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

Sleep health among medical students in Abakaliki Nigeria: A descriptive study

Background

Sleep health focuses on those measurable characteristics of sleep that are most clearly associated with physical, mental, and neurobehavioral well-being, and not necessarily the absence of sleep disorder. Sleep health is characterised by subjective satisfaction, appropriate timing, adequate duration, high efficiency, and sustained alertness during waking hours. Adequate and restful sleep is particularly crucial for medical students, who face unique challenges due to the demanding nature of their academic and clinical responsibilities. There is limited data on sleep health among medical students in Nigeria.

Objectives

This research study investigated the pattern of sleep health among medical students in Abakaliki Nigeria.

Methods

This cross-sectional observational study was undertaken among the medical students of 2 public institutions in Abakaliki Nigeria from 16th to 23rd June 2023.

Results

Out of the 288 medical students (males- 53.1 %, females- 46.9 %), good sleep health was recorded in 6.6 %. The mean SATED sleep score was 4.9 ± 1.7 (male- 4.9 ± 1.8, female- 4.9 ± 1.6) (p-value = 1) and it was significantly lower among the final-year students. Age difference, sex difference, and presence of chronic headache did not significantly affect the SATED sleep score. The mean sleep duration was 6.1 ± 1.5 hours (male- 6.1 ± 1.6, female- 6.0 ± 1.4). Sleep duration (54.5 %) had the best rating while sleep efficiency (44 %) had the lowest rating among the assessed sleep domains.

Conclusion

Sleep health is poor among medical students in Abakaliki Nigeria and significantly poorer among final-year medical students.

Psychiatric Characteristics, Symptoms of Insomnia and Depression, Emotion Regulation, and Social Activity among Swiss Medical Students

Background: Almost by default, young adult students are at increased risk of suffering from mental health issues, and this holds particularly true for medical students. Indeed, compared to the general population and non-medical students, medical students report higher scores for symptoms of depression. For Swiss medical students, research on the associations between psychiatric characteristics and symptoms of depression and insomnia, including cognitive-emotional processes and social activity, has been lacking so far. Given this, the aims of the present study were to relate self-declared psychiatric characteristics to symptoms of depression, insomnia, emotion regulation, and social activity. Methods: A total of 575 medical students (mean age: 22.4 years; 68.9% females) completed an online survey covering sociodemographic information (age and gender), study context (year of study), self-declared psychiatric characteristics and symptoms of depression, insomnia, emotion regulation (cognitive reappraisal vs. emotion suppression), and social activity. Data on insomnia sum scores and categories of historical samples (862 non-medical students and 533 police and emergency response service officers) were used for comparison. Results: Of the 575 participants, 190 participants (33%) self-declared psychiatric issues, such as major depressive disorder; anxiety disorders, including PTSD and adjustment disorders; eating disorders; ADHD; or a combination of such psychiatric issues. Self-reporting a psychiatric issue was related to higher symptoms of depression and insomnia and lower symptoms of social activity and cognitive reappraisal (always with significant p-values and medium effect sizes). Compared to historical data for non-medical students and police and emergency response service officers, medical students reported higher insomnia scores. In a regression model, current self-declared psychiatric issues, female gender, higher scores for insomnia, and lower scores for social activity were associated with higher scores for depression. Conclusions: Among a sample of Swiss medical students, the occurrence of self-declared psychiatric issues was associated with higher scores for depression and insomnia and lower cognitive reappraisal and social activity. Further, insomnia scores and insomnia categories were higher when compared to non-medical students and to police and emergency response service officers. The data suggest that medical schools might introduce specifically tailored intervention and support programs to mitigate medical students' mental health issues. This holds particularly true for insomnia, as standardized and online-delivered treatment programs for insomnia (eCBTi) are available.

Sleep quality and associated factors among university students in Africa: a systematic review and meta-analysis study

Background

Poor sleep quality significantly impacts academic performance in university students. However, inconsistent and inconclusive results were found in a study on sleep among university students in several African nations. Therefore, this study aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in Africa.

Methods

The databases PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar were searched to identify articles. A total of 35 primary articles from 11 African countries were assessed and included in this systematic review and meta-analysis. Data were extracted by using a Microsoft Excel spreadsheet and exported to STATA version 14 for analysis. The I2 test was used to assess the statistical heterogeneity. A random effect meta-analysis model was employed with 95% confidence intervals. Funnel plots analysis and Egger regression tests were used to check the presence of publication bias. A subgroup analysis and a sensitivity analysis were done.

