Sleep disruption in medicine students and its relationship with impaired academic performance: A systematic review and meta-analysis

The prevalence of sleep disturbance and its possible associated factors among iranian medical students: A cross-sectional study with a national meta-analysis

Background

The aim of this cross-sectional study was to investigate the prevalence of sleep disturbance and its possible associated factors among Iranian medical students. Additionally, a national meta-analysis was conducted to provide a comprehensive overview of sleep disturbance in this population.

Methods

A sample of medical students from Guilan University of Medical Sciences, Iran was included in the study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep disturbance. Demographic and lifestyle factors, as well as academic performance, were collected through a self-administered questionnaire. The data collected from this study were combined with existing studies through a meta-analysis to estimate the overall prevalence of sleep disturbance among Iranian medical students using the random effects model.

Results

A total of 249 medical students participated in the study. The prevalence of sleep disturbance among Guilan University of Medical Sciences medical students was found to be 71.1%. A significant difference was observed in total PSQI means regarding medical students' residency (p < 0.001) and their duration of sleep in the last 24 h (p = 0.006). The national prevalence of sleep disturbances was 59% (95% CI: [51%-66%], I2 = 97%).

Conclusion

Sleep disturbance is highly prevalent among Iranian medical students, with various factors contributing to its occurrence. The findings of this study highlight the need for interventions and strategies to improve sleep quality and overall well-being among this population. The national meta-analysis provides valuable insights into the overall burden of sleep disturbance among Iranian medical students and can serve as a reference for future studies and public health initiatives targeting this issue.

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

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

Factors Affecting Sleep Quality among University Medical and Nursing Students: A Study in Two Countries in the Mediterranean Region

Poor sleep quality, a global public health concern, poses a significant burden on individuals, particularly health care university students facing intense academic stress. A three-center cross-sectional study was conducted at the Higher Institute of Nursing and Health Sciences in Tetouan (Morocco), Faculty of Medicine in Tangier (Morocco) and Faculty of Nursing in Valencia (Spain). We collected various data using a sociodemographic questionnaire, the Pittsburgh sleep quality questionnaire, the international physical activity questionnaire (IPAQ) and the smartphone addiction questionnaire short-version (SAS-SV). A total of 1210 students were included in our study (mean age 20.4 years, 67.2% female, nursing students (66.2%) and medical students (33.8%), 76.1% students from Morocco and 33.9% from Spain). Analysis revealed a higher prevalence of poor sleep quality among Moroccans students compared to Spanish ones (p < 0.001), that nursing students showed less favorable sleep quality than medical students (p < 0.011) and that living with a chronic disease was linked to less favorable sleep quality (p < 0.001). Lastly, intense or weak physical activity and smartphone addiction were correlated with poor sleep quality (p < 0.001). In the multivariate analysis, an association persisted between poor sleep quality and factors such as the country of study (Odds ratio (OR): 6.25 [95% Confidence Interval (CI): 4.34-9.09]), involvement in nursing studies (OR: 3.50 [95% CI: 2.36-5.27]), and the presence of chronic diseases (OR: 2.70 [95% CI: 1.72-4.16]), (p < 0.01 each). Our findings highlight the multifaceted factors affecting sleep quality in young university students. The implications underscore the imperative of interventions tailored to this demographic group.

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.

Impact of one night of sleep restriction on sleepiness and cognitive function: A systematic review and meta-analysis

Detrimental consequences of chronic sleep restriction on cognitive function are well established in the literature. However, effects of a single night of sleep restriction remain equivocal. Therefore, we synthesized data from 44 studies to investigate effects of sleep restriction to 2-6 h sleep opportunity on sleepiness and cognition in this meta-analysis. We investigated subjective sleepiness, sustained attention, choice reaction time, cognitive throughput, working memory, and inhibitory control. Results revealed a significant increase in subjective sleepiness following one night of sleep restriction (Standardized Mean Difference (SMD) = 0.986, p < 0.001), while subjective sleepiness was not associated with sleep duration during sleep restriction (β = -0.214, p = 0.039, significance level 0.01). Sustained attention, assessed via common 10-min tasks, was impaired, as demonstrated through increased reaction times (SMD = 0.512, p < 0.001) and attentional lapses (SMD = 0.489, p < 0.001). However, the degree of impaired attention was not associated with sleep duration (ps > 0.090). We did not find significant effects on choice reaction time, cognitive throughput, working memory, or inhibitory control. Overall, results suggest that a single night of restricted sleep can increase subjective sleepiness and impair sustained attention, a cognitive function crucial for everyday tasks such as driving.

Are health behaviors associated with academic performance among tertiary education students? A systematic review of cohort studies

OBJECTIVE

To evaluate the association between health behaviors with academic performance among tertiary education students.

METHODS

Six databases were searched until July 2020 for prospective cohort studies evaluating the association between health behavior(s) (dietary intake, physical activity, sedentary behavior, alcohol intake, sleep, smoking or illicit drug use) and academic performance.

RESULTS

Thirty-four studies were included (18 assessed sleep, 16 alcohol intake, 12 illicit drug use, 10 physical activity, 8 diet, 4 smoking, 2 sedentary behavior). A consistent negative association with academic performance was demonstrated for sleep (12/18 studies), alcohol intake (13/16) and illicit drug use (9/12). Most (7/10) studies found no association between physical activity and academic performance.

CONCLUSION

Findings suggest interventions to mitigate the influence of poor sleep, high alcohol intake, and illicit drug use on academic performance may be needed. Further research of other health behaviors, along with their co-occurrence, with academic performance, is required.

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.

Sleep behaviors predicted sleep disturbances among Chinese health science students: a cross-sectional study

PURPOSE

Healthy sleep is essential for individuals' physiological and psychological health. Health science students experience a high prevalence of sleep disturbances which may be due to maladaptive behaviors. This study aimed to examine the associations of sleep behaviors including sleep hygiene and bedtime procrastination with the associations of sleep disturbances (e.g., poor sleep quality, insomnia, and short sleep).

METHODS

This cross-sectional study included health science students from a medical university in Shanghai, China. Sleep disturbances included poor sleep quality, insomnia, and short sleep. They were measured by the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and one question "How many hours of sleep did you usually get during the past week?", respectively. Sleep behaviors included sleep hygiene and bedtime procrastination measured by the Sleep Hygiene Index (SHI) and Bedtime Procrastination Scale (BPS), respectively. Logistic regression was performed while controlling for potential confounders.

