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The Relation Between Burnout and Sleep Disorders in Medical Students

Abstract

Objective

The aim of this study is to assess the mutual relationships between burnout and sleep disorders in students in the preclinical phase of medical school.

Methods

This study collected data on 127 medical students who filled in the Maslach Burnout Inventory-Student Survey, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Beck Depression Inventory, and Beck Anxiety Inventory. Hierarchical logistic regressions tested the reciprocal influence between sleep disorders and burnout, controlling for depression and anxiety.

Results

Regular occurrence of emotional exhaustion, poor sleep quality, and excessive daytime sleepiness affected 60, 65, and 63 % of medical students, respectively. Emotional exhaustion and daytime sleepiness influenced each other. Daytime sleep dysfunctions affected unidirectionally the occurrence of cynicism and academic efficacy. The odds of emotional exhaustion (odds ratio (OR) = 1.21, 95 % confidence interval (CI) = 1.08 to 1.35) and cynicism (OR = 2.47, 95 % CI = 1.25 to 4.90) increased when daytime sleepiness increased. Reciprocally, the odds of excessive daytime sleepiness (OR = 2.13, 95 % CI = 1.22 to 3.73) increased when emotional exhaustion worsened. Finally, the odds of academic efficacy decreased (OR = 0.86, 95 % CI = 0.75 to 0.98) when daytime sleepiness increased.

Conclusions

Burnout and sleep disorders have relevant bidirectional effects in medical students in the early phase of medical school. Emotional exhaustion and daytime sleepiness showed an important mutual influence. Daytime sleepiness linked unidirectionally with cynicism and academic efficacy.

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References

  1. Dyrbye LN, Thomas MR, Shanafelt TD. Medical student distress: causes, consequences, and proposed solutions. Mayo Clin Proc. 2005;80(12):1613–22.

    PubMed  Article  Google Scholar 

  2. Cardoso HC, Bueno FCDC, Mata JCD, Alves APR, Jochims I, Vaz Filho IHR, et al. Assessing quality of sleep in medical students. Rev Bras Educ Med. 2009;33:349–55.

    Article  Google Scholar 

  3. Mazurkiewicz R, Korenstein D, Fallar R, Ripp J. The prevalence and correlations of medical student burnout in the pre-clinical years: a cross-sectional study. Psychol Health Med. 2012;17(2):188–95.

    PubMed  Article  Google Scholar 

  4. Santen SA, Holt DB, Kemp JD, Hemphill RR. Burnout in medical students: examining the prevalence and associated factors. South Med J. 2010;103(8):758–63.

    PubMed  Article  Google Scholar 

  5. Guthrie E, Black D, Bagalkote H, Shaw C, Campbell M, Creed F. Psychological stress and burnout in medical students: a five-year prospective longitudinal study. J R Soc Med. 1998;91(5):237–43.

    CAS  PubMed Central  PubMed  Google Scholar 

  6. Galan F, Sanmartin A, Polo J, Giner L. Burnout risk in medical students in Spain using the Maslach Burnout Inventory-Student Survey. Int Arch Occup Environ Health. 2011;84(4):453–9.

    PubMed  Article  Google Scholar 

  7. Papp KK, Miller CM, Strohl KP. Graduate medical training, learning, relationships, and sleep loss. Sleep Med Rev. 2006;10(5):339–45.

    PubMed  Article  Google Scholar 

  8. Schaufeli WB, Martínez IM, Pinto AM, Salanova M, Bakker AB. Burnout and engagement in university students. J Cross Cult Psychology. 2002;33(5):464–81.

    Article  Google Scholar 

  9. Rodrigues RND, Viegas CAA, Silva AAA A e, Tavares P. Daytime sleepiness and academic performance in medical students. Arq Neuropsiquiatr. 2002;60:6–11.

