Advertisement

Prevalence of sleep problems among medical students: a systematic review and meta-analysis

  • Haitham JahramiEmail author
  • Julia Dewald-Kaufmann
  • Mo’ez Al-Islam Faris
  • Ahmed M. S. AlAnsari
  • Mohamed Taha
  • Noor AlAnsari
Review Article
  • 32 Downloads

Abstract

Aim

Several studies have shown high prevalence rates of sleep problems among medical students, including insufficient sleep duration, poor sleep quality, and excessive daytime sleepiness. This review aims to systematically summarize the existing literature on sleep problems among medical students and consequently estimate the prevalence of these disturbances.

Subject and Methods

The MEDLINE, EMBASE, ScienceDirect, and ProQuest Medical databases, the Google Scholar engine, and reference lists of retrieved articles were systematically searched and evaluated for quality.

Results

Forty–three studies involving a total of 18,619 students from 13 countries were included in the analyses. Results showed that the mean pooled sleep duration (K = 16, N = 10,512) was 6.3 h per night for medical students, [95% confidence interval (CI) 6.0–6.6]. The results also indicated that 55% [95% CI 48.0%–62.0%] of students reported poor sleep quality (K = 33, N = 15,462) according to the Pittsburgh Sleep Quality Index (PSQI); the mean pooled score of 6.3. Excessive daytime sleepiness (K = 18, N = 5688) was reported by 31.0% [95% CI 24.4%–37.7%] of students according to the Epworth Sleepiness Scale (ESS). Age and gender were not significant moderators for sleep quality or excessive daytime sleepiness. Some differences were obtained between countries, suggesting that cultural values, local conditions, and environment all have an impact on sleep practices and attitudes.

Conclusion

Sleep problems are highly prevalent among medical students and are therefore a severe problem. Prevention and intervention programs targeting these are therefore highly recommended for future studies.

Keywords

Sleep disturbance Pittsburgh sleep quality index Epworth Sleepiness Scale 

Notes

Authors Contribution

HJ and AA designed the study. MT, NA and MF conducted electronic and manual literature search. HJ performed statistical analyses and wrote the first draft along with JDF. AA and MF provided intellectual contributions to strengthening the manuscript and suggested additional data analyses. All authors provided critical revisions of manuscript and approved the final version.

Compliance with ethical standards

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this article.

Declaration of competing interests

The authors declare that they have no competing interests.

Supplementary material

10389_2019_1064_MOESM1_ESM.doc (50 kb)
ESM 1 (DOC 49 kb)

