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ORIGINAL ARTICLE
Year : 2022  |  Volume : 15  |  Issue : 4  |  Page : 524-528  

Quality of sleep among clinical medical students of Bayero university, Kano, Nigeria


1 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Paediatrics, Federal Medical Centre Nguru, Nguru, Yobe State, Nigeria
3 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
4 Department of Psychiatry, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
5 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
6 Division of Paediatric Cardiology, The Limi Children's Hospital, Abuja, Nigeria

Date of Submission14-Apr-2020
Date of Decision08-Jun-2020
Date of Acceptance20-Jul-2020
Date of Web Publication01-Mar-2022

Correspondence Address:
Ibrahim Ahmadu
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_185_20

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  Abstract 


Background: Sleep deprivation and disruptions are associated with both psychological and physiological disorders. Medical students have an increased risk for sleep deprivation. This study aimed to determine the quality of sleep among clinical medical students of Bayero University Kano (BUK). Materials and Methods: This is a cross-sectional study that was conducted between February and March 2019 among clinical students of BUK. The data were obtained using sociodemographic questionnaire as well as the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) self-administered questionnaires. Two hundred questionnaires were administered to the students in their 4th, 5th, and 6th academic year. SPSS version 20 was used for the statistical analysis of the data collected. Results: A total of 181 questionnaires were completed out of the 200 that were administered, making a response rate of 90.5%. There were 114 males (63%) and 67 females (37%), giving a male-to-female ratio of 1.7:1, which is in keeping with the gender distribution of the students. The mean age (± standard deviation) of the students was 23.8 ± 2.9 years. The overall poor sleep quality was found to be 53.0% based on the PSQI, whereas the overall excessive daytime sleepiness was found to be 38.3% using the ESS. Poor sleep quality was found to be 61.1%, 51.7%, and 42.9% among the students in the 4th, 5th, and 6th academic years, respectively (P = 0.14). Excessive daytime sleepiness was found to be 45.8%, 41.7%, and 22.9% among the students in the 4th, 5th, and 6th academic years, respectively (P = 0.03). Conclusion: The prevalence of poor sleep quality is high among the clinical students of BUK.

Keywords: Bayero University Kano, clinical students, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, sleep quality


How to cite this article:
Ahmadu I, Garba NA, Abubakar MS, Ibrahim UA, Gudaji M, Umar MU, Michael GC, Igoche PD, Asani MO, Aliyu I. Quality of sleep among clinical medical students of Bayero university, Kano, Nigeria. Med J DY Patil Vidyapeeth 2022;15:524-8

How to cite this URL:
Ahmadu I, Garba NA, Abubakar MS, Ibrahim UA, Gudaji M, Umar MU, Michael GC, Igoche PD, Asani MO, Aliyu I. Quality of sleep among clinical medical students of Bayero university, Kano, Nigeria. Med J DY Patil Vidyapeeth [serial online] 2022 [cited 2022 Jul 3];15:524-8. Available from: https://www.mjdrdypv.org/text.asp?2022/15/4/524/338910




  Introduction Top


Sleep is defined as a natural and reversible state of reduced responsiveness to external stimuli and relative inactivity that occurs in regular intervals, accompanied by a loss of consciousness.[1] It is a state in which an organism temporarily, partially, and periodically loses its interaction with the surroundings at different intensities, which can be reversed with stimuli.[2]

The duration of sleep hours in adults is recommended at 7 h or more per night on a regular basis.[3] This is necessary for the provision of reparative and restorative body function, therefore providing the basic condition to be healthy both physically and mentally.[2],[3],[4]

Sleep deprivation and sleep disruptions are associated with both psychological disorders such as severe cognitive and emotional problems, as well as physiological disorders such as hypertension, stroke, coronary artery disease, and arrhythmia.[2] The medical student population is one of the populations that have an increased risk for sleep deprivation.[5]

The sleep–wake cycle of medical students is characterized by insufficient sleep duration, delayed sleep onset, and occurrence of napping episodes during the day.[6] Poor sleep quality is associated with reduced academic performance.[4],[7] A recent study in college students showed a significant positive correlation between the amount of sleep per night and grade point averages.[8]

The quality of sleep in Nigerian medical students may be poorer than that of those in developed countries. The reasons for this may include financial constraints from minimal government funding, overcrowded classrooms, poor or nonexistent teaching aids, as well as scarce hostel facilities.[4]

The prevalence of poor sleep pattern among medical students in some countries has been found to be 37%, 51%, 59%, and 66% in Saudi Arabia, the USA, Lithuania, and Pakistan, respectively,[9],[10],[11],[12] while in Nigeria, James et al.[4] reported a prevalence of 32.5%.

