Evaluation of Sleep Patterns and Prevalence of Stress Among Dental Undergraduate Students

Abstract

Background and Objectives:

The association between quality of sleep and psychological distress among dental undergraduate students is a critical area of research due to the high levels of stress and demanding schedules these students face. The objective of this study was to determine the prevalence of sleep disturbance and psychological distress among undergraduate dental students.

Methodology:

In a cross-sectional study conducted among 104 first year dental undergraduate students for a period of 1 month, quality of sleep was analyzed. Prevalidated questionnaires of Pittsburgh Sleep Quality Index (PSQI) and Kessler’s (K10) psychological distress scale were used to collect the data.

Results:

As per PSQI analysis, 43 students (43.1%) report good sleep quality (global score of 0–5), 52 students (51%) reports poor sleep quality (overall score of 6–10), and 7 students (6.9%) reports very poor sleep quality (overall score of 11–21). Responses from K10 revealed that 33 students (32.4%) are likely to be well (total score of 10–19), 23 students (22.5%) have mild psychological distress (total score of 20–24), 13 students (12.7%) have moderate psychological distress (total score of 25–29), and 33 students (32.4%) have severe psychological distress (total score of 30–50). F-Statistic, between and within groups was 0.0064 suggested significant differences in sleep quality across different psychological distress levels.

Conclusions:

57.9% of the students reported poor sleep quality, with many experiencing sleep disturbances such as delayed sleep onset, reduced sleep duration, and daytime sleepiness. PSQI revealed that over half of the participants had poor or very poor sleep quality, while the K10 scale indicated that a significant portion of students experienced moderate to severe psychological distress. The results show that students facing severe psychological distress tend to have worse sleep quality, as evidenced by the statistically significant differences in sleep quality across distress levels.

INTRODUCTION

Sleep is a circadian process required for physical and mental wellbeing. The duration of sleep and quality of sleep is affected by many daily factors including extended lecture classes, clinical postings, lifestyle habits, and mental stress.[1] Sleep deprivation in students can lead to depression, anxiety, and excessive day time sleepiness which can affect their cognitive and psychomotor performance.[2] Understanding of sleep problems among undergraduate students provides insight into preventing health issues and improve sleeping habits for better academic achievement.[3]

The association between sleep quality and psychological distress among undergraduates is a critical area of research due to the high levels of stress and demanding schedules these students face.[4,5] Health university students often experience significant psychological distress, including anxiety and depression, which can negatively affect their sleep patterns.[6,7] Alsaggaf et al. and Azad et al., report sleep quality issues, characterized by difficulty in initiation of sleep, frequent awakenings, and shorter sleep duration, are commonly reported in this population.[8,9] Interventions aimed at enhancing sleep quality, such as stress management techniques and cognitive-behavioral strategies, may help mitigate the impact of psychological distress. Promoting awareness and providing support for mental health and sleep hygiene can play a vital role in fostering a healthier learning environment and better outcomes for undergraduate students.

Pittsburgh Sleep Quality Index (PSQI) is used in clinical and research settings to diagnose sleep issues and track treatment outcomes.[10] It assesses subjective sleep quality, latency, duration, habitual sleep efficiency, daytime dysfunction, sleep disruptions, and sleeping medicine use. This tool is useful in many investigations and therapeutic contexts since it may be used with multiple populations, including different age groups and health problems.[10] Kessler’s Psychological discomfort Scale (K10) is a popular self-report questionnaire that measures psychological discomfort by asking about 30-day anxiety and depression symptoms. Although not designed for sleep quality testing, the K10 can indirectly provide insights. K10 findings supplement PSQI sleep quality measurements.[11]

The objective of the study was to determine the prevalence of sleep disturbance and psychological distress among undergraduate dental students.