References

  1. Abdulghani HM, Alrowais NA, Bin-Saad NS et al (2012) Sleep disorder among medical students: relationship to their academic performance. Med Teach 34(Suppl 1):S37–S41.  https://doi.org/10.3109/0142159X.2012.656749 CrossRefGoogle Scholar
  2. Abdussalam A, Salman MT, Gupta S et al (2013) Poor quality of sleep and its relationship with depression in first year medical students. Adv Life Sience Technol 12:17–21Google Scholar
  3. Akerstedt T, Kecklund G, Axelsson J (2007) Impaired sleep after bedtime stress and worries. Biol Psychol 76:170–173.  https://doi.org/10.1016/j.biopsycho.2007.07.010 CrossRefGoogle Scholar
  4. AlDabal L, BaHammam AS (2011) Metabolic, endocrine, and immune consequences of sleep deprivation. Open Respir Med J 5:31–43.  https://doi.org/10.2174/1874306401105010031 CrossRefGoogle Scholar
  5. Almojali AI, Almalki SA, Alothman AS et al (2017) The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health 7:169–174.  https://doi.org/10.1016/j.jegh.2017.04.005 CrossRefGoogle Scholar
  6. Alnomsi SJ, Albalawi KS, Alali OY et al (2018) The chronotype (eveningness–morningness) effects on academic achievement among medical students in Tabuk City, Saudi Arabia. Egypt J Hosp Med 71:3504–3507Google Scholar
  7. AlQahtani MS, Alkhaldi TM, Al-Sultan AM et al (2017) Sleeping disorders among medical students in Saudi Arabia; in relation to anti-insomnia medications. Egypt J Hosp Med 69(7):2750–2753CrossRefGoogle Scholar
  8. Alsaggaf MA, Wali SO, Merdad RA, Merdad LA (2016) Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Relationship with stress and academic performance. Saudi Med J 37:173–182.  https://doi.org/10.15537/smj.2016.2.14288 CrossRefGoogle Scholar
  9. Asiri AK, Almetrek MA, Alsamghan AS et al (2018) Impact of Twitter and WhatsApp on sleep quality among medical students in King Khalid University, Saudi Arabia. Sleep Hypn 20:247–252CrossRefGoogle Scholar
  10. Azad MC, Fraser K, Rumana N et al (2015) Sleep disturbances among medical sudents: a global perspective. J Clin Sleep Med 11:69–74.  https://doi.org/10.5664/jcsm.4370 Google Scholar
  11. Bahammam AS, Al-Khairy OK, Al-Taweel AA (2005) Sleep habits and patterns among medical students. Neurosci Riyadh Saudi Arab 10:159–162Google Scholar
  12. Belenky G, Wesensten NJ, Thorne DR et al (2003) Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose–response study. J Sleep Res 12:1–12CrossRefGoogle Scholar
  13. Borenstein M, Hedges L, Higgins J, Rothstein H (2005) Comprehensive meta-analysis (version 2). Biostat, EnglewoodGoogle Scholar
  14. Brick CA, Seely DL, Palermo TM (2010) Association between sleep hygiene and sleep quality in medical students. Behav Sleep Med 8:113–121.  https://doi.org/10.1080/15402001003622925 CrossRefGoogle Scholar
  15. Brown FC, Buboltz WC, Soper B (2002) Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behav Med Wash DC 28:33–38.  https://doi.org/10.1080/08964280209596396 CrossRefGoogle Scholar
  16. Buboltz WC, Brown F, Soper B (2001) Sleep habits and patterns of college students: a preliminary study. J Am Coll Health J ACH 50:131–135.  https://doi.org/10.1080/07448480109596017 CrossRefGoogle Scholar
  17. Buysse DJ, Reynolds CF, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213CrossRefGoogle Scholar
  18. Carskadon MA, Vieira C, Acebo C (1993) Association between puberty and delayed phase preference. Sleep 16:258–262CrossRefGoogle Scholar
  19. Choueiry N, Salamoun T, Jabbour H et al (2016) Insomnia and relationship with anxiety in university students: a cross-sectional designed study. PLoS One 11:e0149643.  https://doi.org/10.1371/journal.pone.0149643 CrossRefGoogle Scholar
  20. de Corrêa CC, de Oliveira FK, Pizzamiglio DS et al (2017) Sleep quality in medical students: a comparison across the various phases of the medical course. J Bras Pneumol 43:285–289.  https://doi.org/10.1590/S1806-37562016000000178 CrossRefGoogle Scholar
