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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 26
| Issue : 1 | Page : 31-36 |
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Impact of sleep patterns on the academic performance of medical students of College of Medicine, University of Nigeria
Augustine Uchechukwu Agu1, Emmanuel Anayochukwu Esom1, Samuel Chukwudi Chime1, Pamela Somke Anyaeji2, Godson Emeka Anyanwu1, Emmanuel Nebeuwa Obikili1
1 Department of Anatomy, Faculty of Basic Medical Sciences, University of Nigeria, Enugu Campus, Nigeria
2 Department of Physiology, Faculty of Basic Medical Sciences, University of Nigeria, Enugu Campus, Nigeria
| Date of Submission | 14-May-2020 |
| Date of Decision | 11-Sep-2020 |
| Date of Acceptance | 21-Sep-2020 |
| Date of Web Publication | 21-Oct-2020 |
Correspondence Address:
Emmanuel Anayochukwu Esom
Department of Anatomy, Faculty of Basic Medical Sciences, University of Nigeria, Enugu Campus
Nigeria
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijmh.IJMH_32_20
Background: Sleep is necessary for physical and cognitive health; these functions are susceptible to be impaired by sleep deprivation. This study evaluated the sleep patterns of the medical students and the impact they have on their academic performance. Materials and Methods: One hundred and ninety-three third-year medical students (122 males and 73 females) participated in the study. The students’ sleep patterns were obtained through a structured questionnaire which was divided into two sections: section 1 was used to obtain the students’ demographic data, and section 2 was used to determine the students’ sleep durations, latency, and qualities. Data on their academic performance were obtained from the results of their second-year MBBS professional examination. Descriptive analysis was done and associations between academic performance and the variables were determined using Student’s t-test, χ2 tests, and Spearman’s correlation test. Results: Fifty-nine percent of the students were sleep-deprived and 41% slept for 6 h or more, 42% had sleep latency of less than 10 min, and 60% frequently or sometimes wakeup at night, while 44.1% felt sleepy during school hours. The academic performance correlated positively with sleep duration (P < 0.001), whereas the correlation with sleep latency and quality was negative. The students who were sleep-deprived had poor academic performance and those with short sleep latency had a better academic performance. Conclusion: Poor sleep duration, long sleep latency, and poor sleep qualities negatively affected the academic performance of the students. Keywords: Academic performance, medical students, Nigeria, sleep patterns
How to cite this article:
Agu AU, Esom EA, Chime SC, Anyaeji PS, Anyanwu GE, Obikili EN. Impact of sleep patterns on the academic performance of medical students of College of Medicine, University of Nigeria. Int J Med Health Dev 2021;26:31-6 |
How to cite this URL:
Agu AU, Esom EA, Chime SC, Anyaeji PS, Anyanwu GE, Obikili EN. Impact of sleep patterns on the academic performance of medical students of College of Medicine, University of Nigeria. Int J Med Health Dev [serial online] 2021 [cited 2023 Mar 30];26:31-6. Available from: https://www.ijmhdev.com/text.asp?2021/26/1/31/298783 |
| Introduction | |  |
The need for sleep is basic and universal like the need to eat. It was stated that all animals sleep (with the possible exception of shark).[1] This universality of sleep across species indicates that it is essential to life. Bonnet[2] pointed out that sleep deprivation is a major problem for the current society. To meet up with our daily interest, we often tend to sacrifice some sleep time, without considering its subsequent dangerous effect. Unfortunately, we are usually faced with the consequences of sleep deprivation such as impairment in neurocognitive functions, psychomotor activities, and sleepiness. Ban and Lee[3] stated that the use of modern technologies has changed the habit and lifestyles of most university students worldwide, and this has played a major role in the development of sleep disorders among the students. Although sleep deprivation is common among the nightshift workers and the elderly,[4] Kang and Chen[5] showed that university students have also been affected globally. They stated that the consequences of sleep deprivation include poor academic performance, poor quality of life, and high rate of neuropsychiatric disorders.[5] Hamer et al.[6] noted that sleep deprivation is associated with cardiovascular diseases. Other consequences of poor sleep are glucose intolerance, increase the level of cortisol, and disorder in the activities of the sympathetic nervous system.[7]
Learning and consequent academic performance are influenced by sleep qualities.[8],[9],[10],[11],[12] Medical students have a very tight academic program that can predispose them to irregular sleep habit or short mean sleep duration. Wolfson and Carskadon[10] noted that the academic burden on medical students may lead to irregular sleep patterns and poor sleep quality with a resultant negative impact on their academic performance. It was stated that the burden of irregular sleep patterns and poor sleep qualities amongst medical students are feeling of tiredness, low energy and motivation, chest discomfort and panic,[13] and these will negatively affect their academic performance. Bahammam et al.[14] demonstrated that the sleep/wake habits of the medical students are associated with academic performance. They noted that sleep habits such as late bedtime on weekdays and weekends were associated with poor academic performance.[14] Their findings agreed with the report of Trockel et al.[15] which showed that students with later bedtimes had a lower academic performance.