RESULTS

A total of 464 health science students participated. Poorer overall sleep hygiene and more bedtime procrastination were independently associated with higher odds of poor sleep quality (OR=1.065, 95% CI 1.028-1.103; OR=1.040, 95% CI 1.006-1.075, respectively) and insomnia (OR=1.059, 95% CI 1.018-1.101; OR=1.093, 95% CI 1.049-1.139, respectively). More bedtime procrastination was associated with higher odds of short sleep (OR=1.148, 95% CI 1.093-1.206). Commonly reported specific sleep behaviors, such as "Going to bed later than intended", "Doing other things than sleep at bedtime", and "Easily stopping what I am doing at bedtime", were also related to higher odds of sleep disturbances.

CONCLUSIONS

Sleep hygiene and bedtime procrastination were strong predictors of sleep disturbances. Tailored interventions targeting specific sleep behaviors are warranted to clarify their effect on sleep disturbances.

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

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

Identifying predictors of patient safety competency based on sleep quality in student faculty of nursing and midwifery during the internship period: a multidisciplinary study

BACKGROUND

Ensuring patient safety is of paramount importance in healthcare services. Sleep disorders not only have detrimental effects on the health of healthcare students but also significantly impair their performance, leading to an increased risk of medication errors. These errors can pose a grave threat to the safety and well-being of patients. It is crucial to address and mitigate sleep disorders among internship healthcare students to safeguard the quality of care and minimize potential patient harm.

OBJECTIVES

This study aimed to investigate the predictors of Patient Safety Competency (PSC) based on the sleep quality of internship healthcare students.

METHODS

A study was conducted on 331 students from the Ardabil School of Nursing and Midwifery at Ardabil University of Medical Sciences in northwest Iran from August to December 2022. The participants were selected by stratified random sampling. Data were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Health Professional Education in Patient Safety Survey (H-PEPSS). The collected data were analyzed using SPSS software version 22.0. Person correlation coefficients were used to examine the relationship between PSC level, its dimensions, and sleep quality, while multiple linear regression was conducted to identify the predictors of PSC.

RESULTS

The competency of nurses in patient safety was average in both classroom and clinical settings. However, their ability to work as a team with other healthcare professionals scored the lowest. In addition, the quality of sleep was found to be a predictor of patient safety competency among healthcare students during their internships.

CONCLUSIONS

It is important to note that healthcare students tend to have moderate patient safety competence (PSC), which is positively correlated with their sleep quality. Therefore, it is vital to identify the key factors that directly affect PSC. This would enable nursing and midwifery faculty administrators to take preventive measures to enhance patient safety competence in both classroom and clinical settings. Additionally, organizing educational workshops that engage students and improve their sleep quality could improve patient care. Practical courses are recommended for health professionals and students in clinical settings to enhance patient safety competencies. Additionally, student internships should receive hands-on training to improve teamwork and rest conditions.

Association between Early Guanfacine Discontinuation and Somnolence for Attention-Deficit/Hyperactivity Disorder

Guanfacine, used as a medication for attention-deficit/hyperactivity disorder (ADHD), leads to a high incidence of somnolence, in contrast to methylphenidate, which leads to a high incidence of insomnia. The impact of somnolence on continuing guanfacine treatment is unclear. Therefore, we investigated the reasons for discontinuing guanfacine and analyzed the factors associated with discontinuation caused by somnolence. We surveyed 96 patients under guanfacine from July 2017 to December 2021 at the Saga University Hospital. Patients who discontinued guanfacine by the end date of our study were divided into a median early and late group. We compared the reasons for discontinuation in both groups. Of all patients, 47 continued and 49 discontinued guanfacine. A higher percentage of patients discontinued guanfacine caused by somnolence for ≤70 d than for >70 d of treatment (44.0 vs. 8.3%; p = 0.008). When stratified by the concomitant use of other ADHD drugs, somnolence resulted in a higher discontinuation rate for ≤70 d than for >70 d of treatment without concomitant use (55.0 vs. 7.1%; p = 0.009). Nonetheless, concomitant use resulted in no difference. In conclusion, somnolence affects the early discontinuation of guanfacine as an ADHD drug. The combination of methylphenidate or atomoxetine may decrease withdrawal caused by somnolence.

Disrupted synaptic homeostasis and partial occlusion of associative long-term potentiation in the human cortex during social isolation

Social isolation often occurs in the military mission of soldiers but has increased in the general population since the COVID-19 epidemic. Overall synaptic homeostasis along with associative plasticity for the activity-dependent refinement of transmission across single synapses represent basic neural network function and adaptive behavior mechanisms. Here, we use electrophysiological and behavioral indices to non-invasively study the net synaptic strength and long-term potentiation (LTP)-like plasticity of humans in social isolation environments. The theta activity of electroencephalography (EEG) signals and transcranial magnetic stimulation (TMS) intensity to elicit a predefined amplitude of motor-evoked potential (MEP) demonstrate the disrupted synaptic homeostasis in the human cortex during social isolation. Furthermore, the induced MEP change by paired associative stimulation (PAS) demonstrates the partial occlusion of LTP-like plasticity, further behavior performances in a word-pair task are also identified as a potential index. Our study indicates that social isolation disrupts synaptic homeostasis and occludes associative LTP-like plasticity in the human cortex, decreasing behavior performance related to declarative memory.

