Lack of sleep and its association with academic progress of undergraduate students of foundation university medical college, islamabad, Pakistan

Pakistan Journal of Neurological Sciences (PJNS), Dec 2017

The objective of the study,isto compare the relationship between lack of sleep and the academic performance of the undergraduate students of a medical college of Pakistan. METHODS AND MATERIALS: A cross-sectional study was conducted in a medical college of Pakistanin April 2016. Subjects were recruited by non-probability convenient sampling. A total of 140 subjectswereasked questions about sleep by a properly designed questionnaire from 2nd to 5th Year MBBS. Students having a prior diagnosis of sleep disorder were excluded from study.Data was analyzed using SPSS version 18. RESULTS: A total of 101 females and 39 males participated in the study. Duringnon-exam days, 41.14% of the students slept less than seven hours. The figure approached 80% in exam days. Cross tabulation failed to reveal a correlation between hours of sleep and academic performanceSpearman correlation showed a negative academic performance with less sleep in fourth and fifth year students. CONCLUSION: Students sacrifice their sleep during exams particularly girls. However, the association of sleep hours and academic performance was not established in this study. In fact, there was a negative association between academic performance and decrease sleep in fourth and fifth year students.

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Lack of sleep and its association with academic progress of undergraduate students of foundation university medical college, islamabad, Pakistan

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Lack of sleep and its association with academic progress of undergraduate students of foundation university medical college, islamabad, Pakistan Omair Ali Khan 0 Abdur Rehman Butt 0 Foundation University Medical College, Islamabad. 0 Foundation University Medical College , Islamabad Recommended Citation Article 4 See next page for additional authors Follow this and additional works at: https://ecommons.aku.edu/pjns Part of the Neurology Commons Lack of sleep and its association with academic progress of undergraduate students of foundation university medical college, islamabad, Pakistan Authors Omair Ali Khan, Mahnoor Khalid, Usman Ali, Abdur Rehman Butt, Mahnoor Zafar, and Mahnoor Sherazi O R I G I N A L A R T I C L E Lack of sleep and its association with academic progress of undergraduate students of Foundation University Medical College, Islamabad, Pakistan Date of submission: January 29, 2017 Date of revision: March 16, 2017 Date of acceptance: April12, 2017 OBJECTIVE: The objective of the study,isto compare the relationship between lack of sleep and the academic performance of the undergraduate students of a medical college of Pakistan. METHODS AND MATERIALS: A cross-sectional study was conducted in a medical college of Pakistanin April 2016. Subjects were recruited by non-probability convenient sampling. A total of 140 subjectswereasked questions about sleep by a properly designed questionnaire from 2nd to 5th Year MBBS. Students having a prior diagnosis of sleep disorder were excluded from study.Data was analyzed using SPSS version 18. RESULTS: A total of 101 females and 39 males participated in the study. Duringnon-exam days, 41.14% of the students slept less than seven hours. The figure approached 80% in exam days. Cross tabulation failed to reveal a correlation between hours of sleep and academic performanceSpearman correlation showed a negative academic performance with less sleep in fourth and fifth year students. CONCLUSION: Students sacrifice their sleep during exams particularly girls. However, the association of sleep hours and academic performance was not established in this study. In fact, there was a negative association between academic performance and decrease sleep in fourth and fifth year students. KEYWORDS: Sleep; students; academic performance. INTRODUCTION: Sleep is quintessential to life and health as it is considered food for brain and the primary component that the body needs to revitalize.[1]This alludes to the fact that little doubt exists among health professionals regarding the fundamental importance of sufficient sleep[2]and its integral role in both physical and m e n t a l w e l l - b e i n g o f a n i n d i v i d u a l . [ 3 ] Between juggling an erratic college schedule, academic course and personal life, students often find themselves compromising their sleep by unwillingly minimizing their sleep hours.[4] Because of this, as well as a multitude of other reasons, these students or adolescents appear to be particularly more susceptible to disturbed sleep patterns and have been extensively documented as the most sleep-deprived age group in many countries.[5] This is known to have widespread effects; both short-term as well as long-term, and is a potential obstacle in maximizing the success of emerging adults in college.[6] Sleep is characterized by two factors; quality and quantity, both of which play an equally important role in determining the entire sleep cycle of an individual.[7] If either of these is lacking in any way, a disturbed sleep pattern takes root. Sleep problems have been brewing in our community for quite a while now and recent studies confirmthis by showing that sleep loss has become endemic owing toits increasing prevalence.