Studies have shown that the academic performances of students with normal night’s sleep were significantly better than those with sleep deprivation.[16],[17],[18] Perez-Chada et al.[19] noted that sleep may also be affected by poor academic performance through concomitant stress and some other mechanisms. Sleep deprivation leads to poor metabolism of the prefrontal cortex of the cerebrum and thus reduce judgment and decision making as well as reaction time.[1]
The aims of this study were to evaluate the sleep patterns of the medical students of the University of Nigeria and the impact they have on their academic performance.
| Materials and Methods | | |
Study area
The study was conducted in the Department of Anatomy, College of Medicine, University of Nigeria, Enugu Campus. The campus is located at the center of Enugu metropolis, South-Eastern Nigeria.
Study population
The study population was third-year medical students of College of Medicine, University of Nigeria, Enugu Campus, studying anatomy. A total of 193 students (122 males and 73 females) participated in the study. This represented 87.7% of the 220 students targeted. Their ages range from 18 to 25 years.
Study procedure
The questionnaire was divided into two sections: section 1 was used to obtain the students’ demographic data while section 2 was used to obtain information on the sleep patterns. This was adopted from the Functional Outcomes of Sleep Questionnaire (FOSQ),[20],[21] and it was modified to focus on the sleep durations and qualities. Eight (8) self-reported sleep-related questions were assessed, and these are two continuous variables and six categorical variables. The continuous variables are sleep duration (hours) and sleep latency (minutes to fall asleep) while the six categorical variables include frequency of waking up during the night, feeling sleepy during the school hours, snoring, leg cramps, gasping/sleep apnea, and taking of pills or other medications to help sleep.
With respect to the categorical variables, possible responses were never, rarely (1–2 times/week), sometimes (2–3 times/week) and frequently (4 or more times/week).
The data on the students’ academic performance were obtained from the results of their second MBBS professional examination.
Data analyses
The data were analyzed using the statistical package for the social sciences [SPSS] version 20 to determine the frequency, percentage, and mean of the parameters. Associations between academic performance and the sleep patterns were determined using Student’s t-test, Chi-square test, and Spearman’s correlation.
Ethics
Approval of the study protocol was obtained from the College of Medicine Research Ethics committee, University of Nigeria, Enugu Campus.
Informed consent was obtained from all the participants.
| Results | | |
[Table 1] shows that majority of the students, 59% (8.2% + 50.8%) slept for less than 6 hours in a day while only 41% (36.4% + 4.6%) slept for 6 or more hours in a day.
As shown in [Table 2], 42.5% (13.3% + 29.2%) of the students had sleep latency of less than 10 minutes, while 57.5% (24.6%+ 12.8%+ 10.3%+5.6%+4.1%) had sleep latency of 10 minutes or more.
[Table 3] shows that 60% (18.5% + 41.5%) of the students frequently or sometimes woke up at night, and 44.1% frequently or sometimes felt sleepy during school hours. The percentages of the students that experienced leg cramp, sleep apnea, took sleeping pill, and snored were small.
As shown in [Table 4], there was a significant correlation between academic performance and all the components of sleep patterns; the correlation with sleep duration was positive (P < 0.001) while the correlation with sleep latency and sleep qualities were negative. | Table 4: Spearman’s correlation coefficient of academic performance by sleep patterns
Click here to view |
[Table 5] shows that the students that slept for 2–3 hours had the least academic performance (39%), followed by those that slept for 4–5 hours (47%). Those who slept for 6–7 hours and 8–9 hours had mean academic performances of 67% and 74% respectively. The academic performances of those who slept for 6–7 hours or 8–9 hours were significantly higher than those who slept for 2–3 hours or 4–5 hours, (P < 0.001).
As shown in [Table 6], the students whose sleep latency was within 4 minutes had the highest mean academic performance (65%). Those with sleep latency of 5–9 minutes had a mean academic performance of 64%. The least mean academic performance was obtained by those whose sleep latency was 20 minutes or more. The academic performances of those whose sleep latencies were less than 10 minutes were significantly higher than those whose sleep latencies were 10 minutes or more, (P < 0.001). | Table 6: Academic performance of the students by sleep latency (minutes)
Click here to view |
[Table 7] shows that the students who sometimes or frequently woke up at night, felt sleepy during school hours, snored, experienced sleep apnea and leg cramps, or took sleeping pills had poorer academic performance in the examination. The students who never or rarely experienced any of the poor sleep qualities had better performance.
