The prevalence and association of stress with sleep quality among medical students

Cross-sectional Study on the Correlation of Stress and Sleep Quality of Learning Unit III (1st Year) to VII (5th Year) Medical Students from the University of the Philippines College of Medicine

Background and Objective

Due to their academic load, medical students are highly susceptible to stress. Stress is one of the factors that can alter sleep quality which may consequently affect the cognitive performance of medical students. There has been a lack of published local literature that looks into the association between stress and sleep quality, especially during the COVID-19 pandemic. With this, the general objective of this study is to determine the effect of stress on the sleep quality of medical students from the University of the Philippines Manila - College of Medicine (UPCM).

Methods

A cross-sectional study was conducted using a stratified random sample of 273 males and females of Learning Unit (LU) III (1st year) to VII (5th year) medical students from a college of medicine based in the Philippines, UPCM, during the second semester of the academic year 2021-2022. A self-administered questionnaire was distributed to assess sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and stress level using the Kessler Psychological Distress Scale (K10). Kruskal-Wallis was used to test statistical differences between stress scores and the sleep quality of students from different year levels. Spearman's Rho was used to determine the correlation between stress and sleep, and a binary logistic regression was employed to study the association of stress with sleep while accounting for confounding variables namely caffeine intake, year level, daytime nap, duty hours, clinical rotation, sex, and age.

Results

A high prevalence of stress (79.71%) and poor sleep quality (59.73%) among LU III to LU VII UPCM students were found, with a statistically positive correlation (ρ=0.44) 95CI [0.33-0.55] (p-value<0.001). Both the stress scores and sleep quality indices were not statistically significantly different across LUs. Gathered data and interpreted results showed that medical students suffering from stress are more likely to have poor sleep quality, which can lead to low academic performance and high susceptibility to chronic diseases, compared to those medical students with low levels of stress. Only being an LU IV [OR=1.38 95CI (0.036-4.625)] and LU V [OR=2.13 95CI (0.296-6.936)] student had increased odds of having poor sleep quality compared to LU III students. Caffeine intake, daytime nap, duty hours, clinical rotation, sex, and age were not associated with poor sleep quality.

Conclusion

This study documents a statistically significant association between stress and poor sleep quality among LU III to LU VII UPCM students. A larger study covering multiple medical schools in the Philippines may be of merit for future investigations to generate nationwide data. Additional recommendations include: a) conducting a cross-sectional or a longitudinal study to detect changes in the characteristics of the population, b) observing the differences in the contributing factors at multiple points throughout the year, c) investigating the effect of dwelling set-up on sleep quality may also be investigated and d) determining if sleep quality affects the level of perceived stress of medical students.

The WELLMESS Project (Move Well, Eat Well, Sleep Well, Stress Well)

Introduction Medical education is a rigorous and demanding journey that requires intellectual ability and emotional resilience. Burnout among medical students is a growing concern as it affects individuals' well-being and can have long-term implications on the quality of patient care. Recognizing the protective effects of healthy lifestyle factors such as sleep, physical activity, eating patterns, and screen time, various institutions have implemented wellness programs to promote students' mental and physical well-being. Objectives The main objective of this study was to assess for variations and associations between first- and second-year osteopathic medical students' physical activity, eating patterns, sleep, perceived stress, and phone screen use across 10 different time points throughout the school year. The secondary objective was to assess the impact of month-long health behavior challenges among participants in the five areas studied. Methods A prospective cohort study was performed regarding first- and second-year medical students' physical activity, eating patterns, sleep, perceived stress, and phone screen use, as respectively assessed by the Physical Activity Vital Sign and smartphone step count data; Starting the Conversation diet assessment; Single Item Sleep Quality Scale and a portion of the Pittsburgh Sleep Quality Index; Perceived Stress Scale; and smartphone screen time use data. The assessments, built-in Qualtrics (Qualtrics International Inc., Provo, USA), were sent via email and class-wide GroupMe text message at 10-time points, capturing the beginning, middle, and end of curricular blocks and seasonal breaks. Participants could win one of 20 $25 Amazon gift cards each time they completed the assessment. Behavior challenges were implemented at six of the 10-time points and focused on facilitating health behavior change among participants. Results The response rate for the 10 assessments was low, ranging from 7% to 13%. The means (±SD) for each outcome of interest combined across the 10 time points were as follows: physical activity = 112 (±100) minutes/week; step count = 4,627 (±3179) steps/day; water intake = 5.6 (±4.0) cups/day; diet score = 6.3 (±2.1) where 0 = most healthful and 16 = least healthful; perceived stress = 6.6 (±5.8) where 0 = lowest and 40 = highest; sleep = 6.7 (±1.0) hours/night; sleep quality = 6.3 (±1.8) where 0 = terrible and 10 = excellent; and phone screen time = 328.5 (±147) minutes/day. Statistical analysis indicated variation (p<0.05) in physical activity minutes, steps per day, water intake, diet score, and phone screen time minutes over time. Given low participation, only 6 of the 10 behavior challenges were implemented, in which the participation rate ranged from 36% to 65% of assessment participants. Conclusion Results indicate room for improvement regarding lifestyle factors among medical students' physical activity, eating patterns, sleep, perceived stress, and phone screen time use. A primary limitation of this study is the low participation rate. Building on these efforts, students are developing and delivering monthly wellness workshops, including a research component.

Body weight in relation to hours of sleep, and physical activity in Latin American university students during the Covid-19 pandemic

Introduction: Short sleep, physical inactivity, and being locked up are risk factors for weight gain. Objective: We evaluated weight gain according to sex, age, hours of sleep and physical activity in university students from 10 Latin American countries during the COVID-19 pandemic. Methods: Cross-sectional and multicenter study (n = 4880). Results: The average age was 22.5 ± 4.4 years. 60.2% were currently locked up. 73.6% were women, 48.2% increased their body weight, 66% reported insufficient sleep hours, and 65.9% were inactive. Women gained more weight than men (73.2%) and younger students gained more weight (85.1%). Those who had insufficient sleep hours gained most weight (67.6%). Inactive participants gained most weight (74.7%). Students who have insufficient sleep are 21% more likely to have changes in body weight compared to students who have optimal sleep. Conclusion: The increase in body weight and its risk factors during confinement should be considered as emerging from public health.

Disadvantaged social status contributed to sleep disorders: An observational and genome-wide gene-environment interaction analysis

BACKGROUND

Sleep is a natural and essential physiological need for individuals. Our study aimed to research the associations between accumulated social risks and sleep disorders.

METHODS

In this study, we came up with a polysocial risk score (PsRS), which is a cumulative social risk index composed of 13 social determinants of health. This research includes 239,165 individuals with sleep disorders and social determinants of health data from the UK Biobank cohort. First, logistic regression models were performed to examine the associations of social determinants of health and sleep disorders, including chronotype, narcolepsy, insomnia, snoring, short and long sleep duration. Then, PsRS was calculated based on statistically significant social determinants of health for each sleep disorder. Third, a genome-wide gene-environment interaction study was conducted to explore the interactions between single-nucleotide polymorphisms and PsRS in relation to sleep disorders.

RESULTS

Higher PsRS scores were associated with worse sleep status, with the adjusted odds ratio (OR) ranging from 1.10 (95% Confidence interval [CI]: 1.09-1.11) to 1.29 (95% CI: 1.27-1.30) for sleep disorders. Emotional stress (OR = 1.36, 95% CI: 1.28-1.43) and not in paid employment (OR = 2.62, 95% CI: 2.51-2.74) were found to have significant contributions for sleep disorders. Moreover, multiple single-nucleotide polymorphisms were discovered to have interactions with PsRS, such as FRAS1 (P = 2.57 × 10-14) and CACNA1A (P = 8.62 × 10-14) for narcolepsy, and ACKR3 (P = 1.24 × 10-8) for long sleep.

CONCLUSIONS

Our findings suggested that cumulative social risks was associated with sleep disorders, while the interactions between genetic susceptibility and disadvantaged social status are risk factors for the development of sleep disorders.

Good learning environment of medical schools is an independent predictor for medical students' study engagement

Background

Study engagement is regarded important to medical students' physical and mental wellbeing. However, the relationship between learning environment of medical schools and the study engagement of medical students was still unclear. This study was aimed to ascertain the positive effect of learning environment in study engagement.

Methods

We collected 10,901 valid questionnaires from 12 medical universities in China, and UWES-S was utilized to assess the study engagement levels. Then Pearson Chi-Square test and Welch's ANOVA test were conducted to find the relationship between study engagement and learning environment, and subgroup analysis was used to eradicate possible influence of confounding factors. After that, a multivariate analysis was performed to prove learning environment was an independent factor, and we constructed a nomogram as a predictive model.

Results

With Pearson Chi-Square test (p < 0.001) and Welch's ANOVA test (p < 0.001), it proved that a good learning environment contributed to a higher mean of UWES scores. Subgroup analysis also showed statistical significance (p < 0.001). In the multivariate analysis, we could find that, taking "Good" as reference, "Excellent" (OR = 0.329, 95%CI = 0.295-0.366, p < 0.001) learning environment was conducive to one's study engagement, while "Common" (OR = 2.206, 95%CI = 1.989-2.446, p < 0.001), "Bad" (OR = 2.349, 95%CI = 1.597-3.454, p < 0.001), and "Terrible" (OR = 1.696, 95%CI = 1.015-2.834, p = 0.044) learning environment only resulted into relatively bad study engagement. Depending on the result, a nomogram was drawn, which had predictive discrimination and accuracy (AUC = 0.680).