    PubMed  Article  Google Scholar 

  10. Jansson-Frojmark M, Lindblom K. Is there a bidirectional link between insomnia and burnout? A prospective study in the Swedish workforce. Int J Behav Med. 2010;17(4):306–13.

    PubMed  Article  Google Scholar 

  11. Armon G, Shirom A, Shapira I, Melamed S. On the nature of burnout-insomnia relationships: a prospective study of employed adults. J Psychosom Res. 2008;65(1):5–12.

    PubMed  Article  Google Scholar 

  12. Ekstedt M, Soderstrom M, Akerstedt T, Nilsson J, Sondergaard HP, Aleksander P. Disturbed sleep and fatigue in occupational burnout. Scand J Work Environ Health. 2006;32(2):121–31.

    PubMed  Article  Google Scholar 

  13. Grossi G, Perski A, Evengard B, Blomkvist V, Orth-Gomer K. Physiological correlates of burnout among women. J Psychosom Res. 2003;55(4):309–16.

    PubMed  Article  Google Scholar 

  14. Soderstrom M, Ekstedt M, Akerstedt T, Nilsson J, Axelsson J. Sleep and sleepiness in young individuals with high burnout scores. Sleep. 2004;27(7):1369–77.

    PubMed  Google Scholar 

  15. Melamed S, Ugarten U, Shirom A, Kahana L, Lerman Y, Froom P. Chronic burnout, somatic arousal and elevated salivary cortisol levels. J Psychosom Res. 1999;46(6):591–8.

    CAS  PubMed  Article  Google Scholar 

  16. Peterson U, Demerouti E, Bergstrom G, Samuelsson M, Asberg M, Nygren A. Burnout and physical and mental health among Swedish healthcare workers. J Adv Nurs. 2008;62(1):84–95.

    PubMed  Article  Google Scholar 

  17. Bell RB, Davison M, Sefcik D. A first survey. Measuring burnout in emergency medicine physician assistants. JAAPA. 2002;15(3):40–2. 5-8, 51-2.

    PubMed  Google Scholar 

  18. Vela-Bueno A, Moreno-Jimenez B, Rodriguez-Munoz A, Olavarrieta-Bernardino S, Fernandez-Mendoza J, De la Cruz-Troca JJ, et al. Insomnia and sleep quality among primary care physicians with low and high burnout levels. J Psychosom Res. 2008;64(4):435–42.

    PubMed  Article  Google Scholar 

  19. Ishak W, Nikravesh R, Lederer S, Perry R, Ogunyemi D, Bernstein C. Burnout in medical students: a systematic review. Clin Teach. 2013;10(4):242–5.

    PubMed  Article  Google Scholar 

  20. Hu Q, Schaufeli WB. The factorial validity of the Maslach Burnout Inventory-Student Survey in China. Psychol Rep. 2009;105(2):394–408.

    PubMed  Article  Google Scholar 

  21. Maslach C, Jackson SE. Maslach burnout inventory: manual. second ed. Palo Alto, Calif. (577 College Ave., Palo Alto 94306): Consulting Psychologists Press; 1986.

  22. Carlotto MS, Câmara SG. Psychometric characteristics of the Maslach Burnout Inventory (MBI-SS) in Brazilian college students. Psico USF. 2006;11(2):167–73.

    Article  Google Scholar 

  23. Buysse DJ, Reynolds 3rd CF, 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.

    CAS  PubMed  Article  Google Scholar 

  24. Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, de Barba ME, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med. 2011;12(1):70–5.

    PubMed  Article  Google Scholar 

  25. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–5.

    CAS  PubMed  Google Scholar 

  26. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol. 2009;35(9):877–83.

    PubMed  Article  Google Scholar 

  27. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77–100.

    Article  Google Scholar 

  28. Creamer M, Foran J, Bell R. The Beck Anxiety Inventory in a non-clinical sample. Behav Res Ther. 1995;33(4):477–85.

    CAS  PubMed  Article  Google Scholar 

  29. Gorenstein C, Andrade L. Validation of a Portuguese version of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects. Braz J Med Biol Res. 1996;29(4):453–7.