| Discussion | | |
The present study showed that the majority of medical students were sleep-deprived. This is probably due to the continuous academic burden on them. Due to the demand for vertical and horizontal integration of core basic medical sciences with clinical courses, there was an introduction of other courses such as Medical psychology, Epidemiology, Applied medical sciences, etc. into the preclinical classes. To accommodate these courses, lectures and other academic activities commence at about 7 o'clock in the morning and end around 6 o’clock in the evening, thus leaving the students with only the night hours to carry out their home works, individual readings, group discussions, extracurricular activities, and sleep. Thus, these often leave the students with the option of sacrificing some sleep time to enable them to meet up with these academic activities. The result of this study is in keeping with the findings of other studies which noted that their students were sleep deprived[22] and that poor sleep durations significantly affected the academic performance of school children and adolescents.[23] Rose and Ramanan[12] also reported that the majority of their students had less sleep than the recommended hours of sleep each night
The highest mean academic performance in the present study was obtained by students who slept for 6 h or more whereas those who slept for 5 h or less had the least performance. This implied that the longer the sleep duration, the better the academic performance of the students, and vice versa. Considering the negative impact of poor sleep - feeling of tiredness, chest discomfort, panic, low energy, etc.,[13] the students are bound to have poor academic performance. Sleep deprivation also leads to significant changes in cognitive, concentration, and memory functions[4],[24] and the consequences of these are often deleterious to these students. Our findings corroborate those of other authors who showed that sleep is important to health and necessary for learning and performance of individuals.[23] Other researchers reported that poor sleep was associated with academic performance.[1],[11],[14],[18],[25] Seo and So[26] noted that students who slept for 5 or more hours per day had a better academic performance. Although poor sleep affects academic performance, unfortunately, students who have insufficient sleep duration and experienced poor academic performance were not usually aware of the extent to which their sleep loss impaired their cognitive functions and memory abilities. Williams and Aderanti[1] also noted that poor academic performance may result in poor sleep habit by creating tension, uneasy learning, and psychological stress for the students, thus making it a bi-directional relationship.
The students whose sleep latency was ≤4 minutes had the highest academic performance followed by those within 5–9 minutes. The least performances were obtained by the students with sleep latency of 20 minutes or more. The explanation may not be farfetched because these students are prone to stress, panic, and tension due to the high academic burden in medical college. These panic, tension, and stress with consequent prolonged sleep latency further reduce the sleep duration and quality thereby worsening the academic performance. Our result is in tandem with the findings of other authors who noted that the shorter the sleep latency, the better the academic performance.[10] Dewald et al.[23] also reported that all aspects of sleep patterns affected the academic performance of their students.
Most of the students frequently or sometimes woke up at night. Many of them (44.1%) also felt sleepy during school hours. The reason adduced to this is that sleepiness is a reflection of an increased body need for more sleep due to sleep deprivation. This percentage was higher than those of Taoudi et al.[27] in Morocco where 41% of their students felt sleepy during school hours, and Behammam et al.[22] where 22% of their students felt sleepy during the daytime, but lower than that of Wali et al.[28] in Saudi where 88% of the students felt sleepy during school hours.
The percentage of our students who snored, experienced leg cramp and sleep apnea, or took sleeping pills were small. The academic performances of the students in this group were poor. The findings corroborate those of Wolfson and Carskadon,[10] where adolescents with inadequate sleep, irregular sleep patterns, or poor sleep qualities performed poorly in school. Curcio et al.[29] reported that their students had poor sleep qualities and consequent low academic performance. Similar findings were also noted in other studies.[17],[25],[30] They reported that poor sleep qualities negatively affected the academic performance of their students.
Limitation
The results of this study were limited to the accuracy of students’ responses obtained from the self-administered questionnaires.
| Conclusion | | |
The majority of the students were sleep deprived and had long sleep latency. Students that had sleep duration of 6 hours or more had better academic performance, while those that had sleep duration of fewer than 6 hours, long sleep latency, or poor sleep qualities had the least academic performance.
