Sleep Patterns and Academic Performance among Undergraduate Medical Students: A Cross-sectional Study at a Tertiary Care Teaching Hospital in Chennai, South India

Abstract

Background:

Sleep disturbances are common among college students and may adversely affect mood, physical health, and academic performance. Medical undergraduates are particularly vulnerable due to academic stress and demanding schedules. This study aimed to assess and determine the association between sleep quality and academic performance among medical students. Understanding the relationship between sleep quality and academic achievement may help promote healthier sleep behaviors among students.

Methodology:

A cross-sectional study was conducted from October 2025 to January 2026 among 3^rd-year undergraduate medical students at a tertiary care teaching hospital in Chennai, South India. A total of 100 eligible students were recruited based on the predefined inclusion and exclusion criteria. Data were collected using self-administered, standardized, validated semi-structured questionnaires. Sleep quality and academic performance were assessed and Fisher’s exact test was performed through the SPSS software version 25 to determine the association between the variables.

Results:

Among 100 undergraduate medical students (mean age 21.31 ± 1.10 years), the mean internal assessment score was 41.09 ± 13.93 and the mean global Pittsburgh Sleep Quality Index score was 4.16 ± 1.86. Sleep quality was significantly associated with academic performance (Fisher’s exact test = 15.679, P = 0.001); 65.9% of students with poor academic performance were poor sleepers, whereas the majority of students with fair or good performance were good sleepers, demonstrating a clear link between healthier sleep patterns and better academic outcomes.

Conclusion:

Good sleep quality is significantly associated with better academic performance among medical undergraduates. These findings highlight the importance of promoting healthy sleep habits as a potential strategy to improve the academic outcomes in medical students.

INTRODUCTION

Sleep plays an important role in the lives of human beings, framing their routine according to a 24-h cycle. Spontaneously generated sleep-wake cycle tends to maintain relatively stable schedules. This periodical sleep and wakefulness pattern varies with their age, the demands of their occupation, and their physiological and psychosocial characteristics.[1,2] Since the sleep-wake cycle is in harmony with other circadian rhythms such as deep body temperature and cellular mitosis, the abrupt shift of sleep schedules can lead to internal dissociation among circadian rhythms, which may imply undesirable effects such as somnolence, attention deficits, and performance decrements, which are very common in working shifts and rapid travel across the multiple time zones.[3] Most sleep specialists agree that, although adults require 8 h of sleep per day, the sleep patterns of young adults differ from those of their adult counterparts in several ways, including a need for increased sleep.[4] However, some people need more than 9 h of sleep (long sleepers) while others feel well with <6 h of sleep (short sleepers). Adolescents undergo a phase delay in sleep onset accompanied by increased irregularities in their sleep patterns, jeopardizing sleep sufficiency in students.[5,6]

According to the International Classification of Sleep Disorders, conditions such as dyssomnias, parasomnias, and medical/psychological disorders, which are often neglected, may be responsible for altered patterns among students and as a result, students may use drugs to overcome these problems.[7,8] There are other individual variations as well, such as the morning type of people performing much better in the morning and tend to be drowsy during the evening. Similarly, evening type people like to go to bed and wake up late, do not perform well in the morning, and feel their best in the afternoon and evening.[9] Sleep is clearly an important aspect of successful academic and personal life in college, yet very little attention has been given to finding an appropriate sleeping pattern.[10] This study was designed to investigate the relationship between a healthy sleeping schedule and academic success among undergraduates at a tertiary care teaching hospital in Chennai, South India, with the aim of encouraging medical students to adopt healthier sleep habits by using academic success as motivation. Students mindful of the importance of healthy sleep patterns may be able to improve their achievements.

Objectives

1. To assess the levels of sleep patterns among undergraduate medical students at a tertiary care teaching hospital in Chennai, South India

2. To find out the association between sleep problems and academic performance of undergraduate medical students at a tertiary care teaching hospital in Chennai, South India.

METHODOLOGY

Study design and study setting

A cross-sectional study was conducted from October 2025 to January 2026 at a tertiary care teaching hospital in Chennai, South India. Prior to this, the study proposal was approved by Institutional Research Committee and Institutional Ethics Committee. Appropriate permission to utilize the internal assessment (IA) mark of 3^rd-year undergraduate medical students from community medicine was sought from the head of the department.

Selection criteria of study participants

This study was conducted among 3^rd-year undergraduate medical students attending community medicine theory classes for the current academic year at a tertiary care teaching hospital in Chennai, South India. Finally, 100 eligible participants of 3^rd-year undergraduate medical students were recruited based on the inclusion and exclusion criteria in this study [Figure 1].

Figure 1.

Flow diagram showing selection criteria of study participant enrolment

Data variables, sources of data and data collection

After explaining the study and informed consent was obtained from the study participants, data were collected using self-administered standardized validated semi-structured questionnaires as described in the following sections A and B through online Google forms, followed by section-C IA mark received from the Community Medicine department.