Impact of Sleep Duration, Quality, and Chronotype on Learning and Academic Performance: A Cross-Sectional Study Among First Year Medical Students of a Tertiary Care Institute

Introduction The link between sleep and cognitive processes, such as memory and learning, continues to be one of the most intriguing and perplexing theories. Undergraduate medical students in their first year are particularly vulnerable to sleep disturbances. Academic achievement and learning have been linked to sleep patterns, which include not only the quantity and quality of sleep but also the timing of sleep in relation to the natural sleep onsets, or chronotypes. There have been conflicting reports on the outcomes of sleep and relatively fewer researches focused on the impact of chronotypes on learning and academic achievement among medical students. The current study thus sought to determine the chronotypes of medical students, evaluate the quantity and quality of sleep, and determine the impact of these factors on learning and academic performance. Methods The study was conducted in the Department of Physiology, All India Institute of Medical Sciences (AIIMS) Gorakhpur, India. Sleep health was assessed in 167 first-year medical students using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), morningness-eveningness questionnaire (MEQ), and sleep log books. Learning and memory assessment was performed using Raven's progressive matrices test. Grade point average (GPA) was used to assess their academic performance. The relationship of sleep scores with GPA and RPM scores were obtained by linear regression analysis. One-way analysis of variance (ANOVA) and unpaired t-test were used to investigate other comparisons among categories of chronotypes and those of mean GPA. A p-value of <0.05 was considered as significant. Results The mean GPA and RPM scores obtained in the groups with PSQI ≥ 5 (2.67 ± 1.1, 49.51 ± 6.24, respectively) and PSQI < 5 (3.15 ± 0.59, 54.73 ± 4.01, respectively) and those in the group with ESS ≥ 10 (2.72 ± 1.17, 50.97 ± 5.92, respectively) and ESS < 10 (3.15 ± 0.6, 54.18 ± 3.91, respectively) varied with statistically significant differences (p < 0.05). Statistically significant R-squared values for the relationship of PSQI and ESS scores with RPM and GPA scores were obtained. No correlation between academic grades and chronotype was found. Poor GPA scores were found to be associated with reduced mean sleep duration for one week before the exams. Conclusion Learning and academic performance are negatively impacted by poor sleep quality and daytime sleep dysfunction. No definite evidence for the association of sleep chronotypes with the learning and memory could be attained. Higher test performance is more closely linked to the average sleep length over a duration of time preceding the exams.

A Polysomnographic Study of Effects of Sleep Deprivation on Novice and Senior Surgeons during Simulated Vitreoretinal Surgery

PURPOSE

To assess the impact of a 3-hour polysomnography (PSG)-recorded night of sleep deprivation on next-morning simulated microsurgical skills among vitreoretinal (VR) surgeons with different levels of surgical experience and associate the sleep parameters obtained by PSG with Eyesi-generated performance.

DESIGN

Self-controlled cohort study.

PARTICIPANTS

Eleven junior VR surgery fellows with < 2 years of surgical experience and 11 senior surgeons with > 10 years of surgical practice.

METHODS

Surgical performance was assessed at 7am after a 3-hour sleep-deprived night using the Eyesi simulator and compared with each subject's baseline performance.

MAIN OUTCOME MEASURES

Changes in Eyesi-generated score (0-700, worst to best), time for task completion (minutes), tremor-specific score (0-100, worst to best), and out-of-tolerance tremor percentage. Polysomnography was recorded during sleep deprivation.

RESULTS

Novice surgeons had worse simulated surgical performance after sleep deprivation compared with self-controlled baseline dexterity in the total score (559.1 ± 39.3 vs. 593.8 ± 31.7; P = 0.041), time for task completion (13.59 ± 3.87 minutes vs. 10.96 ± 1.95 minutes; P = 0.027), tremor-specific score (53.8 ± 19.7 vs. 70.0 ± 15.3; P = 0.031), and out-of-tolerance tremor (37.7% ± 11.9% vs. 28.0% ± 9.2%; P = 0.031), whereas no performance differences were detected in those parameters among the senior surgeons before and after sleep deprivation (P ≥ 0.05). Time for task completion increased by 26% (P = 0.048) in the post-sleep deprivation simulation sessions for all participants with a high apnea-hypopnea index (AHI) and by 37% (P = 0.008) among surgeons with fragmented sleep compared with those with normal AHI and < 10 arousals per hour, respectively. Fragmented sleep was the only polysomnographic parameter associated with a worse Eyesi-generated score, with a 10% (P = 0.005) decrease the following morning.

CONCLUSIONS

This study detected impaired simulated surgical dexterity among novice surgeons after acute sleep deprivation, whereas senior surgeons maintained their surgical performance, suggesting that the impact of poor sleep quality on surgical skills is offset by increased experience. When considering the 2 study groups together, sleep fragmentation and AHI were associated with jeopardized surgical performance after sleep deprivation.

FINANCIAL DISCLOSURE(S)

The authors have no proprietary or commercial interest in any materials discussed in this article.

Increased Salivary IL-1 Beta Level Is Associated with Poor Sleep Quality in University Students

Poor sleep quality is a major public health concern for all ages. In particular, university students often face stress levels and changes in social life habits that negatively influence their quality of sleep. This could be associated with psychological well-being in terms of anxiety and depressive symptoms, stress levels, and a poor self-perceived health status. The increases in the pro-inflammatory cytokine interleukin 6 (IL-6), IL-1 beta (IL-1β), and tumor necrosis factor alpha (TNFα), in blood have been linked to poor sleep quality in many diseases, but data on salivary cytokine levels in students are missing or are seldom analyzed. In this study we determined the quality of sleep in a sample of university students and the role of psychological assessment and factors affecting sleep (alcohol intake, tobacco, consumption of stimulant drinks, exercise, and body mass index). We also aimed to shed new light on the associations between sleep quality and salivary inflammatory cytokines (IL-1β, IL-6, and TNFα). Sleep quality was measured with the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI). Perceived stress was assessed using Cohen's Perceived Stress Scale (PSS), and the Goldberg Anxiety and Depression Scale (GADS) was used to assess the level of anxiety or depression. Perceived health status was measured with a visual analogue. Saliva samples was taken in the morning and the inflammatory cytokines was measured via enzyme-linked immunoassay. There was a direct and significant association between the salivary IL-1β concentration and AIS score (r = 0.248; p = 0.038, Pearson correlation) and Pittsburgh scale score (r = 0.274; p = 0.022, Pearson correlation). The relationship between IL-1β and AIS controlling for sex, age, and chronic disease, is still significant (r = 0.260; p = 0.033). The relationship between IL-1β and PSQI controlling for the influence of these variables is also significant (r = 0.279; p = 0.022). Salivary IL-1β concentrations were not significantly associated with any of the scores of the other psychological assessments (PSS, anxiety, depression symptoms, or self-perceived health). Salivary TNFα was significantly and inversely associated with self-perceived health (r = -0.259; p = 0.033, Pearson correlation), but the salivary IL-6 concentration was not associated with any of the sleep quality scale or psychological assessment scores. Our results provide a novel relationship between pro-inflammatory cytokine IL-1β in saliva and poor sleep quality. However, the role of inflammation in poor sleep quality requires further study to identify strategies that could lower inflammation and thus, likely improve sleep quality.

