Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students

Abstract

Background: It has been previously shown that a high percentage of medical students have sleep problems that interfere with academic performance and mental health.

Methods: To study the impact of sleep quality, daytime somnolence, and sleep deprivation on medical students, we analyzed data from a multicenter study with medical students in Brazil (22 medical schools, 1350 randomized medical students). We applied questionnaires of daytime sleepiness, quality of sleep, quality of life, anxiety and depression symptoms and perception of educational environment.

Results: 37.8% of medical students presented mild values of daytime sleepiness (Epworth Sleepiness Scale - ESS) and 8.7% presented moderate/severe values. The percentage of female medical students that presented ESS values high or very high was significantly greater than male medical students (p < 0.05). Students with lower ESS scores presented significantly greater scores of quality of life and perception of educational environment and lower scores of depression and anxiety symptoms, and these relationships showed a dose-effect pattern. Medical students reporting more sleep deprivation showed significantly greater odds ratios of presenting anxiety and depression symptoms and lower odds of good quality of life or perception of educational environment.

Conclusions: There is a significant association between sleep deprivation and daytime sleepiness with the perception of quality of life and educational environment in medical students.

Keywords: Academic environment; Anxiety; Daytime sleepiness; Depression; Medical education; Medical students; Quality of life; Sleep disorders; Sleep quality.

Fig. 1

Sleep pattern and daily sleepiness among medical students. Histograms represent the distribution of self-related sleep hours during weekdays (a), weekends (b), difference between mean weekend and weekday sleep hours (c) and Epworth Sleepiness Scale (ESS) scores of medical students (d). Gray bars represent normal values of ESS and black bars represent increased daytime somnolence

Fig. 2

Quality of life of medical students decreases with higher daily sleepiness scores. Mean and standard error values of VERAS-Q (a), self-evaluation of QoL (b) and WHOQOL-BREF questionnaires (c) in the three groups of medical students based on ESS scores. * p <  0.05 compared to ESS 0–10; § p <  0.05 compared to ESS 16–24; # p < 0.05 compared to ESS 11–15

Fig. 3

Medical students that presents higher daily sleepiness scores (ESS) showed lower perception of educational environment. Bars indicate mean (and standard error) values of DREEM global (a) and domain scores (b) * p < 0.05 compared to ESS 0–10; § p < 0.05 compared to ESS 16–24; # p < 0.05 compared to ESS 11–15

Fig. 4

Higher scores of sleepiness are associated with higher scores of depression and anxiety. Beck Depression Inventory (BDI (a) and State and Trait Anxiety scores (b) (Means and standard errors). BDI scores range from 0 to 21 and STAI scores range from 20 to 80. * p < 0.05 compared to ESS 0–10; § p < 0.05 compared to ESS 16–24; # p < 0.05 compared to ESS 11–15

Fig. 5

Medical students that presents higher daily sleepiness score showed lower quality of sleep measured by PSQI-Br. PSQI-Br global score ranges from 0 to 21, and lower scores represent better quality of sleep. a Mean (and standard error) values of PSQI-Br global scores. b Distribution of number of medical students with each value of PSQI-Br. Values higher than 5 indicate poor quality of sleep (gray bars). * p < 0.05 compared to ESS 0–10; § p < 0.05 compared to ESS 16–24; # p < 0.05 compared to ESS 11–15