[6, 8] Lack of sleep is partially attributed to the fact that students facing an overwhelming amount of pressure due to academic demands tend to fall prey to irregular sleep patterns and succumb tosleep disturbances.[8] These can appear in the form of a host of problems including insomnia, narcolepsy, sleep deprivation or other sleep disorders. [9] Previous studies also throw light on this newly introduced colloquial term - 'pulling an all-nighter' right before an exam. [10] The ramifications of this P A K I S T A N J O U R N A L O F N E U R O L O G I C A L S C I E N C E S 1 7 concept have not yet been clearly stated but all studies go against vouching for it since sleepless nights lead to daytime sleepiness and irregular bouts of naps during the day. [11] In particular, global literature review of medical students' sleeping habits show that they have a more stressful academic program which could contribute to their poor sleep quality above and beyond that already experienced by society. [12] But the epidemiologic studies also show high prevalence in non-medical students as well as general population. [13] In a Lithuanian survey, a study comparing sleep problems in medical students with students in other fields, particularly law and economic students, concluded that medical students had the highest frequency as opposed to other student groups. [14] The main element discriminating them from their peers was a more cumbersome academic load and a different lifestyle. [15] The objective of the study is to compare the relationship between lack of sleep and the academic performance of the undergraduate students of a medical college of Pakistan. METHODS AND MATERIALS: STUDY DESIGN AND SAMPLE SIZE: A cross-sectional study was a done in Foundation University Medical College (FUMC), Islamabad, in April 2016. It was a questionnaire-based survey. The questionnaire was designed after thorough literature review on google scholar and PubMed.The sample comprised of undergraduate students, who were selected on volunteer basis from 2nd year to 5th year of FUMC including only those students who had no past history of sleep disturbances before joining medical studies. The questionnaires were selfadministered and confidentiality was assured. Sample size was calculated by WHO sample size calculator and convenient non-probability sampling was done. INCLUSION AND EXCLUSION CRITERIA: A total of one hundred and forty subjects participated in study including only those students who had no past history of sleep disturbances before joining medical studies. The students were selected from all classes of the medical college from 2nd Year to 5th Year on a voluntary basis. Students of 1st Year were excluded as their annual result after joining medical college had not yet been compiled. Students suffering from chronic sleep problems prior to joining medical college were also excluded. The recruitment and collection of data continued for 2 weeks. OPERATIONAL DEFINITIONS: Lack of sleep was defined as less than 7 hours of sleep per night as defined by World Health organization for old adolescents[16], whereas good academic performance was taken as achieving an average of more than 60% of marks in the last three exams. DATAANALYSIS: Data was entered and analyzed in SPSS version 18.0. Results are expressed in frequencies and percentages. Chi-square test was used to check the relationship of lack of sleep with the academic performance. P-value < 0.05 was taken as level of significance. Spearman correlation test was done to find association between hours of sleep and academic performance. RESULTS: One hundred and forty student volunteers filled the questionnaire. Most of the volunteers were female students (72.1%) while males comprising only 27.9%. Most of the students were day scholars. The general characteristics subjects is given in Table 1. Table 1: General characteristics n=140: Characteristics Gender Male Female Residence Day scholars Hostilities Distribution in classes 2nd year 3rd year 4th year 5th year 41.14% 52.85% N(%) 39(27.9%) 101(72.1%) 99(70.7%) 41(29.3%) 54(38.57%) 22(15.7%) 33(23.57%) 21(15%) 80% 20% Serial no. 1 2 3 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Sleep during non exam days Sleep during exam days less than 7 hours / day more than 7 hours / day A comparison of sleep habits during non-exam days vs. exam days is shown in Figure 1. The figure illustrates that majority of the students develop habit of sleeping less than 7 hours/day during exams. On the other hand, in non-exam days about 41.14% of s t u d e n t s s t i l l h a v e i n a d e q u a t e s l e e p . Cross tabulation was done and chi square was applied to see relationship between academic performance and hours of sleep. The p-value came out to be 0.11. Hence, relationship between hours of sleep and high academic performance was not established. However, the academic performance deteriorated significantly (p 0.01) with same hours of sleep in fourth and final year as compared to second and third year. Spearman correlation (- .3) showed a negative correlation between less hours of sleep and academic performance among fourth and final year students. DISCUSSION: The competitive nature of medical field can hardly be exaggerated. Given the tremendous pressure from society, the expectations from parents and the competitive class mates can literally put an engine jam to a student's life. Young students, might end up sacrificing the basic biological needs, to survive in the hostile environment. The current modular system with all the possible advantages and the almost monthly system of examination might add to this.