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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 2  |  Page : 73-77

Assessment of insomnia and sleep quality among medical students-benghazi university: A cross-sectional study


1 Department of Internal Medicine (Neurology), Faculty of Medicine, Benghazi University, Benghazi, Libya
2 Department of Internal Medicine, Faculty of Medicine, Benghazi University, Benghazi, Libya
3 Department of Internal Medicine, Jamhorya Hospital, Benghazi, Libya

Date of Submission02-Apr-2020
Date of Acceptance16-Apr-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Khaled D Alsaeiti
Department of Internal Medicine, Jamhorya Hospital, Benghazi
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_22_20

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  Abstract 


Background: Academic pressure and its associated stress are responsible for disturbances in the circadian cycle of the students, Medical students have a stressful academic career, so it is important to identify those students with sleep issues, extent of issues and factors contributing to it. The aim of the current study is to determine the frequency of poor sleep quality among fourth and fifth year medical students at Faculty of Medicine, Benghazi university; using the PSQI. Materials and Methods: An observational, cross-sectional study conducted anonymously and voluntarily with undergraduate fourth and fifth year medical students at faculty of medicine, Benghazi university.150 students were assessed using the Pittsburgh Sleep Quality Index (PSQI). Results: 150 medical students were participated in the study, 95(63.3%) were females and 55 (36.7%) were males. The sample's mean age was 26.1 ± 1.1 years (range = 23–30 years). More than half the sample (52.7%) were sleeping alone, 44.7% were sharing a room with a roommate, and 2.7% were married . The calculated means of total PSQI, nocturnal sleep duration, and sleep latency were 7.04 ± 3.47 hours, 6.23 ± 1.51 hours, 38.7 ± 39.1 minutes, respectively. The average wake-up time and The average bedtime were 7.45 ± 1.5, and 4.49 ± 7.06respectively. 115 (76.67%) students were poor sleeper and the prevalence of poor sleep quality was slightly higher among females than males (76.8%) and (74.4%) respectively with P = 0.004. Younger students were about two and half times more prone to have poor sleep quality compared to older participants (OR=2.4; 95% CI: 1.62-3.55). Conclusion: Poor sleep quality is common among our medical students. It established that most medical students have a poor sleep quality, which could be related to their sleep habits. This study highlights a strong need for integrating sleep hygiene education for young students, to improve their sleeping practices and consequent physical and mental health.

Keywords: Insomnia, student, sleep-quality


How to cite this article:
El Sahly RA, Ahmed AM, Amer SE, Alsaeiti KD. Assessment of insomnia and sleep quality among medical students-benghazi university: A cross-sectional study. Apollo Med 2020;17:73-7

How to cite this URL:
El Sahly RA, Ahmed AM, Amer SE, Alsaeiti KD. Assessment of insomnia and sleep quality among medical students-benghazi university: A cross-sectional study. Apollo Med [serial online] 2020 [cited 2020 Jul 8];17:73-7. Available from: http://www.apollomedicine.org/text.asp?2020/17/2/73/287082




  Introduction Top


Sleep medicine is a crucial medical discipline [1] which has gained a substantial attention nowadays.[2] Poor sleep quality is taken into account one among the foremost striking public health problems. The rates of poor sleep quality is increasing in both developing and modern societies.[3],[4] It had been estimated that the prevalence of sleep disorders among the overall population ranged from 22% to 65%.[5],[6] Sleep deprivation may have grave health consequences; leading to increasing disease morbidity and mortality. It had been postulated that sleep deprivation may be related to defect within the immune function, and may be implicated within the pathogenesis of psychological problems and metabolic issues (diabetes mellitus, metabolic syndrome, and obesity).[7]

Academic pressure and its associated stress are liable for disturbances within the circadian cycle of the scholars.[8] Research has repeatedly given evidence that medical students have more severe sleep impairment than students of different other fields [9] The factors accountable for this include longer study period, tougher syllabi, examination stress, clinical duties that that embrace long on-call duties, and emotional challenges and exhaustion related to witnessing human misery.[10],[11] Medical students have a stressful educational career, thus it is necessary to spot those students with sleep problems, extent of this problem and factors contributing that.[12]


