The Prevalence and Risk Factors For Poor Sleep Quality Amongst Medical Students: A Cross Sectional Study


  • Qurat-Ul-Ain Virani Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
  • Humza Thobani Medical College, Aga Khan University, Karachi, Pakistan
  • Syeda Sadia Fatima Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan



Sleep Disorders, Psychological Stress, Medical Education


Introduction: Undergraduate medical students have consistently been shown to have high prevalence of mental health disorders in comparison to their peers from non-medical backgrounds and sleep quality is a critical aspect for maintaining mental wellbeing. The aim of this study is to compile prevalence on poor sleep quality and analyze its potential risk factors. Methodology: A cross sectional study was conducted at the Aga Khan University. Undergraduate medical students asked to fill out a self-reported questionnaire that was sent via email which included the 14-point Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). 302 students responded and the data was analyzed using chi square and logistic regression to determine their association with Sex, BMI, Year of Study and Academic Score. Results: The mean age of study participants was 21.58 + 1.41 years and majority were males (58%). The mean PSQI, ESS and PSS scores were 6.35 + 3.28, 7.72 + 4.58 and 28.38 + 7.81 respectively. 11.3% of participants reported poor sleep quality, which was significantly associated with female sex and academic performance. 28.5% of students had excessive daytime sleepiness, which was significantly associated with female sex and academic year (first year). “Stress” and “Overthinking/Anxiety” were the two most common self-reported reasons for Poor Sleep Quality. 85.4% of students were stressed with an average PSS score of 28.38 + 7.81. Conclusion: This study therefore shows a high prevalence of stress with moderate sleep disturbance prevalence, which was associated with female sex and academic performance.


Mason GM, Lokhandwala S, Riggins T, Spencer RMC. Sleep and human cognitive development. Sleep Med Rev. 2021;57:101472. doi: 10.1016/j.smrv.2021.101472.

Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015; 3;66:143-72. doi: 10.1146/annurev-psych-010213-115205.

Manzar MD, Bekele BB, Noohu MM, Salahuddin M, Albougami A, Spence DW, Pandi-Perumal SR, Bahammam AS. Prevalence of poor sleep quality in the Ethiopian population: a systematic review and meta-analysis. Sleep Breath. 2020;24(2):709-716. doi: 10.1007/s11325-019-01871-x.

Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK. The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health. 2017 Sep;7(3):169-174. doi: 10.1016/j.jegh.2017.04.005.

El Hangouche AJ, Jniene A, Aboudrar S, Errguig L, Rkain H, Cherti M, Dakka T. Relationship between poor quality sleep, excessive daytime sleepiness and low academic performance in medical students. Adv Med Educ Pract. 2018;9:631-638. doi: 10.2147/AMEP.S162350.

Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK. The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health. 2017;7(3):169-174. doi: 10.1016/j.jegh.2017.04.005.

Sameer HM, Imran N, Tarar TN, Khawaja IS. Association of Excessive Daytime Sleepiness With Psychological Distress in Medical Students. Prim Care Companion CNS Disord. 2020 ;22(1):19m02531. doi: 10.4088/PCC.19m02531.

Nadeem A, Cheema MK, Naseer M, Javed H. Comparison of quality of sleep between medical and non-medical undergraduate Pakistani students. J Pak Med Assoc. 2018;68(10):1465-1470.

Seoane HA, Moschetto L, Orliacq F, Orliacq J, Serrano E, Cazenave MI, Vigo DE, Perez-Lloret S. Sleep disruption in medicine students and its relationship with impaired academic performance: A systematic review and meta-analysis. Sleep Med Rev. 2020;53:101333. doi: 10.1016/j.smrv.2020.101333.

Ma H, Li Y, Liang H, Chen S, Pan S, Chang L, Li S, Zhang Y, Liu X, Xu Y, Shao Y, Yang Y, Guo J. Sleep deprivation and a non-24-h working schedule lead to extensive alterations in physiology and behavior. FASEB J. 2019;33(6):6969-6979. doi: 10.1096/fj.201802727R.