  21. Dewald JF, Meijer AM, Oort FJ et al (2010) The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med Rev 14:179–189.  https://doi.org/10.1016/j.smrv.2009.10.004 CrossRefGoogle Scholar
  22. Dimitrov A, Veer IM, Kleeblatt J et al (2018) Chronotype is associated with psychological well-being depending on the composition of the study sample. J Health Psychol 2018:1359105317751618.  https://doi.org/10.1177/1359105317751618 Google Scholar
  23. Dongen HPAV, Rogers NL, Dinges DF (2003) Sleep debt: theoretical and empirical issues. Sleep Biol Rhythms 1:5–13.  https://doi.org/10.1046/j.1446-9235.2003.00006.x CrossRefGoogle Scholar
  24. Drake C, Roehrs T, Breslau N et al (2010) The 10-year risk of verified motor vehicle crashes in relation to physiologic sleepiness. Sleep 33:745–752CrossRefGoogle Scholar
  25. ElArab HE, Rabie MA, Ali DH (2014) Sleep behavior and sleep problems among a medical student sample in relation to academic performance: a cross-sectional questionnaire-based study. Middle East Curr Psychiatry 21:72–80CrossRefGoogle Scholar
  26. Eller T, Aluoja A, Vasar V, Veldi M (2006) Symptoms of anxiety and depression in Estonian medical students with sleep problems. Depress Anxiety 23:250–256.  https://doi.org/10.1002/da.20166 CrossRefGoogle Scholar
  27. Elwasify M, Barakat DH, Fawzy M et al (2016) Quality of sleep in a sample of Egyptian medical students. Middle East Curr Psychiatry 23:200–207CrossRefGoogle Scholar
  28. Enright T, Refinetti R (2017) Chronotype, class times, and academic achievement of university students. Chronobiol Int 34:445–450.  https://doi.org/10.1080/07420528.2017.1281287 CrossRefGoogle Scholar
  29. Fawzy M, Hamed SA (2017) Prevalence of psychological stress, depression and anxiety among medical students in Egypt. Psychiatry Res 255:186–194.  https://doi.org/10.1016/j.psychres.2017.05.027 CrossRefGoogle Scholar
  30. Ford ES, Cunningham TJ, Croft JB (2015) Trends in self-reported sleep duration among US adults from 1985 to 2012. Sleep 38:829–832.  https://doi.org/10.5665/sleep.4684 CrossRefGoogle Scholar
  31. Giri PA, Baviskar MP, Phalke DB (2013) Study of sleep habits and sleep problems among medical students of Pravara Institute of Medical Sciences Loni, Western Maharashtra, India. Ann Med Health Sci Res 3:51–54CrossRefGoogle Scholar
  32. Gladius H, Sowmiya K, Vidya D et al (2017) A study of mobile phone usage on sleep disturbance, stress and academic performance among medical students in Tamil Nadu. Int J Community Med Public Health 5:365–368.  https://doi.org/10.18203/2394-6040.ijcmph20175814 CrossRefGoogle Scholar
  33. Haraszti RÁ, Ella K, Gyöngyösi N et al (2014) Social jetlag negatively correlates with academic performance in undergraduates. Chronobiol Int 31:603–612.  https://doi.org/10.3109/07420528.2013.879164 CrossRefGoogle Scholar
  34. Harvey AG (2000) Pre-sleep cognitive activity: a comparison of sleep-onset insomniacs and good sleepers. Br J Clin Psychol 39(Pt 3):275–286CrossRefGoogle Scholar
  35. Hershner SD, Chervin RD (2014) Causes and consequences of sleepiness among college students. Nat Sci Sleep 6:73–84.  https://doi.org/10.2147/NSS.S62907 CrossRefGoogle Scholar
  36. Hidalgo MP, Caumo W (2002) Sleep disturbances associated with minor psychiatric disorders in medical students. Neurol Sci 23:35–39.  https://doi.org/10.1007/s100720200021 CrossRefGoogle Scholar
  37. Huber R, Ghilardi MF, Massimini M, Tononi G (2004) Local sleep and learning. Nature 430:78–81.  https://doi.org/10.1038/nature02663 CrossRefGoogle Scholar
  38. Hublin C, Kaprio J, Partinen M, Koskenvuo M (2001) Insufficient sleep—a population-based study in adults. Sleep 24:392–400CrossRefGoogle Scholar
  39. Ibrahim N, Badawi F, Mansouri Y et al (2017) Sleep quality among medical students at King Abdulaziz University:a cross-sectional study. J Community Med Health Educ 7:1–6.  https://doi.org/10.4172/2161-0711.1000561 Google Scholar
  40. Institute of Medicine (US) Committee on Sleep Medicine and Research (2006) Sleep disorders and sleep deprivation: an unmet public health problem. National Academies Press (US), Washington (DC)Google Scholar