METHODOLOGY

Study design and study setting

A cross-sectional study of 104 first-year dental undergraduate students was undertaken over a 1-month period to assess sleep quality. The study took place in May and June 2024 at ESIC Dental College in Gulbarga, Karnataka. Prevalidated questionnaires for the PSQI and Kessler’s psychological distress scale were disseminated using Google Forms.

Sample size

All 150 first year dental students were invited to participate in the study. Only those who consented and completed the administration of questionnaire were included in the study.

Ethical considerations

The study was approved with No. 532/GLBDC/IEC/RP/2023/13 by the Institutional Ethical Committee, ESIC Dental College, Kalaburagi. Participation was voluntary, and informed consent was obtained from all participants. Confidentiality and anonymity were maintained throughout the study. Participants were informed of their right to withdraw at any time.

Data acquisition instruments

Pittsburgh Sleep Quality Index

A common method for assessing sleep quality, particularly for clinical patients at risk of psychiatric disorders. The 19 self-reported assessments focused on subjective sleep quality, latency, duration, habitual sleep efficiency, interruptions, sleep medicine usage, and daytime dysfunction. This study eliminated five factors rated by roommates or sleeping partners. The PSQI was validated for people aged 24–83 who experienced severe daytime drowsiness, substantial mental disorders, and difficulty initiating sleep. Allow 5–10 min to administer the questionnaire. The internal reliability coefficient (alpha) of 0.83, global test-retest reliability of 0.85, 89.6% sensitivity, and 86.5% specificity all suggest strong psychometric qualities. Higher scores (0–3) indicate more severe sleep disruptions. Participants frequently reported 30-day sleep quality and difficulty. A global score of five or higher indicated poor sleep quality.

Kessler Psychological Distress Scale (K10)

The 10-question test measures psychological distress based on anxiety and depression. Questions cover the frequency of specific feelings and experiences throughout the past 30 days. Each question is graded on a 5-point scale, with 1 representing never and 5 representing always. The 10 item scores are added for a total score (10–50). Greater psychological anguish is indicated by higher scores. Scores 25–29 indicated moderate mental disorder, whereas 30 or higher indicated serious mental disorder.

Procedure

Those who agreed were provided with access to Google Forms, where they could complete the PSQI and K10 surveys anonymously. During the survey, demographic information such as age and gender were gathered.

Data analysis

Data were processed with SPSS IBM Statistics for Windows, Version 26.0 (IBM Corp., Armonk, NY). Demographics and questionnaire scores were descriptively analyzed. PSQI and K10 mean scores and standard deviations were calculated. Pearson correlation was used to analyze the association between PSQI scores and K10 scores. PSQI and K10 scores were compared across demographic groups using independent samples t-tests and ANOVA. A one-way ANOVA was performed on psychological distress and sleep quality.

RESULTS

Out of 150 students, 104 students have successfully completed this questionnaire study, and the data were used during the analysis. The average age of students was 19.5 (±1.2) years. Out of this group, 63 were female students and 41 male students.

Pittsburgh Sleep Quality Index findings

34% of students reported an average sleep duration of 5 h. 52% of them could sleep only after 11 pm. Around 53% took 45 minutes for the initiation of sleep. Day time sleepiness (58%) was a major complaint due to decreased sleep quality. 57% had decreased enthusiasm to get things done. Although the majority had issues with sleep quality and duration, still 99% of students were reluctant to seek medical assistance. 47% complained of depression, 50% had restlessness, 45% felt hopeless, 37% thought their life was worthless and 43% had a feeling that nothing could cheer them up. As per PSQI analysis, 43 students (43.1%) report good sleep quality (global score of 0–5), 52 students (51%) reports poor sleep quality (global score of 6–10) and 7 students (6.9%) reports very poor sleep quality (global score of 11–21) [Figure 1].

Figure 1.