Conclusion

We concluded that learning environment of school was an independent factor of medical student's study engagement. A higher level of learning environment of medical school came with a higher level of medical students' study engagement. The nomogram could serve as a predictive reference for the educators and researchers.

Prevalence and influencing factors of sleep disorders in medical students after the COVID-19 pandemic

BACKGROUND

The prevalence of sleep disorders among medical students was high during the COVID-19 pandemic. However, fewer studies have been conducted on sleep disorders among medical students after the COVID-19 pandemic. This study investigated the prevalence and factors influencing sleep disorders among Chinese medical students after COVID-19.

METHODS

A total of 1,194 Chinese medical students were included in this study from 9th to 12th July 2023. We used the Self-administered Chinese scale to collect the demographic characteristics. In addition, we used the Chinese versions of the Self-rating Depression Scale (SDS), the Self-rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI) to assess subjects' depression, anxiety, and sleep disorders, respectively. The chi-square test and binary logistic regression were used to identify factors influencing sleep disorders. The receiver operating characteristic (ROC) curve was utilized to assess the predictive value of relevant variables for sleep disorders.

RESULTS

We found the prevalence of sleep disorders among medical students after COVID-19 was 82.3%. According to logistic regression results, medical students with depression were 1.151 times more likely to have sleep disorders than those without depression (OR = 1.151, 95% CI 1.114 to 1.188). Doctoral students were 1.908 times more likely to have sleep disorders than graduate and undergraduate students (OR = 1.908, 95% CI 1.264 to 2.880).

CONCLUSION

The prevalence of sleep disorders among medical students is high after COVID-19. In addition, high academic levels and depression are risk factors for sleep disorders. Therefore, medical colleges and administrators should pay more attention to sleep disorders in medical students after the COVID-19 pandemic. Regular assessment of sleep disorders and depression is essential.

Impact of sleep deprivation on stress levels and cognitive performance in young and middle-aged adults at a Medical University in Ajman, UAE

BACKGROUND

Inadequate sleep is a widespread public health concern, impacting physical and mental health, as well as cognitive well-being. This study explores the link between sleep quality, the inflammatory marker interleukin-6 (IL-6), and cognitive function in two age groups (18-25 years and 35 years and above) at Gulf Medical University.

MATERIALS AND METHODS

Sleep quality was assessed using the Pittsburgh questionnaire, and salivary IL-6 levels were measured. Cognitive function was evaluated using the National Aeronautics and Space Administration-Psychomotor Vigilance Test (NASA-PVT), focusing on mean reaction time (RT), lapses, fastest 10% RT, and slowest 10% RT. Descriptive and inferential statistics were used to analyze the data. The descriptive statistics used were frequency, percentage mean, and standard deviation (SD). The inferential statistics used was the unpaired t-test. The level of significance was taken as P ≤ 0.05. Statistical Package for the Social Sciences (SPSS) 28 was used to analyze the data.

RESULTS

Approximately 75% of young adults and 80% of middle-aged adults reported good sleep quality. Sleep disturbances were reported by 65% of young adults and 95% of middle-aged adults. In both age groups, individuals with poor sleep exhibited higher IL-6 levels, but all IL-6 values remained within the reference range. NASA-PVT results indicated that individuals with poor sleep had higher mean RT and lapses compared to those with good sleep. In the older age group, both mean RT and lapses were higher than in the younger group, suggesting potential age-related effects on psychomotor vigilance.

CONCLUSION

Our findings suggest a connection between poor sleep quality, elevated IL-6 levels, and impaired cognitive performance.

Assessing the prevalence of generalized anxiety disorder in a multicultural medical education setting in Saudi Arabia during the COVID-19 pandemic

Introduction

Mental health among medical students is an area that has been increasingly garnering world-wide attention. Yet, despite this increased attention, research related to anxiety disorders in Saudi Arabia remain limited. This study aims to address this gap by assessing the prevalence of generalized anxiety disorder (GAD) as well as explore its association with students' sociodemographic factors and academic performance among medical students in a Saudi Arabian institute that has a diverse, multicultural student body.

Methods

The study takes place in a unique educational environment: a privately funded institute in Riyadh, the capital of Saudi Arabia, with 32% of its student body comprising international students from over 40 countries, during the COVID-19 pandemic. The study deploys the use of a survey that was sent to the students at this institute via their institutional emails. A survey containing 33 items assessing demographics, GAD using GAD-7 questionnaire, stress-relief measures, online learning experience during the pandemic, mental disorders, anxiety associated with the pandemic, two open-ended questions, and one item assessing sleep difficulty.

Results

The results of the survey showed that a significant majority of the responders' scores in the GAD-7 assessment were in the range of moderate to severe anxiety. The results also suggest that low cGPA and the first academic years are significantly associated with higher GAD-7 scores. Students found severe time constraints, difficult educational content, and lack of psychological support to be major sources of stress. Furthermore, students suggested providing an in-house psychologist, personalized feedback, and guidance on study tactics as methods to reduce anxiety.

Conclusion

These findings, among others, suggest a need for further studies and research in this field to uncover broader patterns and inform targeted mental health support strategies.

The impact of financial stress on student wellbeing in Lebanese higher education

BACKGROUND

The financial crisis has indirectly affected Lebanese university students, leading to economic distress. Accordingly, this study aimed to assess the substantial negative impact of financial stress on the mental health and well-being of Lebanese college students.

METHODS

A quantitative research approach was applied and took place from June 13th to July 25th, 2023, targeting 1272 university students aged 17 and above from private and public universities across Lebanon through convenience sampling. The InCharge Financial Distress/Financial Well-Being scale (IFDFW), Pittsburgh Sleep Quality Index (PSQI), Beirut Distress Scale (BDS-10), Perceived Stress Scale (PSS-10), and Well-Being Index (WHO-5) were used to assess the students' well-being. Descriptive analyses of the data was performed using SPSS software version 25.

RESULTS

1272 university students participated in this study, mostly females, with a mean age of 21.64 (± 4.43) years. Participants reported a lack of financial independence, unemployment, and no income. Positive associations were obtained between the BDS total scale as well as the PSS total and PSQI scores, while there was a significant negative relationship between IFDFW and PSQI scores. Those with a higher GPA, majoring in science/health and medicine, living in rural areas, and graduate students were linked to lower PSQI and BDS-10 scores. Financial aid and financial independence were associated with lower PSQI and BDS-10 scores. PSS-10 scores were higher among students majoring in science/health and medicine. Higher scores on the IFDFW scale correlated with lower BDS-10 and PSS-10 scores. In contrast, females had higher BDS-10 and PSS-10 scores. Scoring higher on the PSS-10 and PSQI scales, living off campus, or majoring in science/health and medicine, were associated with higher on the WHO-5 scale.

CONCLUSIONS

A significant impact of financial stress on college students in Lebanon was obtained, affecting their well-being and mental health aspects. Marital status, gender, academic major, region of living, and financial independence also influences students' experiences. Tailored support and further research are needed to address these multifaceted challenges.

Assessment of Physical Activity and Sleep Quality Among Doctors and Medical Students: A Cross-Sectional Study From South India

INTRODUCTION

Sleep quality is critical for medical professionals and students, who often face sleep disturbances due to demanding schedules. This study explores the association between physical activity and sleep quality among doctors and medical students in Tamil Nadu, India, addressing a notable gap in existing research.

METHODS

This cross-sectional study was conducted in Tamil Nadu, India, targeting doctors and medical students. Participants were recruited through an online Google Forms (Google LLC, Mountain View, California, United States) questionnaire distributed via social media platforms, which included the International Physical Activity Questionnaire (IPAQ) and the Pittsburgh Sleep Quality Index (PSQI) which provided measures of physical activity in MET (Metabolic Equivalent of Tasks) minutes/week and comprehensive sleep quality assessments, respectively, with a PSQI score above 5 indicating poor sleep quality. Data analysis was performed using jamovi version 2.2.2.

RESULTS

 In this study of 222 participants, predominantly young adults (80% were aged 18-40) and medical students (68.6%), we found a high prevalence of poor sleep quality (74.9%). Physical activity levels varied, with only 5.4% engaging in high levels of activity and no significant association between physical activity level and sleep quality (p=0.659). Additionally, while males showed significantly higher MET scores than females (p < 0.001), there was no significant correlation between MET scores and PSQI scores (p=0.205, r=-0.075).

CONCLUSION

This study highlights a high prevalence of poor sleep quality and a low prevalence of high physical activity among medical professionals and students in South India. The study findings underscore the need for targeted interventions to enhance sleep quality and overall well-being in this demographic.