• Section-A information about the sociodemographic profile of the study participants which includes name, age, current residence, healthcare professional course enrolment, the average family income per month in rupees and total no of family members, and socioeconomic status based on B. G. Prasad Classification, 2022

• Section-B Assessment of sleep habits during the past 1 month using a standardized questionnaire-Short 13 items Pittsburgh Sleep Quality Index (PSQI) Survey[11] which assesses five components as follows:

  1. Sleep latency

  2. Sleep duration

  3. Sleep efficiency

  4. Sleep disturbances

  5. Daytime dysfunction.

  Based on 13-question scoring, Add the five component scores together to obtain Global PSQI. If A total score of greater than “4” is indicative of poor sleep quality.

• Section-C assessment of academic performance: Community Medicine IA mark.

Total score categories of Community Medicine IA marks as per The Tamil Nadu Dr M.G.R medical university guidelines are as follows:

1. Fail/Poor academic performance (<50)

2. Average academic performance (50–74)

3. Distinction academic performance (>75).

Data analysis

The data were extracted from Google Forms and data coding was done using Microsoft Excel 2019 (Microsoft Corporation, Redmond, WA, USA).These data were analyzed using SPSS software version 25 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to analyze variables’ frequency, and the Fisher’s exact test was applied at a 95% confidence interval to test the statistical significance.

RESULTS

A total of 100 undergraduate medical students participated in the study. The average age of participants was 21.31 ± 1.10. The mean Community Medicine IA mark was 41.09 ± 13.93.

Socio-demographic characteristics

Most of the participants were aged 20–21 years (62%), followed by 32% aged 22–23 years and 6% were 23–24 years old. The study participants were comprised of 31% males and 69% females. Regarding stay type, 43% were hostellers and 57% were day scholars. The upper socio-economic class was represented by 84% of the study population, 12% were from the upper middle class and 4% were from the middle class [Table 1].

Table 1.

Sociodemographic profile of the participants (n=100)

Variable	Categories	Frequency (n)
Age group (years)	20–21	62
	22–23	32
	23–24	6
Gender	Male	31
	Female	69
Residence type	Hostel	43
	Dayscholar	57
Socioeconomic status	Upper class	84
	Upper middle class	12
	Middle class	4

Sleep quality of undergraduate medical students

Participants had an average global PSQI score of 4.16 ± 1.86, implying that the overall sleep quality of participants was relatively good. The 95% confidence intervals for the components of sleep are shown in Table 2. The average global PSQI score of all participants was 4.16 ± 1.86 (acceptable overall sleep quality). Analysis of the individual items showed a mean Sleep Latency of 0.76 ± 0.82, which corresponds to a short latency to sleep onset. The mean score for sleep duration was 1.14 ± 0.57, and that for sleep efficiency was lower, 0.30 ± 0.58, indicating reasonably good sleep continuity. The mean score of sleep disturbance was 0.87 ± 0.63 and that of daytime dysfunction was 1.09 ± 0.99, both implying a mild level of daytime impairment caused by poor sleep.

Table 2.

Distribution of sleep quality scores based on short Pittsburgh Sleep Quality Index

Sleep component	Mean±SD	95% CI
		Lower	Upper
Sleep latency (C1)	0.76±0.82	0.60±0.72	0.93±0.91
Sleep duration (C2)	1.14±0.57	1.02±0.47	1.25±0.65
Sleep efficiency (C3)	0.30±0.58	0.19±0.45	0.42±0.69
Sleep disturbances (C4)	0.87±0.63	0.75±0.55	1.00±0.70
Daytime dysfunction (C5)	1.09±0.99	0.90±0.88	1.29±1.08
Global PSQI score	4.16±1.86	3.79±1.62	4.52±2.07

PSQI=Pittsburgh Sleep Quality Index, CI=Confidence interval, SD=Standard deviation

The distribution of students based on their global PSQI scores is illustrated in Figure 2. It shows the proportion of students classified as good or poor sleepers according to the global short PSQI score, providing a visual representation of overall sleep quality among the participants.

Figure 2.

Distribution of students’ sleep quality using the Global short Pittsburgh Sleep Quality Index score

The distribution of academic performance based on Community Medicine IA marks is shown in Figure 3. The students’ performance was rated as poor (<50 marks): 44, fair (50–74 marks): 54, and good (≥75 marks): 2.

Figure 3.

Distribution of students’ academic performance

Association between demographic variables and academic performance

There was no statistically significant association observed between academic performance and demographic variables such as age (P = 0.292), gender (P = 0.731), residence (P = 0.157), or socio-economic status (P = 0.107) [Table 3].

Table 3.