[17] This study was conducted for identifying, a relationship between sleep patterns and academic performance. It is a known fact that sleep problem complaints are more common amongst medical students. [18]Surranietal., from Pakistan concluded a prevalence as high as 40% of poor quality sleep on Pittsburg sleep quality Index(PSQI). [19]In our study about 41.14% of the students have less than 7 hours of sleep in non-exam days. However, this is raised to 80% during exam days, with girls significantly more affected (p< 0.01), which is consistent with Surrani. [20]Giri P, from India has contradicting findings. This report concludes a better sleep in female students and much lower prevalence of poor sleep than seen in our research. [21] In our study the academic performance of the females was not significantly better than the male subjects (p < 0.42). However, a sleep less than 7 hours per day was not significantly associated with poor performance. This is consistent with the findings of Eliassonet al. [21]These findings contradict with the findings of many other researchers who have reported the co-relation between sleep and academic performance. [22,23]With same hours of sleep, the students of second and third year had a better performance than the students of fourth year and final year. Is that a consequence of chronic sleep problems or high academic demands is not clear. The limitations of the study include, that psychiatric morbidity and stress levels were not measured in the subjects. Moreover, the sleep patterns of the subjects before admission in medical college was not recorded. Thus, many students may have a sleep disorder prior to admission in medical college. CONCLUSION: Students sacrifice their sleep during exams particularly girls. However, the association of sleep hours and academic performance was not established in this study. There was a decrease in academic performance in students of fourth and fifth year having less than seven hours sleep. This might point out to a cognitive decline due to inadequate sleep over years or increase in academic stress in fourth and fifth years students. Further studies are recommended to correlate less sleep, cognitive decline, academic stress and academic performance. CONFLICT OF INTEREST: None REFERENCES: 1. 2. 3. 4. 5. 6. Wolfson AR, Carskadon MA. Understanding adolescent's sleep patterns and school performance: a critical appraisal. Sleep medicine reviews. 2003 Dec 31;7(6):491-506. Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. Journal of psychosomatic research. 1997 Jun 30;42(6):583-96. Sweileh WM, Ali IA, Sawalha AF, Abu-Taha AS, Sa'ed HZ, Al-Jabi SW. Sleep habits and sleep problems among Palestinian students. Child and adolescent psychiatry and mental health. 2011 Jul 15;5(1):25. health status and health-related behaviors. BMC Public Health. 2006 Mar 8;6(1):59. Afridi S, Jamali R, Iqbal E, Anum M. Perceived stress, triggering factors and coping strategies among the first year MBBS students; a case of Rehman Medical College, Peshawar, Pakistan.. Journal of Medical Students. 2015 Jun 19;1(1). Veldi M, Aluoja A, Vasar V. Sleep quality and more common sleep-related problems in medical students. Sleep medicine. 2005 May 31;6(3):269-75. Surani AA, Zahid S, Surani A, Ali S, Mubeen M, Khan RH. Sleep quality among medical students of Karachi, Pakistan. JPMA.The Journal of the Pakistan Medical Association. 2015 Apr;65(4):380-2. Giri PA, Baviskar MP, Phalke DB. Study of sleep habits and sleep problems among medical students of Pravara Institute of Medical Sciences Loni, Western Maharashtra, India. Annals of medical and health sciences research. 2013;3(1):51-4. Eliasson A, Eliasson A, King J, Gould B, Eliasson A. Association of sleep and academic performance. Sleep and Breathing. 2002;6(01):045-8. Mak KK, Lee SL, Ho SY, Lo WS, Lam TH. Sleep and academic performance in Hong Kong adolescents.Journal of School Health. 2012 Nov 1;82(11):522-7. Ming X, Koransky R, Kang V, Buchman S, Sarris CE, Wagner GC. Sleep insufficiency, sleep health problems and performance in high school students. Clinical medicine insights.Circulatory, respiratory and pulmonary medicine. 2011 Jan 1;5:71. Conflict of interest: Author declares no conflict of interest. Funding disclosure: Nil Author's contribution: Omair Ali Khan; concept, data collection, data analysis, manuscript writing, manuscript review Mahnoor Khalid; data collection, data analysis, manuscript writing, manuscript review Usman Ali; data analysis, manuscript writing, manuscript review Abdu Rehman Butt; data analysis, manuscript writing, manuscript review Mahnoor Zafar; data analysis, manuscript writing, manuscript review MahnoorShirazi; data analysis, manuscript writing, manuscript review IzzaAdnan;manuscript writing, manuscript review Enna Minhas; data analysis, manuscript review Salman Tahir; data analysis, manuscript review Syyedha Abbas; data analysis, manuscript review, manuscript review P A K I S T A N J O U R N A L O F N E U R O L O G I C A L S C I E N C E S Pilcher JJ , Walters AS . How sleep deprivation affects psychological variables related to college students' cognitive performance . Journal of American College Health. 1997 Nov 1 ; 46 ( 3 ): 121 - 6 . 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Omair Ali Khan, Mahnoor Khalid, Usman Ali, Abdur Rehman Butt, Mahnoor Zafar, Mahnoor Sherazi. Lack of sleep and its association with academic progress of undergraduate students of foundation university medical college, islamabad, Pakistan, Pakistan Journal of Neurological Sciences (PJNS), 2017,