Psychological endurance: how grit, resilience, and related factors contribute to sustained effort despite adversity

Many concepts describe how individuals sustain effort despite challenging circumstances. For example, scholars and practitioners may incorporate discussions of grit, hardiness, self-control, and resilience into their ideas of performance under adversity. Although there are nuanced points underlying each construct capable of generating empirically sound propositions, the shared attributes make them difficult to differentiate. As a result, substantial confusion arises when debating how these related factors concomitantly contribute to success, especially when practitioners attempt to communicate these ideas in applied settings. The model proposed here-psychological endurance-is a unified theory to explore how multiple concepts contribute to sustained goal-directed behaviors and individual success. Central to this model is the metaphor of a psychological battery, which potentiates and sustains optimal performance despite adversity. Grit and hardiness are associated with the maximum charge of the psychological battery, or how long an individual could sustain effort. Self-control modulates energy management that augments effort required to sustain endurance, whereas resilience represents the ability to recharge. These factors are constrained by both psychological and physiological stressors in the environment that drain the psychology battery. Taken together, these ideas form a novel framework to discuss related psychological concepts, and ideally, optimize intervention to enhance psychological endurance.

Factors associated with poor sleep quality among dental students in Malaysia

Background

Good sleep quality is crucial for dental students as they must have optimal cognitive function, memory, and decision-making to accomplish their learning requirements. This study aims to determine sleep quality, its associated factors, and the association between sleep quality and academic performance among dental students in Malaysia.

Methods

This cross-sectional study involved dental students at four public universities in Malaysia. A validated Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess their sleep quality. An additional self-administered questionnaire was employed to obtain the students' sociodemographic profile, lifestyle, and academic performance. The data were analysed using descriptive, chi-square, and multiple logistic regression.

Results

Three hundred eighty-four dental students participated in this study. About half of the dental students (51.6%) have poor sleep quality. The mean of sleep hours per night was 5.72 (SD 1.06). The sleep quality was significantly poor among Malay students (P = 0.023), students who stayed at hostel (P = 0.002), and those who consumed caffeinated drinks (P = 0.028). Multiple logistic regression analysis revealed that the poor sleep quality was significantly associated with self-perceived poor academic performance (Adjusted Odds Ratio (AOR) 2.95, 95% CI [1.25-6.96], P-value = 0.013) and students skipping class (AOR 1.70, 95% CI [1.00-2.91], P-value = 0.046).

Conclusions

Most of the dental students in Malaysia have poor sleep quality. Ethnicity, accommodation, and caffeine consumption were significantly associated with sleep quality. Awareness to sleep quality among dental students is needed to ensure they are able to cope with the challenging dental school learning environment.

Poor Health Behaviour in Medical Students at a South African University: A Cross-Sectional Survey Study

BACKGROUND

Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution.

METHODS

A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep).

RESULTS

Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge.

CONCLUSION

Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.

Postponing sleep after a stressful day: Patterns of stress, bedtime procrastination, and sleep outcomes in a daily diary approach

Sleep problems and stress are common among students and are associated with negative effects on academic performance as well as mental and physical health risks, but studies exploring mediating factors between stress and sleep on a daily basis are scarce. This study aimed to investigate the relationship of daily stress, Bedtime procrastination (BP) (i.e., postponing bedtime without external reasons), and sleep outcomes controlling for trait factors such as self-control. N = 96 students at a German university (M = 22.2 years, SD = 4.0) wore a sleep-tracking wearable (Fitbit Charge HR) for two weeks to assess sleep duration and to calculate the gap between the intended time to go to sleep and the objectively measured time of falling asleep. Stress, intended time to go to sleep, and sleep quality were assessed via daily diaries. Established questionnaires were used to measure trait self-control, trait BP, and smartphone addiction. Multilevel analyses indicated that more stress experienced during the day was associated with more BP (b = 2.32, p = 0.008), shorter sleep duration (b = -3.46, p = 0.003), and lower sleep quality (b = 1.03, p = 0.005) after controlling for several trait factors. The association of daily stress with sleep outcomes (quality and duration) was partly mediated by BP. Our findings indicate that BP might be one factor that contributes to stress-linked decreases in sleep duration and quality. Potential reasons for stress-related later time to fall asleep-like higher physiological arousal or stress-related worries-should be investigated in future studies.

Associations of coping and health-related behaviors with medical students' well-being and performance during objective structured clinical examination

Objective structured clinical examination (OSCE) is a valid method to evaluate medical students' competencies. The present cross-sectional study aimed at determining how students' coping and health-related behaviors are associated with their psychological well-being and performance on the day of the OSCE. Fourth-year medical students answered a set of standardized questionnaires assessing their coping (BCI) and health-related behaviors before the examination (sleep PSQI, physical activity GPAQ). Immediately before the OSCE, they reported their level of instant psychological well-being on multi-dimensional visual analogue scales. OSCE performance was assessed by examiners blinded to the study. Associations were explored using multivariable linear regression models. A total of 482 students were included. Instant psychological well-being was positively associated with the level of positive thinking and of physical activity. It was negatively associated with the level of avoidance and of sleep disturbance. Furthermore, performance was negatively associated with the level of avoidance. Positive thinking, good sleep quality, and higher level of physical activity were all associated with improved well-being before the OSCE. Conversely, avoidance coping behaviors seem to be detrimental to both well-being and OSCE performance. The recommendation is to pay special attention to students who engage in avoidance and to consider implementing stress management programs.Clinical trial: The study protocol was registered on clinicaltrial.gov NCT05393206, date of registration: 11 June 2022.

The Prevalence and Predictors of Sleep Disorders and Their Impact on Academic Performance Among Saudi University Students: A Cross-Sectional Study

BACKGROUND

University students encounter a variety of sleep problems that have an impact on their health and academic performance. Therefore, the aim of this study was to evaluate the prevalence of sleep disorders and their impact on academic performance among Saudi university students.

METHODS

This is an online cross-sectional study that involved university students and was conducted between November 2022 and February 2023 in Saudi Arabia. Sleep disorders were examined among undergraduate students through online screening surveys including the Epworth Sleepiness Scale (ESS) to assess excessive daytime sleepiness, the Insomnia Severity Index (ISI) to measure insomnia, and the Berlin questionnaire to examine obstructive sleep apnea (OSA). Restless leg syndrome (RLS) was measured using the RLS rating. SPSS version 29.0 (IBM Corp., Armonk, NY, USA) was used for all statistical analyses. Binary logistic regression analysis was used to identify predictors of having excessive daytime sleepiness, insomnia, sleep-disordered breathing, and RLS.

RESULTS

The sample included 449 participants. According to the ESS, 56.6% (n=254) of students reported excessive daytime sleepiness. Using the ISI, 78.4% (n=352) of students were found to have insomnia. The Berlin questionnaire indicated that 6.7% (n=30) of students had sleep-disordered breathing. Additionally, 13.6% (n=61) of students reported having RLS. Male students had higher odds of sleep-disordered breathing compared to females (p<0.01), while marital status showed that married students had higher odds of sleep-disordered breathing (p<0.05). Students who reported nighttime sleeping had lower odds of insomnia and restless leg syndrome (p<0.05). Having regular sleeping times was associated with higher odds of insomnia (p<0.05). Napping sometimes was associated with higher odds of excessive daytime sleepiness and sleep-disordered breathing (p<0.05). Students working day and night shifts had higher odds of sleep-disordered breathing (p<0.01). Interestingly, students with comorbidities had lower odds of RLS (p<0.01).

CONCLUSION

This study established that sleep disturbances among students significantly reduce grade point averages (GPAs), where the most affected were male students and those who were married. The government should implement sleep education programs, provide resources for the management of sleep, encourage consistent sleep schedules, and come up with targeted interventions for at-risk groups. More research is also recommended on effective sleep interventions.

Predictability of Insulin Resistance Based on the Clinical Manifestations Among Male Medical Students of a Private College in Saudi Arabia

Background Numerous clinical signs and symptoms are thought to be associated with insulin resistance. The purpose of this study was to examine the prevalence of insulin resistance among male medical students attending a private Saudi Arabian institution, based on clinical indications. Methods A convenient non-probability sample consisting of 241 male medical students was used to conduct cross-sectional research. Each participant had an in-person interview as well as anthropometric measurements. The interview consisted of a questionnaire that was used to assess demographic data and clinical manifestations related to insulin resistance. Results The study demonstrated the connection between a few dermatological symptoms and waist circumference as an indicator of insulin resistance. In both the high and normal waist circumference groups, acne was the most common symptom. There was no correlation found between waist circumference and psoriasis, hidradenitis suppurativa, androgenic alopecia, alopecia areata, or vitiligo. Nevertheless, as an indicator of insulin resistance, waist circumference was statistically significantly correlated with both skin tags and acanthosis nigricans. Most students had excessive day sleep, foggy brains, struggled with planning and solving problems, and had a memory that became worse in the past few years. In addition, many students feel hungry even after eating some sweets and usually have extreme thirst. Conclusion Among medical students, skin tags, acanthosis nigricans, and acne were the most prevalent dermatological manifestations. Clinicians need to be aware that skin conditions, sleep difficulties throughout the day, changes in cognition, and food cravings might all be indicators of internal changes and/or illnesses such as diabetes and prediabetes.

