COVID-19 pandemic decreased sleep quality of medical students

Objective

Medical students are especially vulnerable to situations of poor sleep quality due to academic demands. The COVID-19 pandemic brought significant changes and high psychological stress, causing a great impact on this population. Here we aim to analyze the influence of the pandemic on the sleep quality of medical students.

Methods

Cross-sectional, observational, and descriptive study with a quantitative approach carried out with students from medical universities in Rio Grande do Norte state (Brazil) through the online application of two questionnaires: Pittsburgh sleep quality index (PSQI-BR) and sociodemographic questionnaire (SQ).

Results

A total of 142 medical students participated in this study: 103 women and 39 men. We observed a prevalence of low sleep quality in 78.16% of the sample and that the pandemic significantly affected the sleep quality among medical students (p<0.05). We also found an alteration in the sleep pattern in 83% of the participants, mainly due to anxiety symptoms (38%). Finally, we observed no statistically significant difference in sleep quality or sleep patterns between genders or college period (p>0.05).

Discussion

This rate of poor sleep quality is higher than the prevalence of periods before the pandemic (58%). Concerns about COVID-19’s negative impact on medical education, delayed training, and impact on the generation of medical jobs can directly aggravate the sleep quality.

Conclusion

The COVID-19 pandemic negatively influenced the sleep quality of medical students, increasing the prevalence of poor sleep quality and promoting changes in the sleep pattern.

Changes in Cortisol but Not in Brain-Derived Neurotrophic Factor Modulate the Association Between Sleep Disturbances and Major Depression

Sleep disturbance is a symptom consistently found in major depression and is associated with a longer course of illness, reduced response to treatment, increased risk of relapse and recurrence. Chronic insomnia has been associated with changes in cortisol and serum brain-derived neurotrophic factor (BDNF) levels, which in turn are also changed in major depression. Here, we evaluated the relationship between sleep quality, salivary cortisol awakening response (CAR), and serum BDNF levels in patients with sleep disturbance and treatment-resistant major depression (n = 18), and in a control group of healthy subjects with good (n = 21) and poor (n = 18) sleep quality. We observed that the patients had the lowest CAR and sleep duration of all three groups and a higher latency to sleep than the healthy volunteers with a good sleep profile. Besides, low CAR was correlated with more severe depressive symptoms and worse sleep quality. There was no difference in serum BDNF levels between groups with distinct sleep quality. Taken together, our results showed a relationship between changes in CAR and in sleep quality in patients with treatment-resistant depression, which were correlated with the severity of disease, suggesting that cortisol could be a physiological link between sleep disturbance and major depression.