  Materials and Methods Top


An observational, cross-sectional study conducted anonymously and voluntarily with collegian 4th and 5th year medical students at college of medicine, Benghazi University. The study period was from January to Apr 2019. Students of both genders, with 183 students were invited, out of that students responded. There have been 23 incomplete responses that were excluded. Remaining 150 responses were enclosed within the study, a structured form (Pittsburgh Sleep Quality Index [PSQI]).[13] That comprised a standardized, anonymous, confidential, and self-administered information assortment sheet was used. PSQI is an efficient measure of the quality and pattern of sleep. It assesses sleep quality on seven components-subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Its scores vary from minimum 0 to maximum 21. The combined score of all seven elements is termed as “global score of PSQI.”[14]

Global PSQI score ≥5 signifies “poor sleep quality”[13] and indicates that the individual has difficulties in a minimum of two components or moderate difficulties in more than three components. Whereas a score of <5 was indicative of good overall sleep quality.[15] The PSQI has internal consistency and a reliability coefficient (Cronbach's alpha) of 0.83 for its seven components.[16]

The SPSS for Windows, version 17.0 (Statistical Package for the Social Science; SPSS Inc., Chicago, IL, USA) was used to enter and analyze the data. Demographic data were categorized to calculate frequencies and percentages. Moreover, all components of PSQI were categorized as mentioned by Smyth.[14]

Ethical considerations

The study was complied with standards of “Helsinki declaration.” Participants' informed written consents were taken.


  Results Top


One hundred and fifty medical students were participated in the study, 95 (63.3%) were female and 55 (36.7%) were male. The sample's mean age was 26.1 ± 1.1 years (range = 23–30 years). More than half the sample (52.7%) were sleeping alone, 44.7% were sharing a room with a roommate, and 2.7% were married [Table 1]. A summary of demographic characteristics is shown in [Graph 1].
Table 1: Partner × global cross tabulation crowding index (P=0.893)

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The calculated means of total PSQI, nocturnal sleep duration, and sleep latency were 7.04 ± 3.47 h, 6.23 ± 1.51 h, and 38.7 ± 39.1 min, respectively. The average wake-up time and the average bedtime were 7.45 ± 1.5 and 4.49 ± 7.06, respectively.

One hundred and fifteen (76.67%) students were poor sleeper and the prevalence of poor sleep quality was slightly higher among females than males (76.8%) and (74.4%) respectively with P = 0.004. Younger students were about two and half times more susceptible to have poor sleep quality compared to older participants (odds ratio = 2.4; 95% confidence interval: 1.62–3.55).

Scores of the seven components of PSQI questionnaire additionally to pattern of the sleep disturbances are shown in [Table 2].
Table 2: Results for the Pittsburgh Sleep Quality Index components as a function of the number and proportion

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  Discussion Top


Studying medicine at undergraduate level is highly demanding. Physical and psychological well-being of medical students is important for learning, adaptation, and mastering their roles as future doctors. Their own health and their attitudes toward healthy lifestyles can influence their future practice.[11] Learning and memory processing are greatly influenced by adequate sleep. In students, sleep-impaired sleep quality will harm academic performance [9] and cause emotional exhaustion and burnout. Burnout, in return, further aggravates sleep disturbances among medical students.[10]

Our results revealed the presence of high prevalence of poor sleep quality on the PSQI, (76.67%) among medical students. This might be attributed to multiple activities and stresses facing medical students, which may necessitate excessive study during night.

The prevalence of insomnia with in the present study was in congruence with cross-sectional studies report in Tripoli-Libya by Taher et al.,[17] in their review of 201 medical students at February 2010 before the Libyan evolution war, as majority of students (92%) reported poor sleep satisfaction with quality and length of sleep hours [Table 3] and [Table 4].
Table 3: Insomnia effect (trouble being awake while driving, social events)

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Table 4: Sleep disturbance pattern

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This rate coincides with other studies from Egypt (61.6%),[18] Pakistan (77%),[19] and the Kingdom of Spain (79.3%).[20] Such high rates of poor sleep among medical students from different countries requires great concerns for handling stresses facing medical students. This will be improved through counseling and regular education to improve behavior and lifestyle.