The Interplay of Sleep Quality, Mental Health, and Sociodemographic and Clinical Factors among Italian College Freshmen

Background/Objectives: Sleep and mental health are closely linked, with sleep deprivation increasing the risk of mental health problems in college students. This study aimed to analyze the role of sleep in the mental health status of a sample of Italian freshmen, considering various mental health outcomes and potential interactions between sleep and other relevant factors, such as sociodemographic characteristics, academic experiences, and mental health history. Methods: All freshmen from a medium-sized Italian university were invited to participate in a multidimensional online survey (n = 3756). Sleep quality was assessed through questions on average hours of sleep per night and on satisfaction of perceived sleep quality. Mental health outcomes included psychophysical well-being, psychological distress, substance use, and problematic internet use. Statistical analysis involved multivariate analysis of variance, followed by pairwise comparisons. Results: The sample (n = 721) exhibited low levels of well-being and a high prevalence of psychological distress (52.1%). Approximately one-third of students (n = 258) were dissatisfied with their sleep quality, and one-fourth (n = 186) reported inadequate sleep (less than 7 h per night). More specifically, 24.4% of students slept on average six hours per night, and 1.4% slept five hours or less. Satisfaction with perceived sleep quality significantly influenced well-being, psychological distress, and cannabis use (ηp2 = 0.02). Interaction effects were observed between satisfaction with sleep quality and drop-out intentions (ηp2 = 0.01), as well as between satisfaction with sleep quality and history of mental health diagnosis (ηp2 = 0.02), both of which were significant for psychological distress and cannabis use. Conclusions: This study highlights the influence of perceived sleep quality on academic distress among college freshmen, particularly those with higher intentions of leaving university and with a history of mental health diagnosis.

Validating Constructs of the Depression, Anxiety, and Stress Scale-21 and Exploring Health Indicators to Predict the Psychological Outcomes of Students Enrolled in the Pacific Islands Cohort of College Students

The Depression, Anxiety, and Stress Scale-21 (DASS-21) has been used in various countries to assess the mental states of individuals. The objectives of this study were to validate the DASS-21 for use in Guam, an island that endures a high burden of mental health challenges, such as suicide, and examine the predictive impact of selected health indicators on DASS-21 variables. Three years of data (2017-2019) were pooled from the Pacific Islands Cohort of College Students (PICCS) study conducted annually at the University of Guam. In total, 726 students were included in the secondary data analysis. MPlus statistical software was used to perform a confirmatory factor analysis (CFA) for the validation and structural equation modeling (SEM) for the predictive modeling. The results from the CFA suggested an acceptable model fit (RMSEA: 0.073, CFI: 0.901, TLI: 0.889, RMR: 0.044), while SEM suggested that sleep quality and physical activity were significant predictors of DASS-21 variables. Therefore, the DASS-21 is a valid instrument for measuring depression, anxiety, and stress among emerging adults in Guam.

The Prevalence of Depression and Anxiety and Its Association with Sleep Quality in the First-Year Medical Science Students

Methods

A total number of 471 freshmen students (NUMS) participated in the study, pinpointing that the data are collected in 2019 and 2020. In line with measuring depression, anxiety, and sleep quality, the Persian Beck Depression Inventory-II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index were employed. The associations between depression and anxiety with sleep quality were assessed by using the multiple logistic regression model. All statistical analyses were conducted in STATA14, and the significant level was set at P < 0.05.

Results

The prevalence of depression, anxiety, and poor sleep quality in the study population was 21.4%, 31.9%, and 28%, respectively. Analytical analyses indicated that after adjusting for studied covariates, the odds of poor sleep quality in individuals with depression were 3.5 times higher compared to the counter group (P < 0.001). Moreover, the odds of poor sleep quality in individuals with anxiety were 2.1 times higher compared to the counter group (P < 0.001).

Conclusion

Noticeable proportion of freshmen students suffer from depression and anxiety; in line with such a critical issue, our study found that depression and anxiety had a statistical association with sleep quality in study population. From this respect, it seems that providing essential interventions and psychological counseling services could be constructive for the freshmen medical students.

Prevalence and related factors of sleep quality among Chinese undergraduates in Jiangsu Province: multiple models' analysis

Background and aims

In China, a significant number of undergraduates are experiencing poor sleep quality. This study was designed to investigate the prevalence of poor sleep quality and identify associated factors among undergraduates in Jiangsu Province, China.

Methods

A total of 8,457 participants were collected in 2022 using whole-group convenience sampling. The factors studied included basic demographics, family and social support, personal lifestyles, physical and mental health, mobile phone addiction index (MPAI), and the Connor-Davidson resilience scale (CD-RISC). The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Four models, including weighted multiple linear regression, binary logistic regression, weighted linear mixed model, and logistic regression with random effects, were applied to identify associated factors for sleep quality.

Results

Of the 8,457 participants analyzed, 26.64% (2,253) were classified into the poor sleep quality group with a PSQI score >7. No significant relationship was found between sleep quality and gender, native place, economic level of family, physical exercise, dormitory light, dormitory hygiene, and amativeness matter. Risk factors for sleep quality identified by the four models included lower CD-RISC, higher MPAI, fourth grade or above, smoking, drinking, greater academic pressure, greater employment pressure, roommate sleeping late, noisy dormitory, poorer physical health status, poorer mental health status, and psychological counseling.

Conclusions

These findings provide valuable insights for university administrators, enabling them to better understand the risk factors associated with poor sleep quality in undergraduates. By identifying these factors, administrators can provide targeted intervention measures and counseling programs to improve students' sleep quality.

Assessing the daily association of sleep hygiene behaviours with sleep: A between and within persons approach

Sleep hygiene behaviours are recommendations given to both clinical and non-clinical populations with a focus on modifying behaviours to maximise sleep outcomes. However, methodological issues present in sleep hygiene research make it difficult to conclusively determine the impact of each behaviour. This study aimed to address these issues by adopting a two-week, repeated measures design which incorporated objective sleep measures and used linear mixed effect modelling to assess the daily association of a wide range of sleep hygiene behaviours on sleep in a non-clinical, university sample. Between-persons effects revealed that bedtime and frequency of daytime napping, alcohol use, and social media use were negatively related to sleep duration while waketime and frequency of too much water consumption were positively related to sleep duration. Within-person effects revealed that later than usual bedtime, earlier than usual waketime, no sunlight exposure, poor ventilation, having an unpleasant conversation before bed were negatively associated with sleep duration whereas using alcohol to deliberately help full asleep was positively related to sleep duration. In contrast, disproportionately more behaviours were not significantly related to either sleep outcome, only some of which could be explained by individual differences, which suggests that more research is needed to determine the conditions under which these behaviours affect sleep, if at all.

Effectiveness of Brain Gym Exercises Over Cognitive Behavioural Therapy in Improving Sleep Quality Among Healthcare University Students: A Comparative Study

Background More than half of healthcare university students are believed to experience inadequate sleep. The application of brain gym exercises is a relatively new concept that has shown potential for addressing a variety of cognitive and perceptual deficits. Nevertheless, its use in managing sleep disorders is still in the early stages. Though cognitive behavioral therapy (CBT) is still the standard treatment for sleep management, recent research suggests that brain gym exercises may help with sleep disorders like insomnia. Independent studies have demonstrated the efficacy of CBT and brain gym activities in treating sleep disorders. Yet, there remains a paucity of studies directly comparing these two methods in treating individuals with sleep disturbances. Aim and objectives To ascertain the effectiveness of brain gym exercises over cognitive behavioral therapy in improving sleep quality among healthcare university students. Method The experimental study comparing brain gym exercises and cognitive behavioral therapy interventions was conducted in Wardha, Maharashtra, India, from March 2023 to December 2023, with 60 subjects selected after considering inclusion and exclusion criteria. The protocol was administered for 4 weeks for 30 minutes per day. The baseline outcome measures were the insomnia severity index (ISI) and the Pittsburgh sleep quality index (PSQI). The outcome measure was used before and after 4 weeks of interventions to evaluate the outcome of the protocol. The software used in the analysis was SPSS 27.0 version and GraphPad Prism 7.0 version, and p<0.05 was considered as the level of significance. Result Post-treatment, evidence was observed for ISI (20.55, P = 0.0001) and PSQI (18.09, P = 0.0001) in Group A. Post-rehabilitation evidence was observed in Group B for ISI (19, P=0.0001) and PSQI (16.64, P=0.0001). The findings revealed a significantly higher mean difference between Group A and Group B, showing a considerable improvement in outcome measure scores within Group A relative to Group B. Conclusion The statistical analysis demonstrates a notable improvement in the pre-and post-scores of the ISI and PSQI following four weeks of brain gym exercises. In comparison, cognitive behavioral therapy showed comparatively less effectiveness in addressing insomnia. The observed improvement in sleep quality among students highlights that brain gym exercises have the potential to be a non-pharmacological alternative for managing mild to moderate insomnia.