Association between demographic profile and academic performance

Variable	Categories	Academic performance based on community medicine IA mark			Fisher’s exact test value	P
		Poor (<50)	Fair (50–74)	Good (≥75)
Age (years)	20–21	31	29	2	5.043	0.292
	22–23	12	20	0
	23–24	1	5	0
Sex	Male	14	17	0	0.918	0.731
	Female	30	37	2
Residence	Hosteller	16	25	2	3.681	0.157
	Days scholler	28	29	0
Socioeconomic status	Upper class	42	40	2	8.979	0.107
	Upper middle class	2	10	0
	Middle class	0	4	0
Global short PSQI score for sleep quality	Poor sleeper	29	15	0	15.679	0.001***
	Good sleeper	15	39	2

***P<0.001. PSQI=Pittsburgh sleep quality index, IA=Internal assessment

Association between sleep quality and academic performance

A statistically significant association was found between global PSQI sleep quality and academic performance (Fisher’s exact test = 15.679, P = 0.001). Poor sleep quality was strongly associated with lower academic achievement. Among the 44 poor sleepers, 29 (65.9%) scored below 50, and none secured marks in the good performance category (≥75). Conversely, among the 56 good sleepers, the majority 39 (69.6%) achieved fair scores (50–74), and the two students who attained good academic performance were both good sleepers. These results demonstrate a clear and significant relationship between sleep quality and academic performance among medical undergraduates [Table 4].

Table 4.

Association between sleep quality and academic performance

Variable	Categories	Academic performance based on community medicine IA mark				Fisher’s exact test value	P
		Poor (<50), n (%)	Fair (50–74), n (%)	Good (≥75), n (%)	Total, n (%)
Global short PSQI sleep quality	Poor sleeper	29 (65.9)	15 (34.1)	0	44 (100)	15.679	0.001***
	Good sleeper	15 (26.8)	39 (69.6)	2 (3.6)	56 (100)

***P<0.001. PSQI=Pittsburgh sleep quality index, IA=Internal assessment

DISCUSSION

Our study reports a mean age of 21.31 years, with most students (62%) in the 20–21 years age range. Similar, study done by Almalki et al. shows that, a mean age of 22.81 years, emphasizing that this age bracket is common in undergraduate populations.[12] The consistency in age demographics suggests that sleep and performance trends observed in our study are likely representative of the broader medical student population.

In terms of their living situation, 43% of the students were hostellers, while 57% were day scholars. Notably, the majority of our participants (84%) came from the upper socio-economic class, but interestingly, we did not find any statistically significant associations between demographic variables (age, gender, residence, or socio-economic status) and academic performance. This could imply that other factors, such as individual motivation, learning strategies, or sleep quality, might play a more significant role in determining academic success. Similarly a study done by Rocha et al. shows that, during the course of the academic year, there was no correlation found between any of the SES indices and the longitudinal change in PSQI scores.[13]

Now, according to sleep quality, our participants had an average global PSQI score of 4.16, indicating relatively good sleep quality. This is a positive finding, as good sleep is essential for cognitive function, memory consolidation, and overall health. In contrast, study by Rocha et al., shows that, first-generation college students had roughly one-point higher PSQI scores than continuing-generation students, indicating poorer sleep quality.[13]

A study by Johns et al. shows that poor sleep quality is associated with lower academic performance.[14] Similarly in our study, some experienced sleep disturbances (0.87) and daytime dysfunction (1.09). When it comes to academic performance, our results showed that most students (54%) had fair grades, while 44% had poor grades, and only 2% had good grades. This distribution suggests that there might be room for improvement in terms of academic support or resources.

Our study found a pretty striking link between sleep quality and how well students perform academically. It is not exactly surprising that students who sleep better tend to do better in school, but the numbers are still pretty eye-opening. For instance, 65.9% of students who struggled academically were also poor sleepers, while a significant 69.6% of students with fair academic performance were good sleepers. And here’s the kicker: Both students who excelled academically were good sleepers. These findings echo the results of previous studies, like those Medeiros et al. state that both endogenous (such as chronotype) and exogenous (such as school schedules and academic demands) factors may affect a university Student’s sleep-wake cycle; poor sleep-wake patterns (such as irregular or insufficient sleep) may then have an impact on academic performance.[15]

Comparing our findings to previous studies, we can see that sleep quality is a crucial aspect of academic performance. For instance, a study by Curcio et al. showed that good sleep quality is associated with better academic performance, especially in subjects that require complex problem-solving skills. Our results align with these findings, highlighting the importance of sleep quality in undergraduate medical students.[16]

CONCLUSION

Our study suggests that universities and medical schools should prioritize sleep education and provide resources to help students develop healthy sleep habits. This could include workshops on sleep hygiene, stress management, and time management, as well as access to counseling services and sleep clinics. By doing so, we can help students perform better academically, reduce their risk of burnout and depression, and set them up for success in their future careers. It’s not just about getting good grades; it’s about fostering a culture of wellness and self-care that will benefit students for the rest of their lives. By taking care of their sleep, students can ensure they have the energy, focus, and resilience to succeed in all areas of their lives.

Limitations

Finally, our study has some limitations, such as the relatively small sample size and the reliance on self-reported data. Our study focused specifically on medical students, who are notoriously sleep-deprived. This population is particularly vulnerable to the effects of poor sleep, given the demanding nature of their coursework and clinical rotations. Nonetheless, our findings contribute to the growing body of research on sleep quality and academic performance, emphasizing the need for universities and medical schools to prioritize students’ sleep health and well-being.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.