The worldwide prevalence of self-reported psychological and behavioral symptoms in medical students: An umbrella review and meta-analysis of meta-analyses

OBJECTIVE

Medical students frequently experience a range of stressors, such as demanding academic requirements, competition and rivalry, self-doubt, and financial distress. As a result, they are at risk for psychological and behavioral symptoms (PBS) including: depression, anxiety, and sleep difficulties as well as maladaptive substance use.

METHODS

To determine the degree of risk for these symptoms, 13 databases, without language restriction., were searched.

RESULTS

A total of 32 meta-analyses were included in this umbrella review. A global analysis of all self-reported PBS combined yielded a pooled prevalence rate of 30.3% [26.9%; 33.7%]; 95% PI [2.2%; 58.3%]. The highest reported prevalence was for sleep problems 42.0% [35.6%; 48.4%], followed by stress 41.7% [35.3%; 48.1%], burnout 35.8% [25.7%; 45.8%], anxiety 32.5% [27.9%; 37.1%], depression 32.5% [28.8%; 36.1%], internet addiction 26.0% [5.5%; 46.5%], substance use 25.2% [18.9%; 31.6%], eating disorders 9.8% [1.1%; 18.4%], and suicidal thoughts/gestures/acts 8.9% [4.8%; 12.9%]. The prevalence estimates were deemed acceptable for all PBS.

CONCLUSION

The evidence shows that fully one-third of medical students experience a range of problematic PBS, likely attributable to the demanding and intense study environment, the hierarchical structure of medical training facilities, and the vulnerability of the young adulthood time period. Appropriately targeted assessment and intervention efforts are clearly warranted to decrease the psychological burden of medical student training. PROSPERO Identifier: CRD42023391800. Open Science Network (OSF) Identifier: DOI 10.17605/OSF.IO/SXQYN.

The relationship between smartphone addiction and sleep among medical students: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to evaluate the association between smartphone addiction and sleep in medical students. The secondary outcomes included the prevalence of smartphone addiction, duration and purpose of its use, prevalence of poor sleep, duration and quality of sleep.

METHODS

The authors searched PubMed, Cochrane Library, Embase, PsycINFO and CINAHL databases, from inception of each database to October 2022. Quantitative studies in the English language on smartphone addiction and sleep in students studying Western Medicine were included. The Rayyan application was used for title-abstract screening, and Joanna Briggs Institute (JBI) critical appraisal checklist to assess the risk of bias. Heterogeneity tests and meta-synthesis of data were performed using the meta-package in R software. Data on the activities used on the smartphone was synthesized qualitatively.

RESULTS

A total of 298 abstracts were initially assessed for inclusion eligibility: 16 of them were eventually appraised, covering 9466 medical students comprising 3781 (39.9%) males and 5161 (54.5%) females. Meta-correlation between the Smartphone Addiction Scale Short Version (SAS-SV) and Pittsburgh Sleep Quality Index (PSQI) was 0.30 (95%CI = 0.24-0.36), and 0.27 (95% CI = 0.18-0.36) for SAS-SV and sleep duration. The meta-analytic estimation of smartphone addiction prevalence was 39% (95%CI = 0.30-0.50), and score using SAS-SV was 31.11 (95%CI = 29.50-32.72). The mean duration of smartphone daily used was 4.90 hours (95%CI = 3.72-6.08). The meta-analytic estimation on prevalence of poor sleep was 57% (95%CI = 0.48-0.66), and the meta-mean of PSQI and duration of sleep was 5.95 (95%CI = 4.90-7.00) and 5.62h (95%CI = 4.87-6.36) respectively. Medical students used their smartphones mostly for text messaging, followed by photo-sharing or social networking. Its usage for medical education remains unclear.

CONCLUSION

The prevalence of poor sleep and smartphone addiction in medical students was 57% and 39% respectively, with a correlation index of 0.30. Medical students commonly used the smartphone for text-messaging, photo-sharing or social networking, averaging 4.9 hours daily.

Association between impulsivity and cognitive capacity decrease is mediated by smartphone addiction, academic procrastination, bedtime procrastination, sleep insufficiency and daytime fatigue among medical students: a path analysis

BACKGROUND

Medical students are at high risk for sleep disturbance. One possible cause of their sleeping problem is impulsivity. We aim to investigate the possible mediators between medical students' impulsivity and sleep outcomes. Thus, we developed and investigated a model where the predictors were attentional, non-planning, and motor impulsivity subtraits. In the final model, subjective cognitive capacity decrease was the outcome variable. In light of previous findings, academic procrastination, smartphone addiction, and bedtime procrastination were considered important mediators as well as two variables of poor sleep, sleeping insufficiency, and daytime fatigue.

METHODS

Medical students (N = 211; age_M = 22.15 years; age_SD = 3.47 years; 71.6% women) were recruited to complete an online survey comprised of demographics (age, gender), self-administered scales (Abbreviated Impulsiveness Scale, Bedtime Procrastination Scale, Abbreviated Impulsiveness Scale, Academic Procrastination Scale-Short Form) and questions on tiredness, daily fatigue and subjective cognitive capacity decrease. Correlation and path analyses were implemented to examine hypothesized relationships between the variables.

RESULTS

Both attentional impulsivity (β = 0.33, p < .001) and non-planning impulsivity (β = -0.19, p < .01) had a direct relationship with cognitive capacity decrease. Attentional impulsivity was also associated with decreased cognitive capacity with a serial mediation effect via smartphone addiction, academic procrastination, bedtime procrastination, sleep insufficiency and fatigue (estimate = 0.017, p < .01). The indirect link between non-planning impulsivity and cognitive capacity decrease was mediated by academic procrastination, bedtime procrastination, sleep insufficiency and fatigue (estimate = 0.011, p < .01).

CONCLUSIONS

Inability to stay focused and plan tasks effectively (directly and indirectly) predicts poor sleep outcomes. This relationship is mediated by excessive smartphone use, academic procrastination, and bedtime procrastination. Our findings are relevant in light of self-regulatory learning, which is crucial in medical education. This is a recursive cycle of planning, emotion regulation, proper strategy selection and self-monitoring. Future interventions addressing attentional and non-planning impulsivity, problematic smartphone use, academic procrastination, and in turn, bedtime procrastination might make this routine more effective. In the conclusion section, practical implications of the results are discussed.