Sleep Patterns and Associated Insomnia in Junior and Senior Medical Students: A Questionnaire-Based Cross-Sectional Study

Introduction  Appropriate quality and quantity of sleep are critical for good mental health, optimal body functioning, memory consolidation, and other cognitive processes. Objectives  To evaluate the sleeping patterns of medical students in Saudi Arabia and their relationships with psychological distress. Methods  This was a cross-sectional, self-administered, questionnaire-based study. The study included medical students from a university in Jeddah, Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS) were used to evaluate the prevalence and burden of inadequate sleep quality and insomnia in the participants. Results  The majority of the participants was women (76.6%). Furthermore, most participants (96.2%) were aged between 18 and 24 years old, while 54.4% of the participants were in their senior year. According to the AIS scores (mean: 15.85 ± 4.52), 98.7% of the participants exhibited insomnia symptoms. The PSQI scores (mean: 9.53 ± 5.67) revealed that 70.5% of the participants had poor sleep quality. Students in their fundamental and junior years had significantly higher percentages of insomnia symptoms and poor sleep quality compared with students in their senior years. Conclusion  The prevalence of insomnia and poor sleep quality is high among medical students. Therefore, appropriate strategies for early detection and intervention are warranted.

Translating and establishing the psychometric properties of the Jenkins Sleep Scale for Arabic-speaking individuals

BACKGROUND

The Jenkins Sleep Scale is a widely used self-report questionnaire that assesses sleep quality and disturbances. This study aimed to translate the scale into Arabic and evaluate its psychometric properties in an Arabic-speaking population.

METHODS

The Jenkins Sleep Scale was translated into Arabic using forward and backward translation procedures. The Arabic version was administered to a convenience sample of 420 adults along with the Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) for validation purposes. Reliability was examined using Cronbach's alpha and McDonald's omega coefficients. Confirmatory factor analysis (CFA) was also conducted to test the unidimensional factor structure. Convergent validity was assessed using correlations with PSQI and AIS scores.

RESULTS

The Cronbach's alpha and McDonald's omega values for the Arabic Jenkins Sleep Scale were 0.74 and 0.75, respectively, indicating good internal consistency. The 2-week and 4-week test-retest intraclass correlation coefficients were both 0.94 (p < 0.001), indicating excellent test-retest reliability. The CFA results confirmed the unidimensional factor structure (CFI = 0.99, TLI = 0.96, RMSEA = 0.08). The measurement model had an equivalent factor structure, loadings, intercepts, and residuals across sex, age, and marital status. Significant positive correlations were found between the Arabic Jenkins scale score and the PSQI (r = 0.80, p < 0.001) and AIS (r = 0.74, p < 0.001), supporting convergent validity.

CONCLUSION

The Arabic version of the Jenkins Sleep Scale demonstrated good psychometric properties. The findings support its use as a valid and reliable measure for evaluating sleep quality and disturbances among Arabic-speaking populations.

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.

Bifidobacterium breve M-16V regulates the autonomic nervous system via the intestinal environment: A double-blind, placebo-controlled study

We conducted a randomized controlled trial to investigate the potential of Bifidobacterium breve M-16 V to improve mood in humans. In this evaluation, we incorporated the use of near-infrared spectroscopy (NIRS), which has been used to evaluate mood states in studies with small sample sizes. Participants were given B. breve M-16 V (20 billion cells/day) for 6 weeks, and their mood state was assessed before and after ingestion. NIRS data were collected at rest and during a mental arithmetic task (under stress). Intake of B. breve M-16 V decreased the heart rate under stress and increased levels of the GABA-like substance pipecolic acid in stool samples. In addition, B. breve M-16 V improved mood and sleep scores in participants with high anxiety levels. These results suggest that B. breve M-16 V affects the metabolites of the gut microbiota and has the potential to modulate the autonomic nervous system and to improve mood and sleep.

Skipping breakfast and its association with sociodemographic characteristics, night eating syndrome, and sleep quality among university students in Bangladesh

INTRODUCTION

Skipping breakfast has become more common, and it can significantly affect a person's health, performance, mood, and other physiological and psychological factors. In Bangladesh, university students often encounter unhealthy dietary habits, which raises questions about why many university students choose to skip breakfast. The purpose of this study was to investigate the prevalence of skipping breakfast among university students in Bangladesh and explore the contributing factors.

METHODS

Patuakhali Science and Technology University, Bangladesh was the location of this cross-sectional study. Breakfast consumption was measured with the single-question item, "How often do you eat breakfast?" (Almost every day, sometimes, rarely, or never). Skipping breakfast was classified as respondents selecting sometimes, rarely, or never having breakfast. Sociodemographic, behavioral, and sleep-related data were collected as key predictor variables. Multiple logistic regression models identified factors associated with skipping breakfast.

RESULTS

The prevalence of skipping breakfast among study participants (N = 502, 51.6% female and mean age 21.31 years) was 63.5%. Female students were more likely to skip breakfast compared to male students (adjusted odds ratio, AOR = 1.65, 95% CI: 1.06-2.55). Smoker participants had a higher likelihood of skipping breakfast compared to non-smokers (AOR = 3.92, 95% CI: 1.57-9.78). Students with night eating syndrome had a higher likelihood of skipping breakfast compared to their counterparts (AOR = 1.84, 95% CI: 1.06-3.22). Students with poor sleep quality were three times more likely to skip breakfast than their counterparts (AOR = 2.95, 95% CI: 1.93-4.51). Overweight/obese students were less likely to skip breakfast compared to their counterparts (AOR = 0.40, 95% CI: 0.20-0.82).

CONCLUSION

This study highlights a high prevalence of skipping breakfast among university students in Bangladesh. Specifically, students who are females, smokers, poor sleepers and who have night eating syndrome are more likely to skip breakfast compared to their counterparts. These findings underscore a need for targeted interventions and educational programs to promote healthy breakfast habits. Addressing these modifiable risk factors can have a positive impact on students' nutritional practices and their health and wellbeing.

On the correlation between gratitude and resilience in medical students

Objective

Medical students' health and resilience have increasingly been the subject of current research in recent years. A variety of interventions are recommended to strengthen resilience or its known or suspected influencing factors, although the literature shows that the evidence on the effectiveness of the interventions is inconsistent. The present study investigated whether gratitude is a direct protective factor for resilience in medical students or whether resilience factors (optimism, self-efficacy, social support) and stress mediate the effects of gratitude on resilience.

Methods

90 medical students at Witten/Herdecke University took part in the study that determined their gratitude, resilience, optimism, self-efficacy, social support and stress levels using validated questionnaires (GQ-6, RS-25, LOT-R, SWE, F-SozU, PSS). Correlations were analyzed using Pearson correlation coefficients. In addition, a multivariate regression analysis and a path analysis were calculated to determine the direct and indirect effects of gratitude on resilience.

Results

Multivariate regression analysis showed that only optimism, social support and stress were significantly associated with resilience (B=0.48, 95% CI: 0.31, 0.66; B=0.23, 95% CI: 0.01, 0.44 and B=-0.02, 95% CI: -0.03, -0.001, respectively). The direct effect of gratitude on resilience was minimal and not significant in the path analysis. However, there was an indirect effect of gratitude on resilience (B=0.321; p<0.05). Mediation via the optimism variable was mainly responsible for this effect (indirect effect B=0.197; p<0.05).

Conclusion

This study shows that gratitude has only a minimal direct influence on resilience. However, results indicate that optimism as a mediating factor strengthens the resilience of medical students. Against this background, it may be useful to integrate interventions that promote an optimistic attitude into medical studies in order to strengthen the mental health of future doctors in the long term.

Sleep duration and perceptions of sleep quality in British Army recruits during basic training - an observational analysis

Introduction

Sleep is critical to the health, wellbeing and performance of military personnel during basic training. This two-part study evaluated sleep-wake patterns and sleep disturbances in junior soldiers (JS) and infantry recruits in Autumn 2021 (study 1), and non-infantry recruits in spring 2022 (study 2).

Methods

During studies 1 and 2, validated wearable technology combined with a sleep diary was used to quantify sleep-wake indices, sleep disturbances and perceptions of sleep quality. Sleep diary data was analysed descriptively. A series of repeated-measures ANOVAs examined differences in objective sleep-wake indices. Correlation analysis determined associations between time in bed (TIB) and total sleep time (TST).

Results

Significant (p < 0.05) differences in most sleep-wake indices were observed between weeks of basic training for all cohorts. Strong positive correlations between TIB and TST were observed for each cohort across basic training (r = 0.681 - 0.970, p < 0.001), with longer TST associated with greater TIB. The mean±SD sleep duration (hours and mins [hm]) for JS (06:22 ± 00:27hm), non-infantry (05:41 ± 00:47hm) and infantry (05:46 ± 00:34hm) recruits across basic training was consistently below national recommendations. The mean±SD bed and wake times for JS (bedtime: 23:01 ± 00:32hm; awake: 05:34 ± 00:10hm), non-infantry (bedtime: 23:38 ± 01:09hm; awake: 04:47 ± 00:58hm), and infantry (bedtime: 23:13 ± 00:29hm; awake: 05:38 ± 00:26hm) recruits varied across weeks of basic training, with over 80% reporting "fairly bad" or "very bad" sleep quality and frequent periods of "dozing off" during daytime activity. The most commonly reported sleep disturbing factors identified during basic training involved: late-night military admin (e.g., ironing, boot cleaning, kit set up etc), early morning wake times, extraneous noise, light and hot room temperatures within the primary sleeping environment, bed/mattress discomfort, muscle soreness and feelings of stress and anxiety.

