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Chaabane S, Chaabna K, Khawaja S, Aboughanem J, Mittal D, Mamtani R, Cheema S. Sleep disorders and associated factors among medical students in the Middle East and North Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:4656. [PMID: 38409132 PMCID: PMC10897338 DOI: 10.1038/s41598-024-53818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
Sleep disturbances like poor and insufficient sleep are common among medical students in the Middle East and North Africa (MENA) countries; however, the extent of medically defined sleep disorders (SDs) remains unclear. This meta-analysis determines SD prevalence and identifies associated factors among medical students in the MENA. PubMed, Web of Science, Google Scholar, and reference lists of included studies were searched (latest search: June 2022). Meta-analyses included 22 studies and were performed using random-effect models. Included studies used self-reported screening tools for assessing SDs and then estimated the proportion of participants at high risk of developing a SD. Central disorders of hypersomnolence were the most prevalent SD [prevalencepooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalencepooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalencepooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalencepooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalencepooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalencepooled range: 5.6% (Jordan) to 17.4% (Saudi Arabia)]. Female sex, studying in the latter academic years, having anxiety, excessive internet use, and poor academic performance were significantly associated with SDs. SDs are prevalent among MENA medical students. Implementing student-centered interventions targeting high risk groups in medical schools should be considered to improve students' health and wellbeing.
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Affiliation(s)
- Sonia Chaabane
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar.
| | - Karima Chaabna
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Salina Khawaja
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Jasmine Aboughanem
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Dhruv Mittal
- Intern, Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine - Qatar, Education City, Qatar Foundation, P.O. Box. 24144, Doha, Qatar
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Hamed SA, Abdulhamid SK, El-Hadad AF, Fawzy M, Abd-Elhamed MA. Restless leg syndrome in patients with chronic kidney disease: a hospital-based study from Upper Egypt. Int J Neurosci 2023; 133:257-268. [PMID: 33789073 DOI: 10.1080/00207454.2021.1910256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Chronic kidney disease (CKD) is a common cause of restless leg syndrome (RLS). RLS is under-recognized, misdiagnosed and undertreated disorder in our locality. In this study, we aimed to determine the prevalence of RLS due to CKD and its predictors. METHODS This cross-sectional study included 520 patients [male = 200; female = 320; age: 48.45 ± 3.63yrs; uremia duration: 6.44 ± 1.65yrs; CKD5D = 400; CKD3D = 120). RLS diagnosis was done by clinical interviewing according to International RLS Study Group criteria. All underwent detailed biochemical testing and iron and ferritin levels' measurements. Insomnia, depression and anxiety severities were assessed using insomnia sleep index (ISI), Beck Depression Inventory (BDI-II) and State-Trait Anxiety Inventory for Adults (STAI-AD) scales. RESULTS RLS was found in 22.31% [ESKD = 26%, CKD3D = 10%]. Insomnia, depression and anxiety were found in 76.15%, 91.15% and 44.23%, respectively. Insomnia was correlated with depression (r = 0.488, p = 0.001) and anxiety (r = 0.360, p = 0.006) but not RLS. Multiple linear regression analysis showed that ESKD (OR = 3.8, 95%CI = 2.5-8.5, p = 0.001), inadequate dialysis (OR = 4.6, 95%CI = 3.5-8.6, p = 0.001), hyperparathyroidism (OR = 5.1, 95%CI 3.2-13.7, p = 0.0001) and peripheral neuropathy (OR = 5.6, 95%CI = 3.8-12.8, p = 0.0001) were independently associated with RLS. CONCLUSION The prevalence of RLS with CKD is 22.31%. It is 2.6 times more frequent and severe with ESKD compared to CKD3D. It seems that RLS may occur early with CKD and becomes worse with progressive kidney impairment. Also, insomnia, depression and anxiety are common with CKD, however, their severities were not correlated with RLS. Predictors for RLS were ESKD, inadequacy of dialysis, hyperparathyroidism and peripheral neuropathy.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | | | | | - Mohamed Fawzy
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
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Broström A, Alimoradi Z, Lind J, Ulander M, Lundin F, Pakpour A. Worldwide estimation of restless legs syndrome: a systematic review and meta-analysis of prevalence in the general adult population. J Sleep Res 2023; 32:e13783. [PMID: 36600470 DOI: 10.1111/jsr.13783] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 01/06/2023]
Abstract
This systematic review, meta-analysis and meta-regression assessed the prevalence of restless legs syndrome (RLS) in the general adult population. Studies identified in Scopus, PubMed, Web of Science, and PsycInfo between January 2000 and February 2022 were included if they used a case-control or cross-sectional design and reported data regarding the prevalence of RLS. The protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022300709). A total of 97 studies including 483,079 participants from 33 different countries met the eligibility criteria. The Newcastle Ottawa Scale was used to evaluate the methodological quality, and the fill-and-trim method was used to correct probable publication bias, while the jack-knife method was performed to assess small study effect. The corrected overall pooled prevalence of RLS was 3% (95% confidence interval [CI] 1.4%-3.8%). The pooled prevalence of RLS syndrome was affected by methodological quality (no data from non-respondents in the included studies), gender (higher among women), study design (lower prevalence in case-control versus cohort and cross-sectional studies). The figures for corrected pooled prevalence among men, women, alcohol consumers and smokers were 2.8% (95% CI 2%-3.7%); 4.7% (95% CI 3.2%-6.3%); 1.4% (95% CI 0%-4.2%); and 2.7% (95% CI 0%-5.3%), respectively. The prevalence among male and female participants was lower in community-based versus non-community-based studies. Moreover, the prevalence was higher in developed versus developing countries and among elders versus adults. In conclusion, RLS is a common disorder in the general adult population, with a higher prevalence in women; however, prevalence data are affected by study design and quality.