Financial support and sponsorship
No financial support and sponsorship.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Williams TM, Aderanti RA Sleep as a determinant of academic performance of University students in Ogun State, South West, Nigeria. Euro Sci J 2014;10:657-64.  |
| 2. | Bonnet MH Sleep deprivation. In: Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. 3rd ed. Philadelphia, PA: Saunders; 2000. pp. 53-71. |
| 3. | Ban DJ, Lee TJ Sleep duration, subjective sleep disturbances and associated factors among university students in Korea. J Korean Med Sci 2001;16:475-80. |
| 4. | Vasconcelos HCA, Fragoso LVC, Marinho NBP, Araújo MFM, Freitas RWJ, Zanetti ML, et al. Correlation between anthropometric indicators and sleep quality among Brazilian university students. Rev Esc Enferm USP 2013;47:851-8. |
| 5. | Kang JH, Chen SC Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan. BMC Public Health 2009;9:248. |
| 6. | Hamer M, Batty GD, Kivimaki M Sleep loss due to worry and future risk of cardiovascular disease and all-cause mortality: The Scottish health survey. Eur J Prev Cardiol 2012;19:1437-43. |
| 7. | Spiegel K, Leproult R, Van Cauter E Impact of sleep debt on metabolic and endocrine function. Lancet 1999;354:1435-9. |
| 8. | Samkoff JS, Jacques CH A review of studies concerning effects of sleep deprivation and fatigue on residents’ performance. Acad Med 1991;66:687-93. |
| 9. | Fallone G, Owens JA, Deane J Sleepiness in children and adolescents: Clinical implications. Sleep Med Rev 2002;6:287-306. |
| 10. | Wolfson AR, Carskadon MA Understanding adolescents’ sleep patterns and school performance: A critical appraisal. Sleep Med Rev 2003;7:491-506. |
| 11. | Rasekhi S, Ashouri FP, Pirouzan . Effect of sleep quality on the academic performance of undergraduate medical students. Health Scope 2016;5:1-7. |
| 12. | Rose S, Ramanan S Effect of sleep deprivation of the academic performance and cognitive functions among the college students: A cross sectional study. J Chalmeda Anand Rao Institute Med Sci2017;14:51-6. |
| 13. | Chinawa JM, Chukwu BF, Obu HA Sleep practices among medical students in pediatrics department of University of Nigeria teaching hospital, Ituku/Ozalla, Enugu, Nigeria. Niger J Clin Pract 2014;17:232-6. |
| 14. | Bahammam AS, Alaseem AM, Alzakri AA, Almeneessier AS, Sharif MM The relationship between sleep and wake habits and academic performance in medical students: A cross-sectional study. BMC Med Educ 2012;12:61. |
| 15. | Trockel MT, Barnes MD, Egget DL Health-related variables and academic performance among first-year college students: Implications for sleep and other behaviors. J Am Coll Health 2000;49:125-31. |
| 16. | Pilcher JJ, Walters AS How sleep deprivation affect psychological variables related to college students’ cognitive performance. J Am College Health 1997;46:121-6. |
| 17. | Amin HS, Almazroua IS, Alsahlan AS, Alrishan MA, Elmourad HM, Alotaibi MM, et al. Effect of sleep deprivation on the attitude and performance of medical students, Riyadh, Saudi Arabia. Int J Med Sci Public Health 2016;5:575-80. |
| 18. | Datta A, Nag K, Karmakar N, Chakraborty T, Tripura K, Bhattacharjee P Effect of academic performance among students of a medical college of Tripura. Int J Commun Med Public Health 2019;6:293-8. |
| 19. | Perez-Chada D, Perez-Lloret S, Videla AJ, Cardinali D, Bergna MA, Fernández-Acquier M, et al. Sleep disordered breathing and daytime sleepiness are associated with poor academic performance in teenagers. A study using the pediatric daytime sleepiness scale (PDSS). Sleep 2007;30:1698-703. |
| 20. | Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, et al. An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 1997;20:835-43. |
| 21. | Loprinzi PD, Stigler LC, Hager KK Associations between anthropometric and sleep parameters among adolescents: Consideration by gender. J Behav Health 2013;2:236-42. |
| 22. | BaHamman AS, Al-Khairy OK, Al-Taweel AA Sleep habit and patterns among medical students. Neuroscience 2005;10:447-50. |
| 23. | Dewald JF, Meijer AM, Oort FJ, Kerkhof GA, Bögels SM The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Med Rev 2010;14:179-89. |
| 24. | Johnson LC Sleep deprivation and performance in biological rhythms. In: Webb W, editor, New York: John Wiley & Sons; 1982. pp. 111-42. |
| 25. | Ming X, Koransky R, Kang V, Buchman S, Sarris CE, Wagner GC Sleep insufficiency, sleep health problems and performance in high school students. Clin Med Insights Circ Respir Pulm Med 2011;5:71-9. |
| 26. | Seo D, So W Sleep duration and school performance in Korean adolescents. Solud Mental 2014;37:407-13. |
| 27. | Taoudi M, Rocky R, Toufig J, Benaji B, Hakkou F Epidemological study: Chronotype and daytime sleepiness before and during Ramadan. Therapie 1999;54:567-72. |
| 28. | Wali SO, Krayem AB, Samman YS, Mirdad S, Alshimemeri AA, Almobaireek A Sleep disorders in Saudi health care workers. Ann Saudi Med 1999;19:406-9. |
| 29. | Curcio G, Ferrara M, De Gennaro L Sleep loss, learning capacity and academic performance. Sleep Med Rev 2006;10:323-37. |
| 30. | Gikunda RM, Abura GO, Kiriungi L, Muchiri JM The effect of sleep quantity on performance of students in public Universities, Kenya. Merit Research J Edu and Review 2014;2:113-8. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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