Sleep deprivation and drowsiness of medical residents and medical students

Sleep analysis of hospital and out-of-hospital emergency professionals

INTRODUCTION

Sleep deprivation is associated with poorer cognitive functioning and a greater risk of serious diseases. Herein, we analyzed differences in the quality of sleep and excessive daytime sleepiness between hospital emergency services and out-of-hospital emergencies services, and investigated its association with sociodemographic and labor variables.

METHOD

This is a cross-sectional observational study carried out between April 2019 and February 2020, including healthcare professionals from different emergency departments, who were evaluated through the following instruments: "Pittsburgh Sleep Quality Index" and "Epworth Sleepiness Scale".

RESULTS

Four-hundred and four healthcare professionals were included (mean age 40.4 ± 11.1 years), predominantly women (61.4%) from hospital emergency departments (62.6%). A total of 65.3% of the workers had poor sleep quality and 27.7% had excessive sleepiness. Women had poorer sleep quality (p = 0.022) and higher sleepiness (p = 0.010) than men. Hospital emergency workers presented 2-fold increased risk of poor sleep quality (OR = 1.93, p = 0.003) and sleepiness (OR = 1.93, p = 0.009) than out-of-hospital emergency workers. The more optimistic were less likely to have poor sleep quality (OR = 0.73, p = 0.01) or sleepiness (OR = 0.70, p = 0.002). Nurses, emergency medical technicians and nursing assistants also had a higher risk of poor sleep quality compared to physicians (OR = 1.60; p = 0.043).

CONCLUSIONS

Emergency healthcare professionals working in hospital emergency departments had a two-times higher risk of poor sleep quality and sleepiness than out-of-hospital emergency healthcare professionals.

The intersectional effects of motivational and affective factors on managers' performance

Drawing from the effort-recovery model, the authors analyzed the role of daily sleep quality as a driver for self-regulatory resources and consequently of task and contextual performance. Specifically, the authors hypothesized that self-regulatory resources would be a potential mechanism for enhancing workers' performance after a good night's sleep. Moreover, relying on the COR theory, the authors proposed health-related indicators (mental health and vitality) as intensifiers of the previously proposed indirect effect. Daily diary data were collected from 97 managers over five consecutive working days (485 daily observations) and analyzed using multilevel analyses. Sleep quality was positively associated with managers' self-regulatory resources and (task and contextual) performance at the person and day levels. Additionally, results provided support for most of the assumed indirect effects of sleep quality on both performance dimensions via self-regulatory resources. At last, the findings evidenced that these indirect effects were moderated by health indicators in a way that lower scores on health intensified such positive effects. Organizations should create mechanisms that could promote their workers' awareness of the potential benefits of sleeping well at night as well as its impacts on both self-regulatory resources and performance. The current intensification of workload together with working after hours may pose a risk to this important resource source for managers. These findings emphasize the day-to-day variation in self-regulatory resources needed to perform and that workers' sleep quality has the potential to stimulate a resource-building process for such benefits.

The Effect of Aerobic Exercise on Variation of Oxidative Stress, hs-CRP and Cortisol Induced by Sleep Deficiency

The aim of this study was to investigate the impact of sleep deficiency (SD) on oxidative stress, hs-CRP and cortisol levels and to examine the effects of different intensities of aerobic exercise on these parameters under SD conditions. Thirty-two healthy male university students participated in the study and underwent both normal sleep (NS, 8 h of sleep per night for 3 consecutive days) and SD (4 h of sleep per night for 3 consecutive days). After the SD period, the participants performed treatment for 30 min according to their assigned group [sleep supplement after SD (SSD), low-intensity aerobic exercise after SD (LES), moderate-intensity aerobic exercise after SD (MES), high-intensity aerobic exercise after SD (HES)]. Sleep-related factors were measured at NS and SD, while oxidative stress, hs-CRP and cortisol levels were measured at NS, SD and immediately after treatment by group (AT). The results showed that actual total sleep time (ATST) was significantly reduced during SD compared to NS (p < 0.001), while the visual analogue scale (VAS) and Epworth sleepiness scale (ESS) were significantly increased during SD compared to NS (p < 0.001). The difference in reactive oxygen metabolites (d-ROMs) and cortisol levels showed a significant interaction effect (p < 0.01, p < 0.001, respectively), with LES showing a decrease in d-ROMs and cortisol levels compared to SD (p < 0.05). Similarly, SSD showed a decrease in cortisol levels compared to SD (p < 0.05), while HES led to a significant increase in d-ROMs and cortisol levels compared to SD (p < 0.05). Biological antioxidant potential (BAP) and hs-CRP did not show any significant effect (p > 0.05). These results suggest that LES is the most effective exercise intensity for mitigating the negative effects of SD.