Exploring the effects of health behaviors and mental health on students' academic achievement: a cross-sectional study on lebanese university students

BACKGROUND

High academic achievement, an important determinant of future success, is known to be influenced by many factors including dietary behavior, lifestyle and mental health, among others. The objectives of the current study were to explore university students' nutritive habits, daily lifestyle, and mental status, and to scrutinize the associations between these factors and students' academic achievement.

METHODS

A cross-sectional study was conducted among students of a private Lebanese university, using an electronic survey. Diet, eating habits, physical activity, sleep, and smoking were evaluated, and mental health was assessed using a validated Arabic version of the combined Depression, Anxiety, Stress Score (DASS-8). Academic achievement was measured using the Subjective Academic Achievement Scale (SAAS).

RESULTS

A total of 1677 students participated in the questionnaire. The results of a linear regression taking the SAAS score as the dependent variable, showed that students who have a non-scientific versus scientific major (Beta = 0.53), and having breakfast ≥ 4 days per week compared to less than 2 days (Beta = 0.28) were significantly associated with higher SAAS scores. More psychological distress (Beta = - 0.06) and a higher number of days of eating out (Beta = - 0.07) were significantly associated with lower SAAS scores.

CONCLUSIONS

This is the first investigation on a Lebanese university students' academic success in relation to lifestyle and mental profiles. Better academic achievement was demonstrated by students having healthier dietary and lifestyle habits, as well as less distressing mental status. Such results, in light of the compounded and unprecedented crises with which Lebanon has been assailed, suggest the need to focus on promoting healthy habits among students in higher education as a possible driver of better academic success.

Sleep Quality and Sleep Hygiene Behaviours Among University Students in Qatar

Background

Insomnia is a highly prevalent health problem, affecting about one-third of the adult population globally. University students are at a high risk for developing insomnia due to the stressful nature of academic life and often unhealthy sleeping habits. The aim of this study was to explore the prevalence of poor sleep quality and investigate sleep hygiene patterns among university students in Qatar.

Methods

A cross-sectional study was conducted among university students using two validated instruments: the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Hygiene Index (SHI). Data were analyzed using descriptive and inferential statistics, including correlation and multivariate regression analyses.

Results

Two thousand and sixty-two students responded to the web-based survey. The mean PSQI score (7.57±3.03) was indicative of poor sleep quality in approximately 70% of the students. Similarly, the mean SHI score (21.79±6.69) was indicative of poor sleep hygiene patterns in 79% of the students. Academic program type, marital status, gender, and sleep hygiene significantly influenced sleep quality. After controlling for all possible covariates in the multiple regression analysis, sleep hygiene remained as the only factor significantly predicting sleep quality. Students with a good sleep hygiene were about four times more likely to have a good sleep quality compared to those with poor sleep hygiene (adjusted OR= 3.66, 95% CI= 2.8-4.8, p <0.001).

Conclusion

Poor sleep quality and inadequate sleep hygiene practices were highly prevalent among university students in Qatar. Sleep hygiene was found to be the only significant predictor of sleep quality such that those adopting healthy sleep hygiene practices were more likely to have better sleep quality. Interventions to raise awareness on the effect of sleep hygiene on sleep quality among university students are needed.

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

Abstract

Purpose of Review

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

Recent Findings

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

Summary

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

Supplementary Information

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

Assessing the impact of sleep restriction on the attention and executive functions of medical students: a prospective cohort study

OBJECTIVE

To compare the performance of medical students regarding attention and executive functions during a period of sleep restriction (insufficient sleep; period of classes) and a period of free sleep (sufficient sleep; vacation period).

BACKGROUND

Sleep deprivation is associated with poor academic outcomes. Few studies have assessed the cognitive changes associated with sleep deprivation due to insufficient sleep syndrome in students and how they occur in real-life situations.

METHODS

This was a prospective cohort study. Medical students were assessed at two moments (class and vacation). The interval between assessments was 30 days. The Pittsburgh Sleep Quality Index, the Consensus Sleep Diary, the Montreal Cognitive Assessment, the Psychomotor Vigilance Test (PVT) and the Wisconsin Sorting Cards Test were used.

RESULTS

Forty-one students were assessed, 49% were female, with a median age of 21 (20; 23) years. There was a lower number of hours slept (5.75 (5.4; 7.0) vs 7.33 (6.0; 8.0) hours; p = 0.037), and a significantly poorer performance in the PVT (mean reaction time, p = 0.005; Minor lapses, p = 0.009) during the period of classes when compared to the vacation period. There was a correlation between the variation in hours of sleep of the two assessments and a variation in minor lapses in the two assessments (Ro: -0.395; p = 0.011; Spearman's correlation).

CONCLUSIONS

Students had fewer hours of sleep and more reduced attention during the period of classes than during the vacation period. This decrease in sleeping hours was correlated with more impaired attention.

Sleep quality of medical students and relationships with academic performances

OBJECTIVE

Sleep health is a major public health concern because of its correlation with physical and mental health, and it may be particularly altered in medical students. This study aims: i) to examine the sleep characteristics of French medical students and their knowledge about basic sleep hygiene rules and; ii) to examine the correlations between sleep quality and academic performances, as well as between sleep quality and sleep knowledge.

METHODS

Students from 4th, 5th and 6th years of medicine, of the Faculty of Paris Diderot, voluntarily responded to an online questionnaire including PSQI and multiple-choice quizzes (MCQ) about basic sleep hygiene rules.

RESULTS

From the 177 participants, 49.7% had a poor sleep (PSQI>5). Regarding sleep latency, 44.6% needed>30min to fall asleep at least once a week, 26.5% slept 6 hours or less by night, 42.4% of them qualified their sleep quality as bad or very bad. A serious lack of knowledge about basic sleep hygiene rules was observed, with an average score at the MCQ of 6.61/10, and only 31% of medical students were aware of basic good sleep habits. Significant correlations were observed between sleep efficiency and all academic mean scores (both regarding the morning, afternoon, and pooled mean scores), and between sleep disturbances and the morning mean score.

CONCLUSIONS

French medical students have a poor sleep quality, correlating with academic performances, and present a poor knowledge of basic sleep rules. These findings are a call to improve medical training schedules and to develop prevention and training programs.

Cross-cultural adaptation and validation of the Chinese version of the Sleep Health Index

OBJECTIVE

To generate the Chinese Sleep Health Index (SHI-C) in Mandarin with cross-cultural adaptations and test its psychometric properties.