  41. James BO, Omoaregba JO, Igberase OO (2011) Prevalence and correlates of poor sleep quality among medical students at a Nigerian university. Ann Niger Med 5:1–5.  https://doi.org/10.4103/0331-3131.84218 CrossRefGoogle Scholar
  42. Jiang X, Hardy LL, Baur LA et al (2015) Sleep duration, schedule and quality among urban Chinese children and adolescents: associations with routine after-school activities. PLoS One 10:e0115326.  https://doi.org/10.1371/journal.pone.0115326 CrossRefGoogle Scholar
  43. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefGoogle Scholar
  44. Johnson KM, Simon N, Wicks M et al (2017) Amount of sleep, daytime sleepiness, hazardous driving, and quality of life of second year medical students. Acad Psychiatry 41:669–673CrossRefGoogle Scholar
  45. Kalmbach DA, Arnedt JT, Song PX et al (2017) Sleep disturbance and short sleep as risk factors for depression and perceived medical errors in first-year residents. Sleep 40.  https://doi.org/10.1093/sleep/zsw073
  46. Kang J-H, Chen S-C (2009) Effects of an irregular bedtime schedule on sleep quality, daytime sleepiness, and fatigue among university students in Taiwan. BMC Public Health 9:248CrossRefGoogle Scholar
  47. Keyes KM, Maslowsky J, Hamilton A, Schulenberg J (2015) The great sleep recession: changes in sleep duration among US adolescents, 1991–2012. Pediatrics 135:460–468.  https://doi.org/10.1542/peds.2014-2707 CrossRefGoogle Scholar
  48. Knutson KL, Van Cauter E, Rathouz PJ et al (2010) Trends in the prevalence of short sleepers in the USA: 1975–2006. Sleep 33:37–45CrossRefGoogle Scholar
  49. Krystal AD (2012) Psychiatric disorders and sleep. Neurol Clin 30:1389–1413.  https://doi.org/10.1016/j.ncl.2012.08.018 CrossRefGoogle Scholar
  50. Kumar A, Vandana AAN (2016) Analgesics self-medication and its association with sleep quality among medical undergraduates. J Clin Diagn Res JCDR 10:FC07–FC11.  https://doi.org/10.7860/JCDR/2016/22504.8953 Google Scholar
  51. Li L, Wang Y-Y, Wang S-B et al (2017) Sleep duration and sleep patterns in Chinese university students: a comprehensive meta-analysis. J Clin Sleep Med 13:1153–1162.  https://doi.org/10.5664/jcsm.6760 CrossRefGoogle Scholar
  52. Li L, Wang Y-Y, Wang S-B et al (2018) Prevalence of sleep disturbances in Chinese university students: a comprehensive meta-analysis. J Sleep Res 27(3):e12648.  https://doi.org/10.1111/jsr.12648 CrossRefGoogle Scholar
  53. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6:e1000100.  https://doi.org/10.1371/journal.pmed.1000100
  54. Lima PF, Medeiros ALD, Araujo JF (2002) Sleep–wake pattern of medical students: early versus late class starting time. Braz J Med Biol Res 35:1373–1377CrossRefGoogle Scholar
  55. Lund HG, Reider BD, Whiting AB, Prichard JR (2010) Sleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health 46:124–132.  https://doi.org/10.1016/j.jadohealth.2009.06.016 CrossRefGoogle Scholar
  56. Mazurkiewicz R, Korenstein D, Fallar R, Ripp J (2012) The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. Psychol Health Med 17:188–195.  https://doi.org/10.1080/13548506.2011.597770 CrossRefGoogle Scholar
  57. Medeiros ALD, Mendes DB, Lima PF, Araujo JF (2001) The relationships between sleep–wake cycle and academic performance in medical students. Biol Rhythm Res 32:263–270CrossRefGoogle Scholar
  58. Medic G, Wille M, Hemels ME (2017) Short- and long-term health consequences of sleep disruption. Nat Sci Sleep 9:151–161.  https://doi.org/10.2147/NSS.S134864 CrossRefGoogle Scholar
  59. Mirghani HO (2017) The effect of chronotype (morningness/eveningness) on medical students’ academic achievement in Sudan. J Taibah Univ Med Sci 12:512–516.  https://doi.org/10.1016/j.jtumed.2017.03.007 Google Scholar
  60. Mirghani HO, Mohammed OS, Almurtadha YM, Ahmed MS (2015) Good sleep quality is associated with better academic performance among Sudanese medical students. BMC Res Notes 8:706.  https://doi.org/10.1186/s13104-015-1712-9 CrossRefGoogle Scholar
