Relationship between poor quality sleep, excessive daytime sleepiness and low academic performance in medical students

Purpose: Poor quality of sleep and excessive daytime sleepiness affect cognitive ability and have a negative impact on the academic performance of medical students. This study aims to determine the prevalence of excessive daytime sleepiness, sleep quality and psychological distress as well as assess their association with low academic performance in this population. Participants and methods: A cross-sectional study was conducted among 457 medical students from the Faculty of Medicine and Pharmacy of Rabat, Morocco, who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth Sleepiness Scale to determine the quality of sleep and excessive daytime sleepiness, respectively. Sociodemographic variables and psychological distress (Kessler Psychological Distress Scale) were also measured. Multivariate linear regression was performed in order to evaluate the link between low academic performance and sleep quality after adjusting for other covariates. Results: Among the included students, the median age was 20 (19; 21) years; 70.7% of the participants were females. Almost one-third of the students (36.6%) had excessive daytime sleepiness and this was more frequently observed in female students (43% vs 20.1%, <0.001). Furthermore, 58.2% of the students were poor sleepers (PSQI >= 5), while 86.4% of them had psychological distress. The bivariate analysis showed that psychological distress was associated with decreased risk of low performance (beta=0.04; 95% CI=0.005-0.07; P=0.024). Being a poor sleeper was statistically associated with poor academic performance (beta= -0.07; 95% CI=-0.14 to -0.002; P=0.04) in the multivariate analysis. In our study, daytime sleepiness was not statistically associated with academic performance. Conclusion: A poor sleep quality determined by PSQI >= 5 was related to poor academic achievement at the end of the study year in medical students.