Insomnia-A Systematic Review and Comparison of Medical Resident's Average Off-Call Sleep Times

Sleep deprivation is known to have serious consequences, including a decrease in performance, attention and neurocognitive function. It seems common knowledge that medical residents are routinely sleep deprived, yet there is little objective research recording their average sleep times. To discern whether residents may be suffering from the abovementioned side effects, this review aimed to analyze their average sleep times. Thirty papers recording the average sleep time of medical residents were found via a literature search using the key words "resident" and "sleep". An analysis of the mean sleep times cited therein revealed a range of sleep from 4.2 to 8.6 h per night, the median being 6.2 h. A sub-analysis of papers from the USA showed barely any significant differences in sleep time between the specialties, but the mean sleep times were below 7 h. The only significant difference (p = 0.039) was between the mean sleep times of pediatric and urology residents, with the former achieving less sleep. The comparison of methods for data collection showed no significant difference in the sleep times collected. The results of this analysis imply that residents are regularly sleep deprived and may therefore suffer from the abovementioned consequences.

Poor quality sleep is associated with greater carotid intima media thickness among otherwise healthy resident doctors

Background

Sleep is important for maintaining the metabolic processes in the body, and hence, disruption in sleep leads to metabolic derangement and accelerated atherosclerosis. The effect of sleep duration on subclinical atherosclerosis has been examined in several studies; however, data regarding sleep quality is lacking. The study aimed to assess the association between sleep quality and carotid intima-media thickness among healthy young doctors.

Materials and Methods

This was an observational cross-sectional study among 110 healthy young resident doctors. Anthropometric data were recorded and morning fasting venous blood samples were collected to assess fasting blood sugar, lipid profile and glycosylated haemoglobin (HbA1c). Pittsburgh Sleep Quality Index and Berlin questionnaire assessed subjective sleep quality and risk for obstructive sleep apnea, respectively. Carotid ultrasonography was done to detect the intima-media thickness.

Results

Average age of the participants was 26.45 (±1.43) years, and 51.8% were male. Self-reported poor sleep quality was found in 54.5%. Carotid intima-media thickness (CIMT) was increased among 44.5% of participants. In the multivariate analysis, only poor sleep quality appeared to be associated with higher CIMT (P < 0.001, OR = 7.4; 95% CI = 2.70-20.32). When different components of sleep quality was analyzed through multivariate logistic regression, subjective sleep onset latency (>30 min), sleep efficiency (<85%) and sleep disturbance was found to be associated with the increased CIMT.

Conclusion

Poor sleep quality, especially prolonged sleep onset latency, poor sleep efficiency, and sleep disturbance are associated with increased carotid intima-media thickness among healthy young adults.

Perception of health-related quality of life, sleep quality and sleepiness index in an educational environment at a dental school in Southeast Brazil

INTRODUCTION

University entrance is often associated with changes in quality of life, individuals' cognitive and physical behavior. The present study aimed to evaluate health-related quality of life (HRQoL), sleep quality and sleepiness index in dentistry students at a university in Southeast Brazil, in different semesters of their course.

MATERIALS AND METHODS

Samples were obtained from 55 students from the dentistry course at the Federal University of Alfenas (UNIFAL-MG). For collecting information, validated SF-36 questionnaires (Medical Outcomes Study 36-item Short-Form Health Survey), namely, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), were used as instruments in an educational environment. The relationship between the association of demographic factors and academic performance with SF-36, PSQI and ESS was assessed with an alpha of 0.05.

RESULTS

The worst HRQoL parameters reported by the participants were observed in the domains of body pain, vitality, general health perception, and limitations due to emotional and social aspects when associated with the investigated variables. Regarding the relative sleep quality index, differences in the PSQI domains were observed when related to demographic factors and academic performance. There was no significant difference in the sleepiness index of these students according to the mean values of the ESS domains.

CONCLUSION

The SF-36, PSQI and ESS questionnaires indicated that it is a reliable instrument for measuring the impact of quality of life on dentistry students. In addition, dentistry students of UNIFAL-MG had poor indicators of quality of life associated with health and an inadequate index of quality of sleep.

Association between Sleep Quality and Physical Activity in Physical Education Students in Chile in the Pandemic Context: A Cross-Sectional Study

Background: Due to the health restrictions put in place to face the pandemic, a decrease in the levels of physical activity and an alteration in the quality of sleep have been observed. One group susceptible to these changes is represented by students of physical education pedagogy, who, under normal conditions, present high levels of physical activity. However, the correlation between these variables has not been studied in the context of a pandemic lockdown. Objective: The aim of this study was to determine the prevalence of the quality of sleep and physical activity level as a function of gender and evaluate the association between quality of sleep and physical activity level in physical education pedagogy students during the COVID-19 pandemic considering sociodemographic and health characteristics. Methods: This was a cross-sectional study. An online questionnaire was applied to 280 Chilean university students of physical education pedagogy. The survey considered sociodemographic information, healthy habits, and self-reported health and included the International Physical Activity Questionnaire (IPAQ) for physical activity levels and the Pittsburgh Sleep Quality Index (PSQI) for sleep quality. Results: The prevalence of good sleep quality was 20.4%. Furthermore, 52.9% of students had a high level of physical activity. Regression analysis between PSQI global score and age-adjusted physical activity levels indicated that being male and presenting a high level of physical activity favored a better PSQI global score. Conclusions: The prevalence of good sleep quality was low in general and significantly lower in women. Being male and having a high level of physical activity during quarantine benefits good sleep quality, regardless of age.

