medical students at the University of Ghana School of medicine and dentistry. Sleep disorders. 2019;2019(1):1278579.
Hayley AC, Sivertsen B, Hysing M, Vedaa Ø, Øverland S. Sleep difficulties and academic performance in Norwegian higher education students. Br J Educ Psychol. 2017;87(4):722–37.
Alotaibi AD, Alosaimi FM, Alajlan AA, Abdulrahman KA. The relationship between sleep quality, stress, and academic performance among medical students. J Family Community Med. 2020;27(1):23–8.
Al Mohazie MF. Reliability and validity of an arabic translation of academic self-efficacy scale (ASE) on students at king faisal university. Wayne State University; 2018.

No competing interests reported.

SupplementaryMaterial.docx

Download PDF

Editorial decision: Revision requested
28 Aug, 2024
Reviews received at journal
27 Aug, 2024
Reviews received at journal
22 Aug, 2024
Reviewers agreed at journal
19 Aug, 2024
Reviewers agreed at journal
19 Aug, 2024
Reviewers agreed at journal
16 Aug, 2024
Reviewers agreed at journal
16 Aug, 2024
Reviewers agreed at journal
14 Aug, 2024
Reviewers invited by journal
06 Aug, 2024
Editor invited by journal
06 Aug, 2024
Editor assigned by journal
05 Aug, 2024
Submission checks completed at journal
05 Aug, 2024
First submitted to journal
04 Aug, 2024

You are reading this latest preprint version

Prevalence of Sleep Disorders and Its Impact on Academic Performance among Medical Students in Port Said University: A Cross-Sectional Study

Status:

Version 1

Abstract

Background

Objective

Methods

Results

Conclusion

Figures

Introduction

Methods

3.1. Participants

3.2. Sample procedure

3.3. Data collection tool

3.4. Data management

3.5. Ethical consideration

Results

4.1. Demographics

4.2. Pittsburg Sleep Quality Index

4.3. Academic Self-Efficacy Questionnaire

4.4. Inter-relationship between PSQI and Academic Performance

4.5. Inter-relationship between Demographics and PSQI Scores

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1