Minkel J, Moreta M, Muto J, Htaik O, Jones C, Basner M, Dinges D. Sleep deprivation potentiates HPA axis stress reactivity in healthy adults. Health Psychol. 2014;33(11):1430-4. doi: 10.1037/a0034219.

Norbury R, Evans S. Time to think: Subjective sleep quality, trait anxiety and university start time. Psychiatry Res. 2019;271:214-219. doi: 10.1016/j.psychres.2018.11.054.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96.

Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4.

ohns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5. doi: 10.1093/sleep/14.6.540.

Machado-Duque ME, Echeverri Chabur JE, Machado-Alba JE. Somnolencia diurna excesiva, mala calidad del sueño y bajo rendimiento académico en estudiantes de Medicina [Excessive Daytime Sleepiness, Poor Quality Sleep, and Low Academic Performance in Medical Students]. Rev Colomb Psiquiatr. 2015;44(3):137-42. Spanish. doi: 10.1016/j.rcp.2015.04.002.

Perotta B, Arantes-Costa FM, Enns SC, Figueiro-Filho EA, Paro H, Santos IS, Lorenzi-Filho G, Martins MA, Tempski PZ. Sleepiness, sleep deprivation, quality of life, mental symptoms and perception of academic environment in medical students. BMC Med Educ. 2021;21(1):111. doi: 10.1186/s12909-021-02544-8.

Marta OFD, Kuo SY, Bloomfield J, Lee HC, Ruhyanudin F, Poynor MY, Brahmadhi A, Pratiwi ID, Aini N, Mashfufa EW, Hasan F, Chiu HY. Gender differences in the relationships between sleep disturbances and academic performance among nursing students: A cross-sectional study. Nurse Educ Today. 2020;85:104270. doi: 10.1016/j.nedt.2019.104270.

Umar A, Khan MS, Sehgal SA, Jafar K, Ahmad S, Waheed A, Aslam MW, Wajid M, Rehman TU, Khan T, Ditta A, Akmal H, Ashfaq M, Javed T, Tahir R. Epidemiological studies of sleep disorder in educational community of Pakistani population, its major risk factors and associated diseases. PLoS One. 2022;17(4):e0266739. doi: 10.1371/journal.pone.0266739.

Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, Sen S, Mata DA. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016 Dec 6;316(21):2214-2236. doi: 10.1001/jama.2016.17324.

Abdulghani HM, Alrowais NA, Bin-Saad NS, Al-Subaie NM, Haji AM, Alhaqwi AI. Sleep disorder among medical students: relationship to their academic performance. Med Teach. 2012;34 Suppl 1:S37-41. doi: 10.3109/0142159X.2012.656749.

Suh S, Cho N, Zhang J. Sex Differences in Insomnia: from Epidemiology and Etiology to Intervention. Curr Psychiatry Rep. 2018;20(9):69. doi: 10.1007/s11920-018-0940-9.

Haile YG, Alemu SM, Habtewold TD. Insomnia and Its Temporal Association with Academic Performance among University Students: A Cross-Sectional Study. Biomed Res Int. 2017;2017:2542367. doi: 10.1155/2017/2542367.

Peigneux P, Laureys S, Delbeuck X, Maquet P. Sleeping brain, learning brain. The role of sleep for memory systems. Neuroreport. 2001;12(18):A111-24. doi: 10.1097/00001756-200112210-00001.

Asghar AA, Faiq A, Shafique S, Siddiqui F, Asghar N, Malik S, Kamal SD, Hanif A, Qasmani MF, Ali SU, Munim S, Solangi A, Zafar A, Sohail MO, Aimen A. Prevalence and Predictors of the Burnout Syndrome in Medical Students of Karachi, Pakistan. Cureus. 2019;11(6):e4879. doi: 10.7759/cureus.4879.




How to Cite

Virani, Q.-U.-A. ., Thobani, H. ., & Fatima, S. S. . (2023). The Prevalence and Risk Factors For Poor Sleep Quality Amongst Medical Students: A Cross Sectional Study. BioSight, 4(1), 24–32.



Original Article