Pictogram of responses for sleep hygiene parameters and onset of sleep, expressed as percentages, n=104

Kessler Psychological Distress Scale (K10) findings

Responses from K10 revealed that 33 students (32.4%) are likely to be well (total score of 10–19), 23 students (22.5%) have mild psychological distress (total score of 20–24), 13 students (12.7%) have moderate psychological distress (total score of 25–29), and 33 students (32.4%) have severe psychological distress (total score of 30–50) [Tables 1 and 2].

Table 1.

Tabulation of psychological stress and sleep quality (n=104)

	Good sleep quality	Poor sleep quality	Very poor sleep quality
Likely to be well	13	17	1
Mild psychological distress	10	12	2
Moderate psychological distress	5	7	1
Severe psychological distress	14	17	2

Table 2.

ANOVA for sleep quality across different psychological distress levels

Source of variation	SS	df	MS	F	P
Between groups	29.5	3	9.83	4.57	0.0064
Within groups	171.8	12	14.32
Total	201.3	15

SS=Sum of squares, df=Degrees of freedom, F=F-static, n=104. The ratio of variation within and between groups by F-statistic with P value of 0.0064 reveals significant differences in sleep quality across psychological distress levels

DISCUSSION

Sleep patterns are closely linked to stress levels among students, with disruptions in sleep often reflecting heightened stress. When students face academic pressure, social challenges, or personal issues, their sleep quality tends to deteriorate, leading to irregular sleep schedules, insomnia, or difficulty maintaining deep sleep.[12] In turn, poor sleep exacerbates stress, creating a cycle that affects concentration, mood, and overall well-being.[13] Chronic stress can also interfere with the body’s ability to relax, delaying sleep onset and reducing restfulness.[14] Addressing stress through relaxation techniques, time management, and proper sleep hygiene can improve both sleep quality and academic performance.[15]

Previous research using self-reported questionnaires discovered a significant relationship between sleep patterns and stress among college students. Elagra et al. found that dental students had unrealized bad sleep quality and a negative relationship between Grade Point Average and PSQI scores.[16] Jowkar et al. discovered a significant direct link between dental environment stress and PSQI scores, as well as moderate stress and poor sleep quality among dentistry students in Shiraz, Iran.[17] Using self-reported data, Zhao et al. discovered that stress reduces sleep quality, resulting in a feedback loop that increases stress.[16] These findings imply that dental students require stress management to improve their sleep and mental health.

A systematic review and meta-analysis of dentistry students’ depression, anxiety, and sleep disorders revealed 38%, 48%, and 31% prevalence, respectively.[18] This study did not look at how depression and anxiety affect sleep. Many factors other than academic stress may have an impact on students’ sleep patterns and hygiene as they spend more time at university.[18]

Nagarajappa et al. discovered that sleep quality and stress levels influenced academic performance among dentistry students in Bhuvaneshwar, India.[19] This study reported that 57.9% of first-year dentistry students experience sleep disturbances.[19] Rotaro et al. suggest stress, anxiety, and sleep therapy for first-year dental students.[20] This study also shown that psychological stress levels influence sleep quality. Given these concerns, Rahimi et al. advise students to engage in self-care.[21] Wright and Mynett recommend a comprehensive curriculum redesign that incorporates resilience and resourcefulness.[22]

CONCLUSIONS

This study looks at first-year dental students’ sleep quality and psychological disturbance. Most students experienced delayed sleep onset, short sleep duration, and daily weariness. K10 revealed that many students experienced moderate to severe psychological distress, whereas PSQI revealed that more than half had poor or very poor sleep quality. According to statistical study, students who experienced severe psychological distress had poorer sleep quality. This highlights the importance of sleep hygiene and mental health therapy for stress reduction.

The findings corroborate a previous study that linked academic strain and emotional stress to poor dental student sleep. The current study only includes first-year students, limiting its applicability to later-year students who have higher expectations. However, because sleep difficulties and psychological distress are common among dentistry students, they require mental health treatment and stress management. Relaxation, time management, and resilience building in dental education may help with sleep, mental health, and academic performance.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.