This study is, therefore, designed to assess the quality of sleep among clinical students of the Faculty of Clinical Sciences, Bayero University Kano (BUK), Nigeria.


  Materials and Methods Top


This was a cross-sectional study conducted between February and March 2019 among medical students of BUK at their 4th, 5th, and 6th academic years that are currently undergoing clinical postings at various departments in Aminu Kano Teaching Hospital (AKTH). The inclusion criteria are all clinical students who have given written informed consent, whereas the exclusion criteria are students with illness (es) or medications known to affect sleep quality such as hypertension, diabetes mellitus, or depression.

A total of 200 self-administered pretested questionnaires (sample size determined using standard formula) were distributed after obtaining approval of the Ethics and Research Committee of AKTH (NHREC/21/08/2008/AKTH/EC/2446). Stratified sampling method was used to select the study participants. The nature and purpose of the study was explained to the students during a lecture session, and confidentiality was emphasized. Students that consented for the study were given the questionnaire to return during another lecture session within the week.

Questionnaires used

Sociodemographic data sheet

The data sheet included questions on age, gender, marital status, source of education fund, place of residence, number of students per room.

The Pittsburgh Sleep Quality Index

The Pittsburgh Sleep Quality Index (PSQI) is a standardized, 24-item, self-rated questionnaire with a total score ranging from 0 to 21, designed to assess sleep quality as well as alert physicians on the need for further evaluation of individuals with the symptoms of sleep problems. A score of 5 and above indicates poor sleep quality, with higher scores indicative of poorer sleep quality.[13] The PSQI has been validated among Nigerian university students.[14] PSQI was found to have a diagnostic sensitivity of 89.6% and a specificity of 86.5% in differentiating individuals with good sleep quality from those with poor sleep quality.[13]

The Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) is a reliable and validated sleep questionnaire that is used to measure daytime sleepiness. It consists of eight items (with a total score ranging from 0 to 24) that measure individual's general level of daytime sleepiness or the average propensity of falling asleep in daily life activities. A score of 11 and above is generally indicative of sleepiness.[15]

Data analysis

The data collected were analyzed using Statistical Package for the Social Sciences (SPSS) for Windows version 20 (IBM Corp., Armonk, NY, USA). Quantitative variables were summarized using mean and standard deviation (SD), whereas categorical variables were described as frequencies and percentages. Chi-square test was used to determine statistical significance between the variables and sleep quality. P < 0.05 was considered statistically significant, set at 95% confidence interval.


  Results Top


At the end of this study, 181 questionnaires were analyzed out of the 200 (90.5%) questionnaires. There were 114 males (63%) and 67 females (37%), giving a male-to-female ratio of 1.7:1, which is in keeping with the gender distribution of the students. The mean age (± SD) of the students was 23.8 (±2.9) years, with a range of 19–35 years. The mean duration of sleep among the clinical medical students was 5.7 ± 1.1 h.

[Table 1] summarizes the analysis of the PSQI scores with some of the variables of the study participants. The mean PSQI score of the students was 5.1 ± 2.6 (ranging from 0 to 14). The overall poor sleep quality was found in 96 (53.0%) students based on the PSQI. However looking at individual academic year, poor sleep quality was found to be 61.1%, 51.7%, and 42.9% among the students in their 4th, 5th, and 6th academic years, respectively (P = 0.137). Poor sleep quality was most prevalent among the 4th year students, females, married individuals, those residing in the hostel, and those sleeping in a room including more than four persons.
Table 1: Analysis of the Pittsburgh Sleep Quality Index score with some of the study variables

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[Table 2] summarizes the analysis of the ESS scores with some of the variables of the study participants. The mean ESS score of the students was found to be 9.1 ± 4.0 (ranging from 1 to 21). The overall excessive daytime sleepiness was found to be 38.3% using the ESS. Excessive daytime sleepiness was found to be 45.8%, 41.7%, and 22.9% among the students in the 4th, 5th, and 6th academic years, respectively (P = 0.033). Excessive daytime sleepiness was most prevalent among the 4th year students, females, singles, those residing in the hostel, and those sleeping in a room including more than four persons.
Table 2: Analysis of the Epworth Sleepiness Scale score with some of the study variables

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Use of sleeping pills was reported in 12.7% of the students, with males accounting for 63.0% and females 37.0%. However, the difference was not statistically significant (P = 0.905).