Discussion/Conclusion

Our findings contribute to the existing evidence that long-term sleep loss is pervasive during initial military training programmes. The average sleep durations indicate chronic and unrecoverable sleep loss which would be expected to significantly impair physical and cognitive military performance, and increase the risk of injury, illness and attrition rates during basic training. Changes in the design and scheduling of basic training programmes to enable, at the least, minimum sleep recommendations to be met, and to improve sleep hygiene in the primary sleeping environment are warranted.

Stressors and coping strategies among secondary school male students in Abha City, Saudi Arabia

Background

Stress is a biological process in which exposure to stressors is associated with bad health effects, decreased ability of disease management, and a higher likelihood for disease-related complications and comorbidities. Stress has been considered the main factor in the etiology of many diseases such as diabetes mellitus, cardiac diseases, and body aches for centuries. Students meet many stressful situations such as the need for success, academic demands, homesickness, and lack of social support. Coping with stress can be a leading cause in preventing psychological distress and a serious illness.

Methods

A correlational cross-sectional approach was applied to the current research. The research targeted all secondary school male students in Abha city. A multistage cluster sample was applied by selecting schools and students from the Directorate of Education in Abha. Self-administered questionnaire sheets were distributed to students in their classes. The questionnaire covered students' sociodemographic data such as age, grades, parents' education and work, living conditions, and comorbidities. Stressors to which the students were exposed were also enumerated with the degree of stress for each. Stress was assessed using the Holmes-Rahe Stress Inventory for youth. Coping skills were measured using the abbreviated version of the COPE Inventory.

Results

The study included 324 students whose ages ranged from 15 to 20 years old with a mean age of 17 ± 0.9 years old. Approximately 33% of the students were in first grade; 44.4% of the students had no or minimal level of stress while major stress was recorded among 26.5% of the students. In total, 77.8% of the students had moderate coping and none had high coping ability.

Conclusion

The study revealed that more than half of the students had significant levels of stress and one out of each four had major stress. The most common stressors were due to the school environment and future planning. Young age, low socioeconomic status, parents' separation, and having chronic health problems were the most important determinants of stress among the students.

The association between energy-adjusted dietary inflammatory index and physical activity with sleep quality: a cross-sectional study

BACKGROUND

The study aimed to assess the independent and interactive association of energy-adjusted dietary inflammatory index (E-DII) and physical activity (PA) with sleep quality.

METHOD

A cross-sectional study was conducted on the 2466 participants (60% women). A 116-item food frequency questionnaire (FFQ) was applied to calculate E-DII, the International Physical Activity Questionnaire (IPAQ) long form for PA, and the Pittsburgh sleep quality index (PSQI) to assess sleep quality were collected via interview. Multivariate logistic regression was applied to assess independent and interactive associations of E-DII and PA with sleep quality.

RESULT

No significant association was observed between E-DII and sleep quality (OR: 0.96, 95% CI: 0.92_1.01). Also, there was no significant association between the levels of PA and sleep quality. Women had 70% increased odds for poor sleep quality (OR: 1.7, 95% CI: 1.39_2.09) compared with men. No interactive association was observed between E-DII and PA levels with sleep quality.

CONCLUSION

No significant association was observed between E-DII and PA levels with sleep quality. The study indicates a gender difference in sleep quality. Future prospective studies are required to confirm these findings.

Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety

Sleep disorders and fatigue represent prominent symptoms frequently experienced by individuals with multiple sclerosis (MS). Some psychological factors such as depression, stress, and anxiety seem to have a relationship with such problems. This study aimed to examine the role of depression, stress, and anxiety in predicting sleep disorders and fatigue among patients with MS. Employing a cross-sectional descriptive-correlational design, the study involved a sample size of 252 participants selected through purposive sampling based on inclusion and exclusion criteria. We utilized a demographic information questionnaire along with the Mini-Sleep Questionnaire (MSQ), Fatigue Severity Scale (FSS), and Depression, Anxiety, and Stress Scale (DASS-21) to collect data and analyzed them applying SPSS22, incorporating statistical measures including Pearson correlation and regression. The results of the Pearson correlation coefficient showed that sleep disorders had a positive and significant relationship with depression (r = 0.56; P < 0.001), stress (r = 0.40; P < 0.001), and anxiety (r = 0.52; P < 0.001). There was no significant relationship between age and the development of sleep disorders in total score (r = -0.001; P < 0.985), but age had a relationship with insomnia (r = -0.146; P < 0.021) and oversleeping (r = 0.153; P < 0.015). Age and fatigue did not have a significant relationship as well (r = -0.044; P < 0.941). In addition, fatigue had a positive and significant relationship with depression (r = 0.52; P < 0.001), stress (r = 0.48; P < 0.001), and anxiety (r = 0.54; P < 0.001). The results of the regression analysis also showed that depression, stress, and anxiety predict 0.37% of the total variance of sleep disorders (F = 48.34; P < 0.001) and 0.35% of the total variance of fatigue (F = 44.64; P < 0.001). Our findings suggest that depression, stress, and anxiety play a significant role in predicting sleep disorders and fatigue among patients with MS. This study has been reported in accordance with the TREND checklist for nonrandomized trials.

Prevalence and correlates of generalized anxiety disorder and perceived stress among Sudanese medical students

BACKGROUND

Generalized Anxiety Disorder (GAD) causes significant disturbance in an individual's well-being and activity. Whereby, interfering with the dynamic progress in life. Also, anxiety is a product of stress and a major predictor of academic performance. This study aimed to assess the prevalence of Generalized Anxiety Disorder (GAD), measure levels of anxiety and perceived stress, evaluate the academic profile, identify lifestyle characteristics, and explore the relationship between these factors.

METHODS

In this cross-sectional study, 340 Sudanese medical students filled out online questionnaires, composed of the sociodemographic and lifestyle characteristics, academic profile, Generalized Anxiety Disorder-2 scale (GAD-2), and Perceived Stress Scale-10 (PSS-10). Descriptive and inferential statistics were applied using Statistical Package for Social Science (SPSS) Version 20.0 for data analysis.

RESULTS

Of 340 medical students, 3.8% of them were diagnosed with GAD, while 29.1% scored ≥ 3 in GAD-2, indicating a possible diagnosis. The study found that 9.7% of the participants used addictive substances, with 42% of them having high GAD-2 scores. Moreover, high anxiety levels were associated with high-stress scores (p-value = 0.000). Also, high GAD-2 scores were significantly associated with students who spent less than 10,000 SDG (18 USD) weekly, spent more time on entertainment using smart devices (p-value = 0.004), and had an unhealthy diet (p-value = 0.004). Low anxiety levels were associated with better sleep quality (p-value = 0.00), satisfaction with religious practices (p-value = 0.00), and increased leisure/hobby time (p-value = 0.018). High-stress levels were observed in females (p-value = 0.035), those with lower academic performance satisfaction levels, and increased hours of smart device usage for entertainment (p-value = 0.001). Reduced stress levels were associated with being ≥ 23 years old, increased leisure/hobby time (p-value = 0.002), satisfaction with religious practices [F(3, 166.6) = 10.8, p-value = 0.00)], and having a healthy diet (p-value = 0.006).

CONCLUSION

The low prevalence of GAD corresponded with previous literature, but 29.1% of medical students had a high probability of having GAD. The study emphasizes on providing accessible mental health services for medical students and interventions addressing modifiable risk factors.

Evaluation of the benefits of neutral bicarbonate ionized water baths in an open-label, randomized, crossover trial

We previously demonstrated that neutral bicarbonate ionized water (NBIW) bathing enhances blood flow by bicarbonate ions and described the underlying mechanism. However, additional clinical investigation was warranted to investigate the efficacy of NBIW bathing. Hence, we performed a randomized, open-label, crossover trial to examine the effects of NBIW bathing on mental stress, sleep, and immune function. Participants who regularly felt stressed were randomly assigned to NBIW or regular bathing for 4 weeks. Mental stress was assessed with the Brief Job Stress Questionnaire (BJSQ) and the Profile of Mood States Second Edition; sleep quality, with the Pittsburgh Sleep Quality Index Japanese version (PSQI-J) and actigraphy; and immune function, with laboratory tests. PSQI-J scores and actigraphy sleep latency and bed out latency improved significantly more with NBIW bathing than with regular bathing (p < 0.05). Furthermore, NBIW bathing reduced both stress-induced fluctuations in CD4+ and CD8+ T cell counts and fluctuations in the naive to memory T cell ratio and neutrophil phagocytosis, indicating improved immune function. These findings suggest that daily NBIW bathing could improve mental stress, sleep quality, and immune function and bring about positive health effects in those who experience stress in their daily lives.

Hours of sleep and associated factors in college students during the COVID-19 pandemic

BACKGROUND

Sleep alterations are common in college students, particularly during the COVID-19 pandemic. Sociodemographic factors may predict these alterations in this population.

OBJECTIVE

To identify the sociodemographic factors and health characteristics associated with the number of hours of sleep of college students during the COVID-19 pandemic.

METHODS

This was a cross-sectional study carried out with 244 university students from a multicampi public university in the State of Bahia, Northeast Brazil. Data collection was performed online and participants answered a specific questionnaire to assess sleep hours, sociodemographic and health variables.

