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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 26  |  Issue : 1  |  Page : 31-36

Impact of sleep patterns on the academic performance of medical students of College of Medicine, University of Nigeria


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 Submission14-May-2020
Date of Decision11-Sep-2020
Date of Acceptance21-Sep-2020
Date of Web Publication21-Oct-2020

Correspondence Address:
Emmanuel Anayochukwu Esom
Department of Anatomy, Faculty of Basic Medical Sciences, University of Nigeria, Enugu Campus
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_32_20

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  Abstract 

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 2021 Jan 28];26:31-6. Available from: https://www.ijmhdev.com/text.asp?2021/26/1/31/298783




  Introduction Top


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 Top


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 Top


[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.
Table 1: Frequency of students’ sleep duration

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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 2: Frequency of students’ sleep latency

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[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.
Table 3: Sleep qualities of the students

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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

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[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).
Table 5: Academic performance of the students by sleep duration

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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)

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[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.
Table 7: Academic performance of the students by sleep qualities

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  Discussion Top


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 Top


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.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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