  Discussion Top


This is the first study that assesses sleep quality among clinical students of the Faculty of Clinical Sciences, BUK. At the end of our research, the overall prevalence of poor sleep quality among the clinical medical students was found to be 53%. This finding is similar to that found by Brick et al. in the USA, Lohitashwa et al. in India, and Preišegolavičiūtė et al. in Lithuania, with a prevalence of 51%, 58%, and 59%, respectively.[10],[11],[16] However, the prevalence of poor sleep quality in our study is higher than that of the study by Almojali et al. in Saudi Arabia (37%) and that of the study by James et al. in Benin City, Nigeria (32.5%), but lower than that of the study by Nadeem et al. in Pakistan (66%) and that of the study by Sarbazvatan et al. in Iran who reported a prevalence of 70%.[3] The higher prevalence of poor sleep quality in the study by Sarbazvatan et al.[3] as compared to our study may be as a result of the higher proportion of females in their study. Poor sleep quality has been found to be higher in female gender from our study as well as that of previous researchers.

The prevalence of excessive daytime sleepiness in our study was 38.3%. This finding is similar to that of Sahin et al. among medical students of Gulhane Military Medical Academy who found a prevalence of 34.5%.[17] Our finding is also similar to that reported by Abdulghani et al. in Saudi Arabia and that of El Hangouche et al. in Morocco, who reported a prevalence of 36.6% among medical students.[6],[18] However, the prevalence of excessive daytime sleepiness in our study is higher than that of the study by Saygin et al. that reported a prevalence of 17.9% in Turkey but lower than that of the study by Machado-Duque et al. in Colombia, who found a prevalence of 49.8%.[2],[19]

Our study has demonstrated that poor sleep quality is most prevalent among the 4th year students, females, those that are married, those residing in the hostel, as well as those students whose room has more than four persons. These findings are also similar with that of previous researchers. The findings for excessive daytime sleepiness showed a similar pattern as that of poor sleep quality, however excessive daytime sleepiness is more prevalent in students that are singles.

The average duration of sleep among the clinical students from our study was 5.7 ± 1.1 h. This was below the average global value of 6.5–8.5 h among the adult population.[20] The duration of sleep in our study is also lower than that of the study by Moura de Araújo et al. in Fortaleza-ce, Brazil, who reported a mean sleep duration of 6.3 h.[20] Medical students are prone to use medications in order to manage their sleep problems or other conditions such as anxiety disorders.[4] This itself may result in poor sleep quality among the students. In our study, the use of sleeping pills was found to be 12.7% among the students.

The limitation of our study includes the fact that self-administered questionnaire was used to obtain the data in the last 1 month, which may be prone to recall bias. Furthermore, the study was limited to only clinical students, hence it may not be generalized on all medical students.


  Conclusion Top


Poor sleep quality and excessive daytime sleepiness are common among clinical medical students of BUK.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Nadeem A, Cheema MK, Naseer M, Javed H. Assessment of sleep quality and patterns suggestive of somniopathies among students of Army medical college, Rawalpindi. Pak Armed Forces Med J 2018;68:143-8.  Back to cited text no. 12
    
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Aloba OO, Adewuya AO, Ola BA, Mapayi BM. Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. Sleep Med 2007;8:266-70.  Back to cited text no. 14
    
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Lohitashwa R, Kadli N, Kisan R, Sindhuja A, Deshpande D. Effect of stress on sleep quality in young adult medical students: A cross sectional study. Int J Res Med Sci 2015;3:3519-23.  Back to cited text no. 16
    
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Sahin S, Açıkel CH, Türker T, Okyay S. An assessment of daytime sleepiness among students of the Gülhane Military Faculty of Medicine using the Epworth sleepiness scale. TAF Prev Med Bull 2014;13:7-12.  Back to cited text no. 17
    
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Machado-Duque ME, Echeverri Chabur JE, Machado-Alba JE. Excessive daytime sleepiness, poor quality sleep, and low academic performance in medical students. Rev Colomb Psiquiatr 2015;44:137-42.  Back to cited text no. 19
    
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    Tables

  [Table 1], [Table 2], [Table 1], [Table 2]



 

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