Sleeping Disturbances/Disorders in Medical Students of King Saud bin Abdulaziz University for Health Sciences, Riyadh

A sleep disorder exists whenever a lower quality of sleep results in impaired functioning or excessive sleepiness [1]. Studies suggest that sleep disorders affect 50 to 70 million Americans, representing approximately 20 percent of the population [2].

Sleep disorders and disturbed sleep play a major role in the life of college students. College students are at risk of many sleep disorders that affect their performance or lead to inefficient performance [3]. In addition, sleep deficiency can interfere with a student’s daily academic performance [4]. Furthermore, college students have a special lifestyle and unique sleep patterns of their own which might increase the incidence of sleep disorders [5]. Some sleeping disorders or patterns are late bedtime, difficulty in falling asleep, waking more than once from sleep, and being tired during daytime [4].

Several studies have examined sleep disorders among college students due to its obvious importance. In 2012, a study at King Saud University in Riyadh found a high prevalence of sleep disorders, especially among females, and showed that there is a relation between sleep hours, Epworth Sleepiness Scale (ESS), and the academic performance of the students [6].This study aims to determine the sleep patterns and factors of poor sleep quality in university students as well as to measure the effect of sleep disturbances and disorders on the academic performance of King Saud bin Abdulaziz University for Health Sciences medical students.

This was a cross-sectional study conducted in the King Saud bin Abdulaziz University for Health Sciences Riyadh campus during the period of 2011 to 2013. Medical students of the second, third, and, fourth academic years were enrolled after informed consent using convenient sampling techniques. The approximate number of the student population from which study participants were enrolled was 600.We included only male medical students and excluded students with a history of psychiatric disorders or substance dependence such as alcohol or recreational drug use.

Students sleeping disturbances were evaluated by using Epworth Sleeping Scale (ESS), Pittsburgh Sleep Quality Index (PAQI), and their distress was evaluated by the Subjective Units of Distress Scale (SUD) based on a self-administered questionnaire.

ESS measures how likely a person will doze off or fall asleep in eight situations through a number of questions. Scoring of answers is based on a 0 to 3 scale, whereby 3 reflects the negative extreme on the scale.

PSQI differentiates “poor” from “good” sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction over the last month.

SUD is a convenient way for a person to communicate to other people and express how much distress he/she is experiencing at any given time.  There are eleven points on the scale, ranging from zero (absolutely complete relaxation) up to ten (extreme distress).

The data were analyzed using SPSS (Statistical Package for Social Sciences) version 21. Descriptive statistics were presented as mean ± standard deviation for the numerical variables (e.g. total scores), the categorical variables (e.g. demographic data, patterns of sleep, quality of sleep, and effect on students performance) were presented as frequencies and percentages. The continuous variables (total scores) were compared with the demographic variables using statistic t-test or ANOVA as appropriate. The categorical variables (sleep patterns, sleep quality, and effect on student’s performance) were compared using Chi-square test. A relationship between the student’s distress and their grade was determined by using one-way ANOVA. A p-value of < 0.05 was considered as statistically significant. We also determined the Pearson’s correlation between the Pittsburgh Sleep Quality Index (PSQI) and Epworth sleeping scale (ESS)

The mean ±SD age of participants was 24.5±3.03 years and most were living with their family or roommate(s) (93%). Most students had gone to bed between 11 p.m. to 2 a.m.; 12 a.m. was the most frequent bedtime. The mean ±SD time to fall asleep was 32.4±34.7 minutes. The majority of the students wake up in the morning between 6 a.m. and 8 a.m. The mean ±SD of actual hours of sleep was 5.6±2.6 hours [Table 1(a)]. The most common factors affecting students to get optimal sleep were: not being able to sleep within 30 minutes, waking up in the middle of the night or early morning, having to get up to use the bathroom, having a bad dream, and feeling too cold [Table 1(b)]. The mean ±SD PSQI score was 9.93±4.8 points. When students were asked about their sleep quality during the last month, the majority answered that they had a good sleep (54%).

The mean score for ESS was 8.2±5.4.  Most students (74%) had a score below 10 indicating that they had normal daytime sleepiness and good night sleep. The most frequent cause to doze off or fall asleep was lying down to rest in the afternoon, sitting quietly after a lunch, sitting and reading, and watching TV, respectively [Table-2]. There was a relationship between the academic year and ESS; a higher percentage of the students in 3^rd and 4^th year were sleepy (ESS ≥ 10) than a 2^nd year (P = 0.04). Although the smokers were sleepier than nonsmokers (41% vs. 21% respectively), it was not statistically significant (P = 0.07). There was no relationship between having a medical illness and feeling sleepy (P = 0.75) (Table-3). There was a positive moderate correlation between PSQI and ESS with a correlation coefficient of 0.41.There was no relation between the student’s grades and their level of distress (P = 0.37) (Table-4).

This was a cross-sectional study conducted in the King Saud bin Abdulaziz University for Health Sciences Riyadh campus during the period of 2011 to 2013. Medical students of the second, third, and, fourth academic years were enrolled after informed consent using convenient sampling techniques. The approximate number of the student population from which study participants were enrolled was 600.We included only male medical students and excluded students with a history of psychiatric disorders or substance dependence such as alcohol or recreational drug use.

Students sleeping disturbances were evaluated by using Epworth Sleeping Scale (ESS), Pittsburgh Sleep Quality Index (PAQI), and their distress was evaluated by the Subjective Units of Distress Scale (SUD) based on a self-administered questionnaire.

ESS measures how likely a person will doze off or fall asleep in eight situations through a number of questions. Scoring of answers is based on a 0 to 3 scale, whereby 3 reflects the negative extreme on the scale.

PSQI differentiates “poor” from “good” sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction over the last month.

SUD is a convenient way for a person to communicate to other people and express how much distress he/she is experiencing at any given time.  There are eleven points on the scale, ranging from zero (absolutely complete relaxation) up to ten (extreme distress).

The data were analyzed using SPSS (Statistical Package for Social Sciences) version 21. Descriptive statistics were presented as mean ± standard deviation for the numerical variables (e.g. total scores), the categorical variables (e.g. demographic data, patterns of sleep, quality of sleep, and effect on students performance) were presented as frequencies and percentages. The continuous variables (total scores) were compared with the demographic variables using statistic t-test or ANOVA as appropriate. The categorical variables (sleep patterns, sleep quality, and effect on student’s performance) were compared using Chi-square test. A relationship between the student’s distress and their grade was determined by using one-way ANOVA. A p-value of < 0.05 was considered as statistically significant. We also determined the Pearson’s correlation between the Pittsburgh Sleep Quality Index (PSQI) and Epworth sleeping scale (ESS)

We conclude that medical students get less actual sleep hours than the normally needed duration. However, most students had normal day time sleepiness. Future studies are needed to determine an association between sleep duration and disorders with academic performance.

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