  61. Mohammadbeigi A, Absari R, Valizadeh F et al (2016) Sleep quality in medical students; the impact of over-use of mobile cell-phone and social networks. J Res Health Sci 16:46–50Google Scholar
  62. Mokros Ł, Witusik A, Michalska J et al (2017) Sleep quality, chronotype, temperament and bipolar features as predictors of depressive symptoms among medical students. Chronobiol Int 34:708–720.  https://doi.org/10.1080/07420528.2017.1316730 CrossRefGoogle Scholar
  63. Nadeem A, Cheema MK, Naseer M, Javed H (2018) Assessment of sleep quality and patterns suggestive of somniopathies among students of Army Medical College, Rawalpindi. Pak Armed Forces Med J 68 (1):143–148Google Scholar
  64. Najafi Kalyani M, Jamshidi N, Salami J, Pourjam E (2017) Investigation of the relationship between psychological variables and sleep quality in students of medical sciences. Depress Res Treat 2017:7143547. https://www.hindawi.com/journals/drt/2017/7143547/. Accessed 13 Apr 2018
  65. Oginska H, Pokorski J (2006) Fatigue and mood correlates of sleep length in three age-social groups: school children, students, and employees. Chronobiol Int 23:1317–1328.  https://doi.org/10.1080/07420520601089349 CrossRefGoogle Scholar
  66. Ohayon MM, Roberts RE, Zulley J et al (2000) Prevalence and patterns of problematic sleep among older adolescents. J Am Acad Child Adolesc Psychiatry 39:1549–1556CrossRefGoogle Scholar
  67. Pagnin D, de Queiroz V, Carvalho YTMS et al (2014) The relation between burnout and sleep disorders in medical students. Acad Psychiatry 38:438–444.  https://doi.org/10.1007/s40596-014-0093-z Google Scholar
  68. Prashanth S, Kavyashree HM, Krishnamurthy L et al (2015) Quality of sleep in medical students. J Public Health Med Res 3:8–10Google Scholar
  69. Priya J, Singh J, Kumari S (2017) Study of the factors associated with poor sleep among medical students. Indian J Basic Appl Med Res 6:422–429Google Scholar
  70. Ramamoorthy S, Mohandas MP, Sembulingam P et al (2014) Prevalence of excessive daytime sleepiness (EDS) among medical students. World J Pharm Res 3(4)Google Scholar
  71. Rasekhi S, Ashouri FP, Pirouzan A (2016) Effects of sleep quality on the academic performance of undergraduate medical students. Health Scope 5:e31641CrossRefGoogle Scholar
  72. Rathi A, Ransing RS, Mishra KK, Narula N (2018) Quality of sleep among medical students: relationship with personality traits. J Clin Diagn Res 12(9):VC01–VC04Google Scholar
  73. Rique GLN, Fernandes Filho GMC, Ferreira ADC, de Sousa-Muñoz RL (2014) Relationship between chronotype and quality of sleep in medical students at the Federal University of Paraiba, Brazil. Sleep Sci 7:96–102.  https://doi.org/10.1016/j.slsci.2014.09.004 CrossRefGoogle Scholar
  74. Roenneberg T, Kuehnle T, Pramstaller PP et al (2004) A marker for the end of adolescence. Curr Biol CB 14:R1038–R1039.  https://doi.org/10.1016/j.cub.2004.11.039 CrossRefGoogle Scholar
  75. Sahraian A, Javadpour A (2010) Sleep disruption and its correlation to psychological distress among medical students. Shiraz E Med J 11:12–17Google Scholar
  76. Sarbazvatan H, Amini A, Aminisani N, Shamshirgaran SM (2017) Sleep quality and academic progression among students of Tabriz University of Medical Sciences, Northwest of Iran. Res Dev 6:29–33Google Scholar
  77. Sawyer A, Fisher A, Llewellyn C, Gregory AM (2015) Self-reported sleep quality, weight status and depression in young adult twins and siblings. BMC Obes 2:50.  https://doi.org/10.1186/s40608-015-0079-8 CrossRefGoogle Scholar
  78. Saygın M, Öztürk Ö, Gonca T et al (2016) Investigation of sleep quality and sleep disorders in students of medicine. Turk Thorac J 17:132–140.  https://doi.org/10.5578/ttj.30513 CrossRefGoogle Scholar
  79. Sedov ID, Cameron EE, Madigan S, Tomfohr-Madsen LM (2018) Sleep quality during pregnancy: A meta-analysis. Sleep Med Rev 38:168–176.  https://doi.org/10.1016/j.smrv.2017.06.005 CrossRefGoogle Scholar