METHODS

This study used a cross-sectional design. Health science students were included (N = 271) and a sub-set (n = 74) was invited for the re-test. Cross-cultural adaptation of the SHI-C was performed prior to formal validation. The SHI-C, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Bedtime Procrastination Scale, and Sleep Hygiene Index were used to measure variables of interest. Exploratory factor analysis was used to evaluate the structure validity. Bivariate analyses were used to evaluate the construct validity.

RESULTS

Exploratory factor analysis identified 3 factors (ie, sleep quality, sleep duration, and disordered sleep) accounting for 55.6% of the total variance. The SHI-C total and sleep quality sub-index scores were significantly associated with both PSQI global score (r = -0.132, p < .05; r = -0.182, p < .01, respectively) and ISI score (r = -0.655, p < .05; r = -0.820, p < .05, respectively). SHI-C total, sleep quality sub-index, and sleep duration sub-index scores were significantly associated with Bedtime Procrastination Scale and Sleep Hygiene Index scores (r = -0.238 to -0.368, p < .05). Students with insomnia (ISI > 9) or poor sleep quality (PSQI > 5) had significantly lower SHI-C scores than those without (73.5 vs. 89.0, p < .01; 84.1 vs. 86.7, p < .05, respectively). SHI-C showed good internal consistency (Cronbach's alpha = 0.73) and test-retest reliability (intraclass correlation coefficient = 0.82).

CONCLUSIONS

The SHI-C demonstrated good validity and adequate reliability in a Chinese sample of health science students. It could be used to measure sleep health in future research and practice. Psychometric properties of the SHI-C among other Chinese populations remain to be confirmed.

Association between Chronotype and Sleep Quality among Chinese College Students: The Role of Bedtime Procrastination and Sleep Hygiene Awareness

Chronotype and sleep quality have been shown to play significant roles in influencing people's physical and mental health. The current study focuses on examining the relationship between chronotype and sleep quality among Chinese college students and exploring the mediating role of bedtime procrastination and the moderating role of sleep hygiene awareness. A sample of 2822 college students (female = 71.4%) aged between 17 and 29 years (M = 19.77, SD = 1.41) were included and completed the measures of the Pittsburgh Sleep Quality Index (PSQI), Morningness-Eveningness Questionnaire (MEQ), Bedtime Procrastination Scale (BPS) and Sleep Hygiene Awareness Scale (SHAS). The results showed that evening-type students reported the lowest sleep quality and highest levels of bedtime procrastination. In contrast, the highest sleep quality and lowest levels of bedtime procrastination were shown by morning-type, exhibiting the neither-type students' intermediate chronotype. Bedtime procrastination partially mediated the relationship between chronotype and sleep quality. Furthermore, sleep hygiene awareness moderated the direct effect of chronotype on sleep quality and the effect of chronotype in the path from chronotype to bedtime procrastination. Specifically, higher levels of sleep hygiene awareness could buffer the adverse effect of chronotype on self-reported sleep quality but bolstered the negative effect of chronotype on bedtime procrastination. Our results suggest that individuals with an evening preference are inclined to postpone their bedtime and further experience poorer sleep quality at night. Sleep hygiene awareness may serve as a protective factor for poor nocturnal sleep. Overall, the findings highlight the importance of reducing bedtime procrastination and improving sleep hygiene awareness in the interventions designed to help college students to own a better sleep quality, especially for those with evening chronotypes.

Digital technology and its impacts on the sleep quality and academic performance during the pandemic

BACKGROUND

Sleep deficits caused by the overuse of digital technology is observed among medical students. Due to the coronavirus disease 2019 (COVID-19) pandemic, an emergency remote teaching method was put into practice, which may have resulted in changes in the sleep-wake cycle. The balance between the influences of external and internal synchronizers can be affected by sudden alterations in daily life, including changes in nightly habits and sleep quality, which can lead to increased levels of anxiety and reduced functional performance, for example.

OBJECTIVE

To understand the relationship between the use of digital technology, changes in the circadian cycle, and academic performance during the pandemic.

METHODS

The present is an analytical, cross-sectional, observational study in which a sample of 123 medical students filled out an online questionnaire on self-perception regarding sleep quality and academic performance before and during the pandemic.

RESULTS

Assessing changes in sleep quality and productivity, the study revealed that 100% of the students made continuous use of screens before bedtime. Thus, during the period of social distancing and remote classes, 77.2% of the students reported "poor" or "very poor academic performance, which was probably related to the fact that 65.9% of these students were unable to maintain their productivity due to daytime sleepiness.

CONCLUSIONS

The prolonged use of screens was associated with poor sleep quality and changes in academic performance, with significant psychological impact. Thus, it is worth emphasizing the importance of sleep hygiene in light of the new forms of teaching implemented during the COVID-19 pandemic.

Effectiveness of Multidomain Dormitory Environment and Roommate Intervention for Improving Sleep Quality of Medical College Students: A Cluster Randomised Controlled Trial in China

Medical students are vulnerable to sleep disorders, which could be further exaggerated by poor dormitory environment and roommate behaviour. However, there is little evidence of whether dormitory environment intervention is effective in improving the sleep quality of medical college students in developing countries. The present study aimed to evaluate the effects of a comprehensive multidomain intervention on dormitory environment and roommate behaviour among medical college students in China. In this cluster randomised controlled trial, a total of 106 dormitories (364 students) were randomly allocated into an intervention group (55 dormitories, 193 students) and a control group (51 dormitories, 171 students). The intervention group received a three-month intervention with multiple components to improve or adapt to sleep environments in dormitories; the control group received no intervention. Primary and secondary outcomes were measured at study enrolment and three months later for both groups. The linear mixed-effects models showed that, compared with the control group, the intervention was associated with a significantly decreased Pittsburgh Sleep Quality Index (β = -0.67, p = 0.012), and a marginally significant effect on reducing roommates' influence on sleep schedule (β = -0.21, p = 0.066). Students in the intervention group rated "making dormitory sleep rules" and "wearing eye masks" as the most effective intervention measures. These findings could contribute to the limited body of scientific evidence about sleep intervention in Chinese medical students and highlight the importance of dormitory sleep environments in maintaining sleep quality.