Common mental disorders among medical students: systematic review and meta-analysis of Brazilian studies

BACKGROUND

Common mental disorders (CMDs) have been correlated with consequences in different domains of life.

OBJECTIVE

To summarize the prevalence rates of CMDs and factors associated with them among students at Brazilian medical schools.

DESIGN AND SETTING

Systematic review and meta-analysis of studies developed in Brazilian medical schools.

METHODS

In October 2021, searches were carried out in seven electronic databases, in Google Scholar and in reference lists. Observational studies reporting prevalence rates of CMDs among students at Brazilian medical schools were sought. Variables associated with CMDs arising from multivariate regression models were included in the synthesis. A meta-analysis was developed using a random-effects model and the risk of bias was assessed using an instrument developed from previous references.

RESULTS

Fourteen original studies were included. The pooled prevalence rate of CMDs among undergraduate students at Brazilian medical schools was 43.3% (95% confidence interval = 38.9% to 47.6%; I2 = 87%; n = 3,927). Among the nine studies in which multivariate analyses were conducted, five showed risk associations between CMDs and medical school-related dissatisfactions, among which the desire to abandon the medical course can be highlighted (n = 3). In three studies, CMDs were associated with sleep indicators.

CONCLUSION

Considering that the prevalence of CMDs among medical students is higher than in the general population, we recommend that Brazilian medical schools should give greater attention to this topic, and should enable expansion of care offerings relating to mental health.

SYSTEMATIC REVIEW REGISTRATION

Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020142184).

The Study of Variation of Metabolites by Sleep Deficiency, and Intervention Possibility of Aerobic Exercise

The purpose of this study is to determine the difference in sleep-related factors and metabolites between normal sleep (NS) and sleep deficiency (SD) and to analyze the variations in metabolites according to the intensity of aerobic exercise under SD conditions. This study was conducted on 32 healthy male university students. Participants experienced both NS (8 h of sleep per night for 3 consecutive days) and SD (4 h of sleep per night for 3 consecutive days). After the SD period, the participants underwent treatment for 30 min by the assigned group [sleep supplement after SD (SSD), low-intensity aerobic exercise after SD (LES), moderate-intensity aerobic exercise after SD (MES), high-intensity aerobic exercise after SD (HES)]. For analysis, sleep-related factors were measured, and metabolites were analyzed by untargeted metabolite analysis using gas chromatography-time-of-flight mass spectrometry. As a result, SD showed that total sleep time (TST), duration of rapid eye movement (REM), duration of light sleep, and duration of deep sleep were significantly decreased compared to NS, whereas the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and visual analogue scale (VAS) were significantly increased compared to NS. The difference in metabolites between NS and SD showed that there were significant changes in the seven metabolites. There were 18 metabolites that changed according to the treatment groups in SD conditions. In summary, SD can exacerbate sleep quality, induce daytime sleepiness, increase fatigue, and increase metabolites that cause insulin resistance. Aerobic exercise under SD conditions can reduce metabolites that induce insulin resistance and increase the metabolites that help relieve depression caused by SD. However, HES has a negative effect, which increases fatigue, whereas LES has no negative effect. Thus, this study suggests that LES is the most appropriate exercise method under SD conditions.

The Effect of Night Duty of Pharmacists on Sleepiness and Concentration at Daytime

Background: The changing responsibilities of pharmacists contribute to a lack of qualified pharmacists to fill vacant positions, particularly in rural areas. Consequently, pharmacy managers cover various duties, including an increasing number of nights being on duty that can impair daytime concentration and performance. The objective of the study was to assess the effect of night duties on daytime sleepiness, sleep quality, and concentration abilities of pharmacists. Methods: 22 pharmacists, both sexes, aged 27 to 60 years, were recruited and their sleep time, sleep efficiency, and mobility (actigraphy) were assessed during a night on duty and a control night using an actimetry. Daytime sleepiness and concentration were assessed using standardized questionnaires (ESS, KSS, d2-R). Results: Significant differences were observed between the night shift and control nights with respect to sleep time, sleep efficiency, and mobility. Daytime sleepiness was significantly increased after night shifts (ESS: 11.64 vs. 2.09; KSS: 6.77 vs. 2.41 after a night shift and control night, respectively; p < 0.001) and concentration diminished compared to control nights (d2-R KL: 220.95 vs. 260.36 after a night shift and control night, respectively; p < 0.001). Conclusions: The results provide evidence that night duties lead to high daytime sleepiness in pharmacists, which in turn may negatively affect their ability to concentrate and their error rate. Existing regulations on emergency pharmacy services should be reconsidered regarding the safety of the pharmaceutical supply.