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Affiliation(s)
- Anders Broström
- School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Zainab Alimoradi
- Social Determinants of Health Research Centre, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Jonas Lind
- Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.,Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
| | - Martin Ulander
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden
| | - Fredrik Lundin
- Department of Neurology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Amir Pakpour
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Elrassas HH, Elsayed YAR, Abdeen MS, Shady MM, Shalash A, Morsy M. Restless Legs Syndrome among patients receiving antipsychotic and antidepressant drugs. Hum Psychopharmacol 2022; 37:e2817. [PMID: 34533852 DOI: 10.1002/hup.2817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with Restless Legs Syndrome (RLS) experience psychological distress and diminished quality of life. Antipsychotics and antidepressants are known to be linked to RLS. AIMS This study aims to investigate the presence of RLS in psychiatric patients who receive antipsychotic and antidepressant drugs and to determine potential risk factors for its occurrence. METHODS Two hundred patients who received antipsychotic and antidepressant drugs for more than 1 month were recruited from two tertiary psychiatric centers in Cairo, Egypt. One hundred apparently healthy volunteers were also included. All patients and controls were screened using the four-items questionnaire (Arabic version) for RLS. RLS severity was scored according to the validated Arabic version of International Restless Legs Syndrome Study Group rating scale (IRLS). Mimicking conditions were carefully investigated and excluded. RESULTS Forty-one percent of the patients who receive antipsychotic and antidepressant drugs were found to have RLS. Family history, past history and smoking are potential risk factors. Trazodone and haloperidol were less associated with RLS. CONCLUSIONS Although limited by its cross-sectional design, these findings suggest that patients who receive antipsychotic and antidepressant are susceptible to RLS. However, these results need to be replicated on a wider scale.
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Affiliation(s)
- Hanan Hany Elrassas
- Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | - Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Morsy
- Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ergin N, Kılıç BB, Ergin A, Varlı S. Sleep quality and related factors including restless leg syndrome in medical students and residents in a Turkish university. Sleep Breath 2021; 26:1299-1307. [PMID: 34410581 DOI: 10.1007/s11325-021-02437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim was to determine sleep quality and related factors including restless leg syndrome in the 6th year medical students and medical residents in Pamukkale University, Faculty of Medicine, Denizli, Turkey. METHODS The data collection phase of this cross-sectional study was completed between November 1st and December 31st, 2019, with a questionnaire including 59 items. Three hundred forty-one medical students and residents participated in the study. The Pittsburgh Sleep Quality Index was used to determine the participants' sleep quality. The International Restless Legs Syndrome Study Group Diagnostic Criteria and the Restless Leg Syndrome Rating Scale were used for the diagnosis and for determining the seriousness of restless leg syndrome, respectively. RESULTS The mean age (SD ±) was 26.6 ± 3.2. Men (50%) and medical residents (59%) constituted the majority. Most of the participants (70%) had poor sleep quality, and 9% had restless leg syndrome. Despite losing their significance in multivariable analysis, a relationship existed between restless leg syndrome and sleep quality in bivariate comparisons (p = 0.04). According to the multiple variable analysis, age (p = 0.008), female gender (p = 0.04), insufficient income (p = 0.009), being on-medication (p = 0.007), being a current smoker (p = 0.01), not sleeping at the usual time (p = 0.04), and listening to music before sleeping (p = 0.03) were identified as independent risk factors for poor sleep quality. CONCLUSIONS The prevalence of poor sleep quality and restless leg syndrome are high in the 6th year medical students and residents. Necessary measures should be taken to reduce the effect of negative conditions on these vulnerable groups.
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Affiliation(s)
- Nesrin Ergin
- Department of Neurology, Medical Faculty, Pamukkale University, Denizli, Turkey.
| | - Bilge Betül Kılıç
- Department of Public Health, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Ahmet Ergin
- Department of Public Health, Medical Faculty, Pamukkale University, Denizli, Turkey
| | - Sema Varlı
- Department of Public Health, Medical Faculty, Pamukkale University, Denizli, Turkey
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Prevalence of Restless Legs Syndrome among Medical Students of Karachi: An Experience from a Developing Country. SLEEP DISORDERS 2020; 2020:7302828. [PMID: 32148967 PMCID: PMC7049861 DOI: 10.1155/2020/7302828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 12/23/2019] [Accepted: 01/29/2020] [Indexed: 12/03/2022]
Abstract
Background Restless legs syndrome (RLS) is a neurological disorder characterized by an uncomfortable sensation in the legs which gets worse in the evening or night, relieved upon movement. The aim of this study was to specify the prevalence of RLS in the group of young medical students and to assess the effect of RLS on sleep, as sleep disturbance is one of the chief complaints of RLS patients. We also studied its association with smoking as it is considered an aggravating factor. Method This was a cross-sectional study conducted from June 2017 to July 2018 in Karachi. A total of 300 students (220 females and 80 males) participated and were given questionnaires to detect RLS based on criteria proposed by the International Restless Legs Syndrome Study Group. Subjects who were positive for RLS were further asked questions about sleep by using the Epworth Sleepiness Scale and severity of RLS by using RLS Rating Scale. They were also asked about their smoking status. Results The frequency of RLS is 8% among young adults. Out of 300 medical students, 24 students were classified positive for RLS with a female preponderance (66.7% were females and 33.3% were males). The severity of RLS was more rated to be mild to moderate. The effect of RLS on sleep was in the mild range. The p value of smoking status comparing with gender came out to be <0.001, and p value of smoking status comparing with gender came out to be <0.001, and Conclusion It is concluded that we found RLS to be present significantly in our population that is without comorbidities. Our results showed female preponderance and a mild sleep disturbance in our study population. More attention is needed to recognize RLS and to manage the aggravating factors of RLS.
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