    CAS  PubMed  Google Scholar 

  30. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893–7.

    CAS  PubMed  Article  Google Scholar 

  31. Gorenstein C, Andrade L, Vieira Filho AH, Tung TC, Artes R. Psychometric properties of the Portuguese version of the Beck Depression Inventory on Brazilian college students. J Clin Psychol. 1999;55(5):553–62.

    CAS  PubMed  Article  Google Scholar 

  32. Ferrara M, De Gennaro L. How much sleep do we need? Sleep Med Rev. 2001;5(2):155–79.

    PubMed  Article  Google Scholar 

  33. Soderstrom M, Jeding K, Ekstedt M, Perski A, Akerstedt T. Insufficient sleep predicts clinical burnout. J Occup Health Psychol. 2012;17(2):175–83.

    PubMed  Article  Google Scholar 

  34. Vandekerckhove M, Cluydts R. The emotional brain and sleep: an intimate relationship. Sleep Med Rev. 2010;14(4):219–26.

    PubMed  Article  Google Scholar 

  35. Hublin C, Kaprio J, Partinen M, Koskenvuo M. Insufficient sleep—a population-based study in adults. Sleep. 2001;24(4):392–400.

    CAS  PubMed  Google Scholar 

  36. Zohar D, Tzischinsky O, Epstein R, Lavie P. The effects of sleep loss on medical residents' emotional reactions to work events: a cognitive-energy model. Sleep. 2005;28(1):47–54.

    PubMed  Google Scholar 

  37. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81(1):82–5.

    PubMed  Article  Google Scholar 

  38. Carskadon MA. Sleep's effects on cognition and learning in adolescence. Prog Brain Res. 2011;190:137–43.

    PubMed  Article  Google Scholar 

  39. Killgore WD, Kahn-Greene ET, Lipizzi EL, Newman RA, Kamimori GH, Balkin TJ. Sleep deprivation reduces perceived emotional intelligence and constructive thinking skills. Sleep Med. 2008;9(5):517–26.

    PubMed  Article  Google Scholar 

  40. Abdulghani HM, Alrowais NA, Bin-Saad NS, Al-Subaie NM, Haji AMA, Alhaqwi AI. Sleep disorder among medical students: relationship to their academic performance. Medl Teach. 2012;34(s1):S37–41.

    Article  Google Scholar 

  41. Walker MP. The role of sleep in cognition and emotion. Ann N Y Acad Sci. 2009;1156:168–97.

    PubMed  Article  Google Scholar 

  42. Curcio G, Ferrara M, De Gennaro L. Sleep loss, learning capacity and academic performance. Sleep Med Rev. 2006;10(5):323–37.

    PubMed  Article  Google Scholar 

  43. Walker MP. Cognitive consequences of sleep and sleep loss. Sleep Med. 2008;9 Suppl 1:S29–34.

    PubMed  Article  Google Scholar 

  44. Halbach MM, Spann CO, Egan G. Effect of sleep deprivation on medical resident and student cognitive function: a prospective study. Am J Obstet Gynecol. 2003;188(5):1198–201.

    PubMed  Article  Google Scholar 

  45. Dyrbye LN, Massie Jr FS, Eacker A, Harper W, Power D, Durning SJ, et al. Relationship between burnout and professional conduct and attitudes among US medical students. JAMA. 2010;304(11):1173–80.

    CAS  PubMed  Article  Google Scholar 

  46. Ohayon MM. Epidemiology of excessive daytime sleepiness. Sleep Med Clin. 2006;1(1):9–16.

    Article  Google Scholar 

  47. Souza JC, Magna LA, Aiache S, Magna NS. Excessive daytime sleepiness in the general population of Brazilian city. J Bras Psiquiatr. 2008;57:34–7.

