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

Abstract

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 [prevalence_pooled range: 30.9% (Jordan) to 62.5% (Saudi Arabia)], followed by insomnia disorders [prevalence_pooled range: 30.4% (Jordan) to 59.1% (Morocco)], circadian rhythm sleep-wake disorders [prevalence_pooled range: 13.5% (Jordan) to 22.4% (Saudi Arabia)], sleep-related breathing disorders [prevalence_pooled range: 12.2% (Jordan) to 22.5% (Pakistan)], sleep-related movement disorders [prevalence_pooled range: 5.9% (Egypt) to 30.6% (Saudi Arabia)], and parasomnias [prevalence_pooled 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.

Figure 1

PRISMA flow chart 2020. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71. http://www.prisma-statement.org/.

Figure 2

Publication bias assessed via the Doi plot using the prevalence of each sleep disorder as an effect estimate (ES) and the LFK (Luis Furuya-Kanamori) index. In the Doi plot, the dots representing individual prevalence measures extracted from each study on each outcome (sleep disorders).