  80. Siddiqui AF, Al-Musa H, Al-Amri H et al (2016) Sleep patterns and predictors of poor sleep quality among medical students in King Khalid University, Saudi Arabia. Malays J Med Sci 23:94–102.  https://doi.org/10.21315/mjms2016.23.6.10 Google Scholar
  81. StataCorp (2015) Stata Statistical Software: Release 14. StataCorp LP, College Station, TXGoogle Scholar
  82. Stutts JC, Wilkins JW, Scott Osberg J, Vaughn BV (2003) Driver risk factors for sleep-related crashes. Accid Anal Prev 35:321–331CrossRefGoogle Scholar
  83. Surani AA, Zahid S, Surani A et al (2015) Sleep quality among medical students of Karachi, Pakistan. J Pak Med Assoc 65:380–382Google Scholar
  84. Taylor DJ, Bramoweth AD, Grieser EA et al (2013) Epidemiology of insomnia in college students: relationship with mental health, quality of life, and substance use difficulties. Behav Ther 44:339–348.  https://doi.org/10.1016/j.beth.2012.12.001 CrossRefGoogle Scholar
  85. Thomsen DK, Mehlsen MY, Christensen S, Zachariae R (2003) Rumination--relationship with negative mood and sleep quality. Personal Individ Differ 34:1293–1301.  https://doi.org/10.1016/S0191-8869(02)00120-4 CrossRefGoogle Scholar
  86. Tononi G, Cirelli C (2006) Sleep function and synaptic homeostasis. Sleep Med Rev 10:49–62.  https://doi.org/10.1016/j.smrv.2005.05.002 CrossRefGoogle Scholar
  87. van der Heijden KB, Vermeulen MCM, Donjacour CEHM et al (2018) Chronic sleep reduction is associated with academic achievement and study concentration in higher education students. J Sleep Res 27:165–174.  https://doi.org/10.1111/jsr.12596 CrossRefGoogle Scholar
  88. Veldi M, Aluoja A, Vasar V (2005) Sleep quality and more common sleep-related problems in medical students. Sleep Med 6:269–275.  https://doi.org/10.1016/j.sleep.2004.12.003 CrossRefGoogle Scholar
  89. Wang L, Qin P, Zhao Y et al (2016) Prevalence and risk factors of poor sleep quality among Inner Mongolia Medical University students: A cross-sectional survey. Psychiatry Res 244:243–248.  https://doi.org/10.1016/j.psychres.2016.04.011 CrossRefGoogle Scholar
  90. Waqas A, Khan S, Sharif W et al (2015) Association of academic stress with sleeping difficulties in medical students of a Pakistani medical school: a cross sectional survey. PeerJ 3:e840.  https://doi.org/10.7717/peerj.840 CrossRefGoogle Scholar
  91. Watson NF, Badr MS, Belenky G et al (2015) Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep 38:843–844.  https://doi.org/10.5665/sleep.4716 CrossRefGoogle Scholar
  92. Yazdi Z, Loukzadeh Z, Moghaddam P, Jalilolghadr S (2016) Sleep hygiene practices and their relation to sleep quality in medical students of Qazvin University of Medical Sciences. J Caring Sci 5:153–160.  https://doi.org/10.15171/jcs.2016.016 CrossRefGoogle Scholar
  93. Yu D, Ren Q, Dong B et al (2017) The sleep quality of medical students in China: a meta-analysis. Sleep Biol Rhythms 15:299–310.  https://doi.org/10.1007/s41105-017-0118-6 CrossRefGoogle Scholar
  94. Zailinawati AH, Teng CL, Chung YC et al (2009) Daytime sleepiness and sleep quality among Malaysian medical students. Med J Malaysia 64:108–110Google Scholar
  95. Zerbini G, Merrow M (2017) Time to learn: How chronotype impacts education. PsyCh J 6:263–276.  https://doi.org/10.1002/pchj.178 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Ministry of HealthManamaKingdom of Bahrain
  2. 2.College of Medicine and Medical SciencesArabian Gulf UniversityManamaKingdom of Bahrain
  3. 3.Department of Psychiatry and Psychotherapy, University HospitalLudwig Maximilans University MunichMunichGermany
  4. 4.Hochschule FreseniusUniversity of Applied Sciences MunichMunichGermany
  5. 5.Department of Clinical Nutrition and Dietetics, College of Health sciences/Research Institute for Medical and Health Sciences (RIMHS)University of SharjahSharjahUnited Arab Emirates

Personalised recommendations