RESULTS

Significant associations were observed between hours of sleep and older students (odds ratio adjusted -ORaj: 3.75; 95% Confidence Interval -CI: 1.81-7.75; p < 0.01), attending the final semesters (ORaj: 1.85; 95% CI: 1.05-3.25; p < 0.03), and who reported having some disease (ORaj: 2.18; 95% CI: 1.05-4.50; p < 0.03) with greater chances of getting less sleep. However, those who used tobacco (ORaj: 0.08; 95% CI: 0.01-0.45; p < 0.001) were likely to have more hours of sleep per night.

CONCLUSION

Sleep restriction was common among participating college students, which has likely intensified due to the COVID-19 pandemic and its restrictions. This encourages specific public health actions, contemplating the health and hours of sleep of this population.

Changes in brain function and heart sound in acute sleep deprivation individuals

AIMS

Sleep deprivation (SD) has become a health problem in modern society due to its adverse effects on different aspects. However, the relationship between sleep and cardiovascular system function remains unclear. Here we explored the changes occurring in the brain and the heart sounds after SD.

METHODS

Ninety healthy adult men were recruited and subjected to 36 h of Sleep Deprivation (SD). They participated in a number of tests, including measurements of the heart sound, blood oxygen, and heart rate every 2 h. By using of principal component analysis to reduced the dimensionality of heart sound data. While the ALFF and ReHo indexes were measured via fMRI before and after SD. Correlation and regression analyses were used to reveal the relationship between fMRI and heart sound changes due to SD.

RESULTS

In this study, there were no abnormal values in the heart rate and blood oxygen during 36 h of SD, whereas the intensity of heart sounds fluctuated significantly increased and decreased. The ALFF was increased in bilateral pericalcarine(Calcarine), left anterior cuneus, (Precuneus_L), right superior temporal gyrus(Temporal_Sup_R), left supplementary motor area (Supp_Motor_Area_L); However, it was reduced in the right medial superior frontal gyrus (Frontal_Sup_Medial_R), right dorsolateral superior frontal gyrus (Frontal_Sup_R) and left medial frontal gyrus (Frontal_Mid_L). The regression analysis uncovered that the intensity of the heart sound in the systole, s1, and s2 phase could be explained by Calcarine_L changes.

CONCLUSION

Acute sleep deprivation affects cardiac-brain axis and the specific brain regions. Calcarine_L changes during sleep deprivation are involved in regulating heart contractions.

Sleep Quality and Perceived Stress among Health Science Students during Online Education-A Single Institution Study

Recently, online education has been gaining prominence in university life. Our survey aimed to examine sleep quality and perceived stress levels among students at the University of Pécs Faculty of Health Sciences. A cross-sectional, quantitative, descriptive survey was conducted between February and March 2023. The online survey included the Hungarian versions of the internationally validated Athens Insomnia Scale (AIS) and Perceived Stress Scale (PSS). Statistical analysis involved descriptive statistics, independent t-tests, analysis of variance (ANOVA), and Mann-Whitney and Kruskal-Wallis tests (p < 0.05). We analyzed 304 responses, and females dominated (n = 270; 88.8%). Students in a relationship had significantly higher AIS scores (t = -2.470; p = 0.014). Medium average (2.50-3.49) students and those who rarely/never exercise showed significantly higher AIS and PSS (p ≤ 0.05). Students on the phone/watching a series during online education, daily laptop/TV use for more than 2 h, and pre-sleep use of smart devices for more than 60 min also negatively affected AIS and PSS scores (p ≤ 0.05). Nursing, physiotherapy, and radiography students were the most affected regarding insomnia and perceived stress (p ≤ 0.05). Our survey shows that excessive smart device use and lack of exercise are associated with higher stress levels and poorer sleep quality.

Poor sleep quality and associated determinants among textile and garment manufacturing workers in Addis Ababa, Ethiopia

Background

Sleep is a physiological process that is essential to human physical, emotional, and mental health. Sleep difficulties affect an estimated 150 million individuals globally, with roughly 17% of the population in developing countries. As a result, the purpose of this study was to determine the prevalence and associated factors of poor sleep quality among textile and garment manufacturing workers in Addis Ababa, Ethiopia, in 2022.

Methods

A facility-based cross-sectional study was done from July 15th to August 15th, 2022, using a simple random sample technique. The degree of self-reported poor sleep quality was quantified using a validated, interviewer-administered, standardized Pittsburgh Sleep Quality Index. To determine the relationship between independent variables and poor sleep quality, multivariable logistic regression analysis was carried out with a p-value of less than 0.05 and a 95% confidence interval (CI).

Results

The prevalence of poor sleep quality was 75.4% (95% CI: 70.8, 80). Working more than 8 h per day (AOR = 2.83, 95% CI: 1.01, 7.94), work dissatisfaction (AOR = 3.27, 95% CI: 1.52-7.05), and using electronic materials before sleeping (AOR = 2.08, 95% CI: 1.01-4.30) were all associated with poor sleep quality.

Conclusion

Poor sleep quality was common among garment and textile industrial workers. Work dissatisfaction, working hours, and the utilization of electronic materials before bedtime were all substantially related to poor sleep quality, which should be taken into account and addressed early to reduce poor sleep quality.

Sweet dreams are not made of this: no association between diet and sleep quality

STUDY OBJECTIVES

Numerous studies have emphasized the significance of nutrition on the quality of sleep, but few have evaluated the effect of various coexisting dietary markers on middle-aged adults. We assessed the association between sleep quality and a large array of dietary markers among middle-aged, community-dwelling participants.

METHODS

Data from the first, second, and third follow-ups of CoLaus|PsyCoLaus, a population-based study in Lausanne, Switzerland, was used. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Dietary intake was assessed by a validated food frequency questionnaire.

RESULTS

Data from 3857 (53% women, 57.2 ± 10.4 years), 2370 (52% women, 60.7 ± 9.5 years), and 1617 (52% women, 63.5 ± 9.0 years) participants from the first, second, and third follow-ups was used. Bivariate correlations showed fish, vegetables, fruit, and cheese intake to be associated with a better sleep quality (lower Pittsburgh Sleep Quality Index), while rusks, sugar, and meat intake were associated with a poorer sleep quality (higher Pittsburgh Sleep Quality Index). After multivariable adjustment, participants reporting poor sleep quality (Pittsburgh Sleep Quality Index > 5) had a lower Mediterranean diet score and a lower likelihood of complying with the meat and fish recommendations, but the results were inconsistent between surveys. No association was found between sleep quality and macro- or micronutrients in the three surveys.

CONCLUSIONS

No consistent associations were found between a large panel of nutritional markers and sleep quality. Components of the Mediterranean diet such as dairy, fruits, and vegetables might favor good sleep quality, while increased consumption of sugary foods or meat might favor poor sleep quality.

CITATION

Oliveira JL, Marques-Vidal P. Sweet dreams are not made of this: no association between diet and sleep quality. J Clin Sleep Med. 2023;19(12):2005-2014.

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.

A coping model for school psychological counsellors: A qualitative study

This study analyzed the coping processes of psychological counsellors working in high schools in Turkey in the face of the challenges experienced in counselling sessions. The study used a qualitative research design: grounded theory. Semistructured interviews conducted with 33 high school counsellors were analyzed following Strauss and Corbin's analysis guidelines to create a coping model. The core category in the model was 'coping' while 'actions/reactions' explained what counsellors do to cope. Finally, 'environmental factors' and 'personal factors' influenced their coping processes. The findings are discussed in light of the existing literature to provide suggestions for school counsellors to develop self-care/coping strategies, increase their resilience and decrease their burnout.

The relationship between depressive symptoms and sleep quality in medical staff after their infection with COVID-19

Background

Healthcare workers (HCWs) play a crucial role in managing infectious diseases like COVID-19. However, the demanding working conditions during the pandemic have led to an increased risk of depression and sleep disorders among these dedicated professionals. Therefore, this study aimed to examine the relationship between depressive symptoms and sleep quality in medical staff who had contracted COVID-19.

Methods

This descriptive study involved a sample of 203 HCWs who had contracted COVID-19. These HCWs were employed at a hospital affiliated with Kerman University of Medical Sciences in 2020. The data for this study were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI). Statistical analysis was conducted using SPSS22, with a significance level set at less than 0.05.

Results

The study found that the mean score for depressive symptoms among the participants was 11.67 ± 2.68, while the mean score for sleep quality was 5.47 ± 3.02. It was observed that 18.2% of the participants experienced moderate depression, 10.3% had severe depression, and 59.6% had poor sleep quality. Furthermore, a significant and positive correlation was identified between sleep quality and depression (r = 0.54; p = 0.001). Multiple regression models indicated that the harmful pattern and sleep quality together could predict 34% of the variance in depression. Additionally, the use of sedatives and depression were found to predict 33% of the variance in sleep quality.

Conclusion

The findings of our study indicated a high prevalence of depressive symptoms and insomnia among medical staff who had contracted COVID-19. These results provide valuable insights for health managers, highlighting the need for implementing interventions in epidemic environments to reduce the vulnerability of HCWs.