    Google Scholar 

  48. Souza JC, Magna LA, Reimao R. Excessive daytime sleepiness in Campo Grande general population, Brazil. Arq Neuropsiquiatr. 2002;60(3-A):558–62.

    PubMed  Article  Google Scholar 

  49. Wing YK, Chen L. Cross-cultural epidemiology of daytime sleepiness: universality, diversity and definition issues. Sleep Med. 2009;10(2):164–6.

    CAS  PubMed  Article  Google Scholar 

  50. Young TB. Epidemiology of daytime sleepiness: definitions, symptomatology, and prevalence. J Clin Psychiatry. 2004;65 Suppl 16:12–6.

    PubMed  Google Scholar 

  51. Veldi M, Aluoja A, Vasar V. Sleep quality and more common sleep-related problems in medical students. Sleep Med. 2005;6(3):269–75.

    PubMed  Article  Google Scholar 

  52. Da Nóbrega Danda GJ, Rocha Ferreira G, Azenha M, Rocha De Souza KF, Bastos O. Sleep-wake cycle pattern and excessive daytime sleepiness in medical students. J Bras Psiquiatr. 2005;54(2):102–6.

    Google Scholar 

  53. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012:1–9.

  54. Dyrbye LN, Thomas MR, Huntington JL, Lawson KL, Novotny PJ, Sloan JA, et al. Personal life events and medical student burnout: a multicenter study. Acad Med. 2006;81(4):374–84.

    PubMed  Article  Google Scholar 

  55. Dyrbye LN, Thomas MR, Power DV, Durning S, Moutier C, Massie Jr FS, et al. Burnout and serious thoughts of dropping out of medical school: a multi-institutional study. Acad Med. 2010;85(1):94–102.

    PubMed  Article  Google Scholar 

  56. Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334–41.

    PubMed  Article  Google Scholar 

  57. Bahammam AS, Alaseem AM, Alzakri AA, Almeneessier AS, Sharif MM. The relationship between sleep and wake habits and academic performance in medical students: a cross-sectional study. BMC Med Educ. 2012;12:61.

    PubMed Central  PubMed  Article  Google Scholar 

  58. Shiralkar MT, Harris TB, Eddins-Folensbee FF, Coverdale JH. A systematic review of stress-management programs for medical students. Acad Psychiatry. 2013.

  59. de Niet G, Tiemens B, Lendemeijer B, Hutschemaekers G. Music-assisted relaxation to improve sleep quality: meta-analysis. J Adv Nurs. 2009;65(7):1356–64.

    PubMed  Article  Google Scholar 

  60. Nieradko B, Borzecki A. Exercise behavior, sleep habits and time management among students of the Medical University of Lublin. Ann Univ Mariae Curie Sklodowska Med. 2003;58(1):358–61.

    PubMed  Google Scholar 

  61. Dias M, Pagnin D, de Queiroz PV, Reis RL, Olej B. Effects of electroacupuncture on stress-related symptoms in medical students: a randomised controlled pilot study. Acupunct Med. 2012;30(2):89–95.

    PubMed  Article  Google Scholar 

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Acknowledgments

The authors would like to thank Márcio Amaral de Oliveira Filho, Naira Vanessa Anomal Gonzalez, Ana Emília Teófilo Salgado, Bernardo Cordeiro e Oliveira, Caio Silva Lodi, and Raquel Muniz da Silva Melo.

Disclosures

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Correspondence to Daniel Pagnin.

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Pagnin, D., de Queiroz, V., Carvalho, Y.T.M.S. et al. The Relation Between Burnout and Sleep Disorders in Medical Students. Acad Psychiatry 38, 438–444 (2014). https://doi.org/10.1007/s40596-014-0093-z

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  • DOI: https://doi.org/10.1007/s40596-014-0093-z

Keywords

  • Medical students
  • Emotional problems
  • Career development