On the other hand, lower prevalence is reported among most studies conducted in Brazil (28.15%),[21] Mexico,[22] and India.[23] A Chinese study reported 19.15% of medical students with poor sleep quality on the PSQI.[24] However, in Europe, a Lithuanian study revealed poor sleep quality in 40% of the medical students, as measured by the PSQI.[25] In Africa the prevalence in Nigeria (32.5%)[26] and Ethiopia (55%).[27]

The prevalence of poor sleep varies among the studies possibly due to difference in measurement tools, culture, socio-demographic variables, and personality traits of medical students. Furthermore, the prevalence of poor sleep quality is higher in medical students than within the general population and other students.

Most studies found no gender-based differences within the results.[22],[24] Few studies have reported gender-based differences within the results of sleep quality; higher number of males were involved in an Indian study,[23] whereas higher number of females were involved in a Brazilian study.[21] Within the present study, we observed poor sleep quality among the female students (76.8% vs. 76.3%, P = 0.004), the cause behind gender difference in sleep quality remains unobvious. However, this might be attributed to higher prevalence of psychological problems as anxiety and depression among females compared to males, and therefore, the association between these problems and sleep disturbance.[28]

The average sleep duration of our study group was 6.23 ± 1.51 h. This result is almost like the results in quite few studies from different parts of the world with average sleeping hours around 6 h/day. One study in Ethiopia revealed mean sleep duration of <6 h by 44% of students.[27] In studies in Pakistan,[29] Palestine [30] and Saudi Arabia.[31] The mean total sleep time was also reported as 6 h. In a study in India, majority of the medical students slept between 6 and 7 h.[23] It is documented that medical course places critical demands on student's time and these finding point to the fact that this time is etched out from the student's sleeping hours around 60% of students reported a very good or good sleep quality. In addition, 80% of students scored 85% or more within the sleep efficiency component, which indicates very good sleep efficiency. This contradictory finding of poor measured sleep quality coupled with good subjective sleep was also reported in other studies, including a study in Saudi Arabia [31] and Ethiopia [27] which reported a good or very good subjective sleep quality by a majority of students, while a high percentage (55.8%) had high PSQI scores indicating poor sleep quality. These findings indicate that there is habitual acceptance of any sleep nearly as good sleep by medical students.

Sleep onset latency, i.e., time taken to fall asleep after getting to bed. Normal sleep onset latency should be within 15–20 min. Shorter as well as longer sleep onset latency indicates poor sleep.[32] Within the present study, sleep onset latency within 15 min was reported by 34.7% of students.

In the present study, daytime dysfunction was reported by 35.3% of the participants, who had difficulty staying awake during the day a minimum of once every week. This is consistent with the literature, although there are variations across studies within the proportion of medical students reporting daytime sleepiness: 31%;[33] 42.1%;[34] and 63%.[10]

Frequent use of sleeping medication was identified in 16% of the participants within the present study, this proportion is same as that found in a study involving medical students in Saudi Arabia, which identified that 17% of these students used drugs for sleep induction; this fact indicates the necessity for early intervention programs targeting poor lifestyle habits.[35]

The study has its limitations too. It had been only done in one institute and cannot be generalized. It did not take into consideration reasons predisposing to impaired sleep and also did not take into account the consequences of disturbed sleep. We propose prospective studies to assess the consequences of sleep deprivation on the psychological and physical health of those students. We also propose controlled trials to evaluate whether adequate sleep actually improves the psycho-social health and academic performance among medical students. Another major limitation is that each one components of sleep quality that were assessed are subjective, and trust on the respondent's self-assessment.


  Conclusion Top


Poor sleep quality is common among our medical students. It established that the majority of medical students have a poor sleep quality, which might be related to their sleep habits. This study highlights a strong need for integrating sleep hygiene education for young students, to enhance their sleeping practices and consequent physical and psychological status.

Acknowledgment

All students contributed in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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