Poor Sleep Quality and Daytime Sleepiness in Health Professionals: Prevalence and Associated Factors

This study aimed to examine the prevalence rates of poor quality sleep and daytime sleepiness in health professionals and their association with socioeconomic, lifestyle, and anthropometric factors and psychosocial work conditions. This cross-sectional study was performed with health professionals from various public and private hospitals in Rio Verde, Goiás, Brazil. Daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index, respectively. The variables were analyzed using multiple hierarchical Poisson regression in the statistical package Stata version 13.0. A total of 244 health professionals participated in this study (women, 78.28%). The rates of abnormal daytime sleepiness and poor sleep quality were 50.41% (n = 123) and 55.74% (n = 136), respectively. Reduced physical activity was associated with poor sleep quality (prevalence ratio (PR) = 1.32; 95% confidence interval (CI) 1.02–1.70, p = 0.035). Age between 20 and 29 years (PR = 2.59; 95% CI 1.37–4.91, p = 0.021) and 30 and 49 years (PR = 2.09; 95% CI 1.12–3.91, p = 0.021), as well as excessive alcohol consumption (PR = 1.29; 95% CI 1.01–1.66, p = 0.048), were risk factors for daytime sleepiness. Conversely, adequate bodyweight (PR = 0.52; 95% CI 0.33–0.82, p = 0.005) was considered a protective factor. The present findings suggest high rates of abnormal daytime sleepiness and poor sleep quality among healthcare professionals. We emphasize the importance of physical activity, adequate weight, and healthy habits for better quality sleep and reduced daytime sleepiness.

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

Sleep disruption severely impairs learning ability, affecting academic performance in students. This systematic review and meta-analysis aimed at assessing the prevalence of sleep disruption in medical students and its relationship with academic performance. PubMed, Web of Sciences, EBSCO and SciELO databases searches allowed to retrieve 41 papers with data about the prevalence of sleep deprivation, 20 of which also contained data on its association with academic performance. Poor sleep quality was reported by 5646 out of 14,170 students in 29 studies (39.8%, 95% confidence interval = 39.0-40.6%), insufficient sleep duration by 3762/12,906 students in 28 studies (29.1%, 23.3-29.9%) and excessive diurnal sleepiness by 1324/3688 students in 13 studies (35.9%, 34.3-37.4). Academic grades correlated significantly with sleep quality scores (r, 95% CI = 0.15, 0.05-0.26, random-effects model; p = 0.002, n = 10,420 subjects, k = 15 studies) and diurnal sleepiness (r = -0.12, -0.19/-0.06 under the fixed effects model, p < 0.001, n = 1539, k = 6), but not with sleep duration (r = 0.03, -0.12/0.17 under the random-effects model, p = 0.132, n = 2469, k = 9). These findings advocate for an urgent intervention aiming at improving sleep quality among medical students as a way of increasing academic achievements and, ultimately, the quality of health care.

Sleep quality in medical students: a comprehensive meta-analysis of observational studies

PURPOSE

Poor sleep quality is common in medical students and is associated with a number of negative health outcomes. However, the prevalence estimates of poor sleep quality in medical students vary widely across studies. We thus conducted a meta-analysis of the prevalence of poor sleep quality and its mediating factors in medical students.

METHODS

A systematic literature search of PubMed, EMBASE, Web of Science, PsycINFO, and Medline Complete was performed. The random-effects model was used to analyze the pooled prevalence of poor sleep quality and its 95% confidence intervals (CIs).

RESULTS

A total of 57 studies with 25,735 medical students were included. The pooled prevalence of poor sleep quality was 52.7% (95% CI: 45.3% to 60.1%) using the Pittsburgh Sleep Quality Index (PSQI). The pooled mean total PSQI score across 41 studies with available data was 6.1 (95% CI: 5.6 to 6.5). Subgroup analyses found that PSQI cutoff value and study region were associated with the prevalence of poor sleep quality (P = 0.0003 VS. P = 0.005). Across the continents, poor sleep quality was most common in Europe, followed by the Americas, Africa, Asia, and Oceania. Meta-regression analyses found that smaller sample size (slope = - 0.0001, P = 0.009) was significantly associated with higher prevalence of poor sleep quality.

CONCLUSIONS

Poor sleep quality is common among medical students, especially in Europe and the Americas continets. Due to the negative health outcomes, regular screening of poor sleep quality and effective interventions are needed for medical students.