Prevalence and influencing factors of sleep disturbance among medical students under the COVID-19 pandemic

BACKGROUND

Medical students may feel severe psychological stress during COVID-19, which might impair their ability to sleep. This research aimed to look at the risk factors for sleep disturbance and the prevalence of sleep disturbance among medical students.

METHODS

538 medical students in total were recruited for this research. Anxiety, depression, and sleep disturbance were assessed using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). To evaluate the possible risk variables, we computed descriptive statistics for each assessment item and ran univariate and logistic regression analyses.

RESULTS

Medical students had a 63.6% prevalence of sleep disturbance (n = 342). According to logistic regression, introverted students are 1.77 times more likely than extroverted students to have sleep disturbance (OR = 1.77, 95% CI 1.08-2.91). Medical students with depression had a 5.6-times higher risk of sleep disturbance than those without depression (OR = 5.60, 95% CI 3.43-9.15). Additionally, medical students with anxiety were 3.95 times more likely than those without anxiety to have sleep disturbance (OR = 3.95, 95% CI 2.04-7.64).

CONCLUSIONS

According to this research, the COVID-19 pandemic caused significant sleep disturbance among medical students. Additionally, among medical students, introversion, anxiety, and depression were risk factors for sleep disturbance.

Interplay between stress, sleep, and BDNF in a high-risk sample of young adults

Children in institutional care have a high risk to experience childhood adversities (CAs), with consequences for physical and mental well-being. The long-term effects of CAs on the brain, including consequences for neuronal plasticity and sleep, are poorly understood. This study examined the interplay between stress (including CAs), sleep, and brain-derived neurotrophic factor (BDNF), a prominent marker for neuronal plasticity. Participants (N = 131, mean age = 26.3±3.4 years, 40 females) with residential youth-care history completed questionnaires measuring CAs (Childhood Trauma Questionnaire, CTQ), psychological well-being (World Health Organization-Five Well-Being Index, WHO-5), and sleep disturbances (Pittsburgh Sleep Quality Inventory, PSQI). Hair cortisol and serum BDNF concentration were measured using enzyme-linked immunosorbent assays. The analyses were conducted by using bootstrap regression models. There was no association of stress parameters or sleep with BDNF concentration. However, we found a significant association of CAs and well-being with sleep disturbances. Last, we found an association between CAs and BDNF in sleep-healthy but not sleep-disturbed participants. Our findings indicated a role of sleep disturbance in the association between stress and BDNF. Still, further studies are warranted using vulnerable groups at-risk to understand long-term effects on mental health and sleep.

"Life will never be the same": a qualitative analysis of the impact of COVID-19 on adults with a history of insomnia

Study Objectives

To utilize qualitative data analysis to enrich our understanding of the impact of coronavirus (COVID-19) on those with a pre-pandemic history of insomnia.

Methods

The sample included 208 participants who completed the Coronavirus Impact Scale in April and May 2020. A content analysis was used to analyze responses to a free-response item "Please tell us about any other ways the coronavirus has impacted your life" (n = 175), using a combination of inductive and deductive coding.

Results

Both negative and positive themes emerged, including altered access to health care, negative financial impacts, and various emotions surrounding COVID-19. Some shared "silver linings" such as having more time for physical activity and deepening familial connections.

Conclusions

This analysis provides novel insight into the shared concerns and lived experiences of those with a history of insomnia. Understanding these unique stressors can enable healthcare professionals to better anticipate the needs of this population, as well as learn to navigate future stressful events.

Perceived Stress, Grit, and Self-Care Behaviors in First-Year Medical Students

Medical students experience more stress than the general population, which over time can cause mental and physical disease, including burnout. Identifying factors impacting stress during early medical training could inform strategies to minimize its impacts throughout training and in clinical practice. This study surveyed 238 first-year osteopathic medical students to assess stress (Perceived Stress Scale; PSS), grit, sleep quality (Pittsburgh Sleep Quality Index; PSQI), physical activity (Godin-Shephard Leisure-Time Physical Activity Score; LTPA), and nutrition habits (Rapid Eating Assessment for Participants; REAP) within the first 2 weeks of starting medical school and again 10 weeks later. Incomplete responses were removed, leaving 204 study participants. We observed statistically significant decreases in grittiness (∆grit = -2.230%, P = .002) and physical activity (∆LTPA = -22.147%, P < .0001), while perceived stress (∆PSS = 34.548%, P < .0001) and poor sleep quality (∆PSQI% = 19.853, P < .0001) increased. Correlation analyses identified the strongest relationships were between ∆PSS vs ∆PSQI (r = .47, P < .0001) and ∆PSS vs ∆LTPA (r = -.20, P < .01). Multivariable linear regression analysis isolated ∆PSQI (P < .0001) and ∆LTPA (P = .012) as statistically significant predictors of ∆PSS. These results suggest early, repeated curricular interventions focused on physical activity and sleep hygiene may help students better manage stress during medical education.

The potential effect of walking on quantitative sensory testing, pain catastrophizing, and perceived stress: an exploratory study

OBJECTIVES

Studies suggest that a range of pain mechanisms, such as poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity, are likely to enhance clinical pain. Animal studies suggest that these pain mechanisms can be modulated by increasing physical activity, but human data are needed to support this hypothesis. This exploratory study aimed to investigate the changes in pain mechanisms after a simple self-directed walking program of 8-weeks. Additionally, this exploratory study investigated the interaction between changes over time in assessments of poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity and how these changes interacted with each other.

METHODS

This prospective cohort study included 30 healthy subjects who were assessed at baseline and 4- and 8-weeks after initiating the walking program (30 min walking/day for 8 weeks). Self-report outcomes included: Pain Catastrophizing Scale (PCS), the Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index. Pressure pain thresholds, temporal summation of pain and conditioned pain modulation (CPM) were assessed using cuff algometry.

RESULTS

Twenty-four subjects completed all the visits (age: 42.2, SD: 14.9, 16 females). PCS and PSS significantly decreased at the 8-week's visit compared to baseline (p<0.05). No significant differences were seen for an improvement in quality of sleep (p=0.071) and pain sensitivity (p>0.075) when comparing the 8-week's visit to the baseline visit. Changes in pain mechanisms comparing baseline and 8-weeks data were calculated and regression analyses found that an improvement in PCS was associated with an improvement in CPM (R2=0.197, p=0.017) and that a higher adherence to the walking program was associated with a larger improvement in PCS (R2=0.216, p=0.013).

CONCLUSIONS

The current exploratory study indicates that a simple self-directed walking program of 8-weeks can improve pain catastrophizing thoughts, perceived stress. Higher adherence to the walking program were associated with an improvement in pain catastrophizing and an improvement in pain catastrophizing was associated with an increase in conditioned pain modulation.

The interaction between stress and sleep disorders among foreign medical students in Georgia

OBJECTIVES

This study aimed to: a. Investigate daytime sleepiness, stress, and pre-sleep arousal prevalence among foreign medical students in Georgia. b. Explore gender-based associations between sleep and stress parameters.

METHODS

Mental health was assessed in 207 foreign medical students in Georgia using the Epworth Sleepiness Scale (ESS), Pre-Sleep Arousal Scale (PSAS), and Student-Life Stress Inventory (SLSI).

RESULTS

Most participants reported elevated stress levels and excessive daytime sleepiness (EDS). EDS affected 25.1% of students, with slightly higher prevalence in males. PSAS was prevalent in 97.1% of students. Stress was widely reported, with 78% experiencing it, with a higher prevalence in females. Significant correlations were observed between sleepiness and arousal, including somatic (r = 0.41) and total scores (r = 0.28). Sleepiness was also linked to stressors like pressure, changes, self-imposed stress, and overall self-evaluation stress (r = 0.45). Strong correlations existed between ESS, Total PSAS, and overall self-evaluation SLSI scores for both genders. Gender differences were observed in the associations with Cohen's d within the small to moderate size. Men showed significant associations between ESS and stressors: conflict, pressure, chances, all stress reaction categories, and total SLSI scores (p < 0.001). In women, ESS correlated significantly only with overall self-evaluation (p < 0.001). Excessive daytime sleepiness, especially with somatic and total PSAS, predicted total SLSI scores for the entire sample and both genders, with stronger predictive values for total PSAS.

CONCLUSION

The study reveals a high prevalence of clinical sleepiness and its significant correlation with pre-sleep arousal and stress among foreign medical students, with females experiencing more difficulties than males.

Sleep reactivity is associated with social anxiety and disordered-eating behaviors in college students

Objective: Investigate whether sleep reactivity was associated with social anxiety and disordered-eating behaviors in a college population. Participants: One hundred ninety-eight college-age men and women. Methods: Participants completed self-report measures of social anxiety, disordered-eating behaviors and sleep reactivity. Results: Sleep reactivity was associated with greater dietary restriction and purging, controlling for social anxiety but it was not associated with binge eating. Sleep reactivity was associated with elevated symptoms of social anxiety, controlling for disordered-eating behaviors. Conclusions: The results suggest that sleep reactivity represents a shared correlate of disordered-eating behaviors and social anxiety that may partially explain their co-occurrence. Interventions to help college students high in sleep reactivity effectively manage stress and regulate their sleep may aid in the prevention and treatment of social anxiety and disordered-eating behaviors.