Factors associated with poor academic performance among undergraduate dental students: A cross‐sectional study

OBJECTIVE

To evaluate the factors associated with poor academic performance among undergraduate dental students enrolled at a public university in Brazil.

METHODS

A semi-structured questionnaire addressing the exploratory variables of interest (sociodemographic and economic characteristics, use of medications and drugs, dentistry as the first choice of undergraduate course, and the Pittsburgh Sleep Quality Index) was hosted on Google Forms and shared with all dental students at the Federal University of Pelotas. Academic performance was evaluated based on institutional records, access to which the participants had previously authorized; students with good (average ≥7.0 points) or poor academic performance (average <7.0 points) were considered. Adjusted logistic regressions were performed to verify the association between academic performance and the exploratory variables (p < 0.05).

RESULTS

In total, 244 students were included, of whom 18.8% had poor academic performance. Increased age (OR: 1.34; 95%CI: 1.18-1.52), non-white skin color (OR: 1.34; 95%CI: 1.18-1.52), the use of medications for anxiety and depression (OR: 1.34; 95%CI: 1.18-1.52), and poor sleep quality (OR: 1.34; 95%CI: 1.18-1.52) were factors associated with poor academic performance.

CONCLUSION

A low prevalence of poor academic performance was observed. Non-white skin color, increased age, use of anxiolytics or antidepressants, and poor or disturbed sleep may reduce dental students' academic performance.

Health-promoting factors among students in higher education within health care and social work: a cross-sectional analysis of baseline data in a multicentre longitudinal study

Background

Educational environments are considered important in strengthening students’ health status and knowledge, which are associated with good educational outcomes. It has been suggested to establish healthy universities based on a salutogenic approach – namely, health promotion. The aim of this study was to describe health-promoting resources and factors among first-semester students in higher education in healthcare and social work.

Methods

This cross-sectional study is based on a survey distributed among all students in seven healthcare and social work programmes at six universities in southern Sweden. The survey was carried out in 2018 using a self-reported, web-based questionnaire focussing on general health and well-being, lifestyle factors together with three validated instruments measuring health-promoting factors and processes: the Sense of Coherence (SOC) scale, Salutogenic Health Indicator Scale (SHIS) and Occupational Balance Questionnaire (OBQ).

Results

Of 2283 students, 851 (37.3%) completed the survey, of whom 742 (87.1%) were women; 722 (84.8%) were enrolled on healthcare programmes, and 129 (15.2%) were enrolled on social work programmes. Most reported good general health and well-being (88.1% and 83.7%, respectively). The total mean scores for the SOC scale, SHIS and OBQ were, respectively, 59.09 (SD = 11.78), 44.04 (SD = 9.38) and 26.40 (SD = 7.07). Well-being and several healthy lifestyles were related to better general health and higher SOC, SHIS and OBQ scores. Multiple linear and logistic regressions showed that perceived well-being and no sleeping problems significantly predicted higher general health and higher SOC, SHIS and OBQ scores. Being less sedentary and non-smoking habits were significant predictors of higher SOC.

Conclusions

Swedish students in higher education within the healthcare and social work sector report good general health and well-being in the first semester, as well as health-promoting resources (i.e. SOC, SHIS and OBQ), and in some aspects, a healthy lifestyle. High-intensity exercise, no sleeping problems and non-smoking seem to be of importance to both general health and health-promotive resources. This study contributes to knowledge about the health promotive characteristics of students in the healthcare and social work fields, which is of importance for planning universities with a salutogenic approach.

Meditative practices, stress and sleep among students studying complementary and integrative health: a cross-sectional analysis

Background

The International Cohort on Lifestyle Determinants of Health (INCLD Health) is an ongoing, prospective cohort study assessing the health behaviours and lifestyles of higher education students, including their use of specialty diets and complementary and integrative health (CIH) practices. Purpose: This cross-sectional analysis of the INCLD Health cohort aims to (1) evaluate the associations between perceived stress, sleep disturbance, and meditative practices with diurnal salivary free cortisol and (2) evaluate the associations of meditative practices as well as mind-body practices with perceived stress and sleep disturbance.

Methods

Serial multivariable linear regression models, adjusting for sociodemographic and lifestyle behaviours, were used to assess associations of (1) perceived stress, sleep disturbance, and meditative practices with salivary cortisol, and (2) meditative practices as well as mind-body practices with perceived stress and sleep disturbance. Meditative and mind-body practices were evaluated using a stress-management and self-care survey; perceived stress and sleep disturbance were evaluated using the 10-item Perceived Stress Scale (PSS), and the patient reported outcome measures information system-29 (PROMIS-29) sleep sub-score respectively. Salivary cortisol was collected at 4 time points over a 24-hour period and area under the curve (AUC) calculations conducted.

Results

82.5% (n = 80) of participants utilized at least monthly meditative practices. Greater disturbed sleep, but not perceived-stress, meditative, nor mind-body practices was independently associated with increased AUC cortisol (b = 0.02, 95% CI: 0.002–0.05, p = 0.03) after adjusting for age, sex, race, ethnicity, and BMI. Neither meditative nor mind-body practices were associated with perceived stress or disturbed sleep.

Conclusions

Among INCLD Health participants, greater sleep disturbance, but not perceived stress or meditative practices were associated with daytime cortisol.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03582-5.

Psychotic Experiences and Sleep Quality in the Emerging Adulthood: The Interplay Between Emotional Neglect, Bodily Threat, and Defense Mechanisms

ABSTRACT

The present study investigated the integrated role of emotional neglect, bodily threat, and defense mechanisms in understanding sleep quality and psychosis experiences in a sample of emerging adults. A sample of 898 emerging adults (295 males) with an age range between 19 and 30 years participated in this study. The emotional neglect and bodily threat factors of the Traumatic Experiences Checklist, the Defense Style Questionnaire-40, the Pittsburgh Sleep Quality Index, and the psychosis factor of the Inventory of Personality Organization were administered. Results of path analyses showed that the emotional neglect and bodily threat factors predicted lower sleep quality. A path from emotional neglect and bodily threat to sleep quality via defense styles was also found. The defense styles mediated the relationships between emotional neglect and bodily threat factor with psychosis experiences. These findings provide new insight into the psychological mechanisms underlying the onset of poor sleep quality and psychotic experiences during emerging adulthood.