Results

A total of 16,275 study participants from 35 studies were included in this meta-analysis and systematic review. The overall pooled prevalence of poor sleep quality among university students in Africa was 63.31% (95% CI: 56.91-65.71) I2 = 97.2. The subgroup analysis shows that the combined prevalence of poor sleep quality in East, North, West, and South Africa were 61.31 (95% CI: 56.91-65.71), 62.23 (95% CI: 54.07-70.39), 54.43 (95% CI: 47.39-61.48), and 69.59 (95% CI: 50.39-88.80) respectively. Being stressed (AOR= 2.39; 95% CI: 1.63 to 3.51), second academic year (AOR= 3.10; 95% CI: 2.30 to 4.19), use of the electronic device at bedtime (AOR= 3.97 95% CI: 2.38 to 6.61)) and having a comorbid chronic illness (AOR = 2.71; 95% CI: 1.08, 6.82) were factors significantly associated with poor sleep quality.

Conclusion

This study shows that there is a high prevalence of poor sleep quality among university students in Africa. Being stressed, in the second year, using electronic devices at bedtime, and having chronic illness were factors associated with poor sleep quality. Therefore, addressing contributing factors and implementing routine screenings are essential to reduce the burden of poor sleep quality.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023493140.

An Umbrella Review and a Meta-analysis of Meta-analyses of Disordered Eating Among Medical Students

Objective

To prevent eating disorders in future physicians, this umbrella review and meta-analysis of previous meta-analyses estimates the prevalence of disordered eating (DE) among medical students worldwide and identifies key risk factors.

Methods

Four databases were searched electronically between their inception and February 1, 2023. The search was later updated to December 31, 2023.

Results

The search yielded prevalence rates for medical students who scored above established cutoffs on validated assessment measures for DE. These were computed to provide an overall pooled estimate. The data was taken from 2 previous reviews. Both these systematic reviews found a 15.1% (95% confidence interval [CI]: 14.7%-15.6%) prevalence rate of DE among medical students. The equivalent Hedges' G = 0.30 (95% CI: 0.29-0.31), the equivalent odds ratio = 1.74 (95% CI: 1.71-1.77), I2 = 97.6%, and the excess of statistical significance is P = .001. The trim and fill adjusted effect size was 16.0% (95% CI: 14.0%-20.0%).

Conclusion

Because eating disorders put students' safety and well-being at risk and because the health of early-stage physicians is vital to the welfare of a country, early signs of disordered eating must become a priority of medical schools and a signal for effective prevention and intervention. The recommendation is to ensure supportive environments, provide easy access to effective care, and hold clear expectations for student eating behavior.

Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis

Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.

Prevalence of Insomnia and Factors Influencing Its Incidence in Students of Tbilisi State Medical University: A Cross-Sectional Study

Sleep is essential for overall health and well-being, however, medical students often face challenges in the form of insomnia or sleep-related disorders. This cross-sectional study investigates the factors influencing the incidence of insomnia in medical students at Tbilisi State Medical University during the 2022-2023 academic year. Using an online questionnaire, data was collected from 174 respondents with self-reported insomnia, and processed with spreadsheet software. The questionnaire collected demographic information, and data regarding sleeping patterns, and asked respondents to choose 'yes' or 'no' for each factor and its effect on their self-reported insomnia. After applying inclusion and exclusion factors, 122 responses were used for analysis. A chi-square analysis was conducted to verify the statistical significance of the data (p = 0.002002). The study revealed a high prevalence of 70.11% of respondents reporting sleeping difficulties. A total of 71.30% of respondents reported excessive workload as the most significant factor contributing to the incidence of their insomnia. Sixty-eight percent of respondents reported mental health issues (including anxiety and depression), and 65.5% reported improper sleep hygiene (including daytime napping and irregular sleep schedules) to play a role in the incidence of their insomnia. Social media and entertainment platform usage (59.8%) and stimulant consumption (48.4%) were comparatively less prominent but still noteworthy contributors to insomnia. The study also found that the majority of respondents (59.8%) experience onset-related insomnia, while 40.4% experience maintenance-related insomnia. This study found excessive workload to be the factor that most influenced the incidence of insomnia in medical students at Tbilisi State Medical University. This can be attributed to the increased academic load a medical student has to face and the worry about academic performance. Proper sleep hygiene, mental health support, and workload adjustments are suggested to decrease the incidence of insomnia among medical students at Tbilisi State Medical University.