Time to Sleep?-A Review of the Impact of the COVID-19 Pandemic on Sleep and Mental Health

Sleep is intrinsically tied to mental and overall health. Short sleep duration accompanies the modern lifestyle, possibly reaching epidemic proportions. The pandemic and subsequent lockdowns determined a fundamental shift in the modern lifestyle and had profound effects on sleep and mental health. This paper aims to provide an overview of the relationship between sleep, mental health and COVID-19. Contrasting outcomes on sleep health have been highlighted by most reports during the pandemic in the general population. Consequently, while longer sleep durations have been reported, this change was accompanied by decreases in sleep quality and altered sleep timing. Furthermore, an increased impact of sleep deficiencies and mental health burden was generally reported in health care workers as compared with the adult general population. Although not among the most frequent symptoms during the acute or persistent phase, an increased prevalence of sleep deficiencies has been reported in patients with acute and long COVID. The importance of sleep in immune regulation is well known. Consequently, sleep deficiencies may influence multiple aspects of COVID-19, such as the risk, severity, and prognosis of the infection and even vaccine response.

The Association Between Alcohol-Related Problems and Sleep Quality and Duration Among College Students: a Multicountry Pooled Analysis

Alcohol consumption and sleep disorders are both prevalent and relevant problems among college students, but the relationship between these conditions is unclear. This study aimed to analyze the association between alcohol-related problems and sleep in first-year college students from Brazil, Chile, and Spain. Cross-sectional analyses were performed with data from three independent studies with first-year college students from each country. The risk of alcohol-related problems (RARP) and sleep quality and duration were self-reported using mixed methods. Pooled odds ratios (p-OR) and 95% confidence intervals (95% CI) of suboptimal sleep quality and of short (< 7 h) and long (> 8 h) sleep duration were estimated according to RARP adjusting for the main confounders. Of the 1830 students included (31.2% Brazilian, 42.2% Chilean, and 26.6% Spanish), 61.6% were female, and the mean age was 20.0 ± 3.6 years. Overall, 25.0% and 9.9% of the students were classified as intermediate and high RARP, respectively. In the combined results for the three countries, intermediate-to-high RARP was associated with a higher likelihood of suboptimal sleep quality (p-OR: 1.24; 95% CI: 1.00 to 1.52; I2 heterogeneity statistics: 43.0%), regardless of sociodemographic and lifestyle covariates and of self-rated health. The frequency of alcohol consumption was not associated with sleep quality or sleep duration. In this multicountry pooled analysis, first-year college students at risk of alcohol-related problems were more likely to report worse sleep quality. The coexistence of alcohol-related problems and sleep disorders could potentiate its adverse health effects among these young adults.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-022-00763-8.

Abnormal resting-state functional connectivity of hippocampal subregions in children with primary nocturnal enuresis

OBJECTIVE

Previous neuroimaging studies have shown abnormal brain-bladder control network in children with primary nocturnal enuresis (PNE). The hippocampus, which has long been considered to be an important nerve center for memory and emotion, has also been confirmed to be activating during micturition in several human imaging studies. However, few studies have explored hippocampus-related functional networks of PNE in children. In this study, the whole resting-state functional connectivity (RSFC) of hippocampus was investigated in children with PNE.

METHODS

Functional magnetic resonance imaging data of 30 children with PNE and 29 matched healthy controls (HCs) were analyzed in our study. We used the seed-based RSFC method to evaluate the functional connectivity of hippocampal subregions defined according to the Human Brainnetome Atlas. Correlation analyses were also processed to investigate their relationship with disease duration time, bed-wetting frequency, and bladder volume.

RESULTS

Compared with HCs, children with PNE showed abnormal RSFC of the left rostral hippocampus (rHipp) with right fusiform gyrus, right Rolandic operculum, left inferior parietal lobule, and right precentral gyrus, respectively. Moreover, decreased RSFC of the left caudal hippocampus (cHipp) with right fusiform gyrus and right supplementary motor area was discovered in the PNE group. There were no significant results in the right rHipp and cHipp seeds after multiple comparison corrections. In addition, disease duration time was negatively correlated with RSFC of the left rHipp with right Rolandic operculum (r = -0.386, p = 0.035, uncorrected) and the left cHipp with right fusiform gyrus (r = -0.483, p = 0.007, uncorrected) in the PNE group, respectively. In the Receiver Operating Characteristic (ROC) analysis, all the above results of RSFC achieved significant performance.

CONCLUSIONS

To our knowledge, this is the first attempt to examine the RSFC patterns of hippocampal subregions in children with PNE. These findings indicated that children with PNE have potential dysfunctions in the limbic network, sensorimotor network, default mode network, and frontoparietal network. These networks may become less efficient with disease duration time, inducing impairments in brain-bladder control, cognition, memory, and emotion. Further prospective research with dynamic observation of brain imaging, bladder function, cognition, memory, and emotion is warranted.

Sex differences in the factors associated with sleep duration in university students: A cross-sectional study

BACKGROUND

Insufficient sleep duration among university students was commonly associated with many detrimental effects. University students experience substantial environmental and psychological changes. Female and male university students may differ in many spheres. However, most research on sleep duration of university students is based on an aggregate sample rather than digging the sex-specific profiles. The objective of this study is to examine potential sex differences in the correlates of sleep duration and explore the underlying mechanism of correlations.

METHODS

This is a large-scale university-based mental health survey, which was conducted in university students in Qinghai Province in Northwest China in December 2019. A multi-stage logistic regression was separately fitted by sex to examine the factors associated with short sleep duration in university students.

RESULTS

A total of 5,552 university students with an average sleep duration of 6.88 h (SD = 1.04) were included, among which 35.0% of the participants may currently be sleeping less than the optimal duration. Female students (6.84 h, SD = 1.00) slept shorter than males (6.94 h, SD = 1.09). The only parallel between sexes was that both female and male students with 3-5 times weekly breakfast were less likely to have short sleep duration. Adjusting for depressive symptoms in the following step eliminated the association between anxiety symptoms and short sleep duration in the model for female students. Female-specific associated factors with short sleep duration were age, grade, academic pressure, weekly physical exercise, depressive symptoms. Male-specific characteristics were current smoking tobacco cigarette, self-perceived health, duration of daily Internet use.

CONCLUSION

Characteristic profiles of sleep duration differed between female and male university students; only a few male-specific factors were identified. Psychological guidance and education courses as well as other interventions to improve university students' sleep and related health should be designed and implemented based on sex differences.