sleep pattern and its disorders with standard classification.ppt

Sleep introduction and mentioning the main classification according to ICSD

1. ىلاــعت لاــق(( : قَلَخ يذ�لا كِّ بر مساب أرقا(1 )
قَلَع نم َناسنلإا َقَلـَخ(2 ) مركلأا َك�برو أرقا(3 )
ملقلاب َم�لَع يذ�لا(4 )ملعي مل ام َناسنلإا َم�لَع))
ميظعلا الله قدــص
ةروسقلعلا

2. Assessment of Daytime Sleepiness and
Quality of Sleep Among Medical & Medical
Science Students –Sana’a –2024.

3. Researchers by :
1. LwayAbbas Mohammed Al-Ahdal
2. YahyaMohammed Ahmed
Alshalyly
5. NayefMujahidAli Zabal
7. Hassan Taha Ali Al_habshi
9. Sami JamilMohammed Alshakry
11. EmranNasser Abdulwase
Alsaqqaf
2. Mohammed Mansour Al-Himi
4. Ramez Ghles Qaid Ghles
6. Moheb Adel Mohammed Ali
Alkohaly
8. Muhammed Musleh Abdullah
Taher
10. Shareefa Ahmed Omer Al-
Dossary
12. Safa Naser Ahmed Al-fakeer
Supervisor
Dr. Rania Jaashan, MD
Anesthetist and critical care Medicine
Consultant
Al-Razi University
Co-Supervisor
Dr. Saleem N. Hamilah, BS, MsRC, RCP,
FNIV
Master of Science in Respiratory Care
Fellowship in Non-Invasive Ventilation,
Al-Razi University

4. Outline
01
04
02
05
03
Introduction Objetives
Research
methodology
Results
Conclusion and
recommendatio
n
Background
Problem
statement
Justification of
the study

5. Introduction
01

6. Background of the
study :
Sleepisanintegralpartofhealthandwell-being.Itisanactive
processishighlyregulatedandevolutionarilyconserved.Sleep
isrequiredforpreservationofenergy,restoration,reparation,
andrejuvenationofnormalphysiologicfunction,including
immunity,musclegrowth,tissuerepair,proteinsynthesis,and
clearanceofbrainmetabolitessuchasadenosine.Sleep
facilitatesbrainneuralplasticity,theprocessbywhichthe
centralnervoussystemaltersitselfbothstructurallyand
functionallyinresponsetoexperiences,whichisimportantfor
consolidatingmemoriesandlearning.(Broaddusetal.,2022)

7. Background
cont..
Nowadays,sleep-relatedproblemsareaprevalentoccurrence
amonguniversitystudents.Poorsleepqualityisoneofthemost
studiedaspectsofsleepcomplaints,affectingfrom10%to50%
ofthispopulation.Poorsleepqualityconsequencesaremany
andhaveaprofoundimpactinthestudent’spsychobiological
health.Universitystudentslivethroughaperiodof
psychologicalchallengeandadaptation,sincethetransition
fromhighschooltoprofessionallife.Abruptautonomy
challengesstudentstodealwithmanychoices,fromtheir
academicandsociallifetotheirintimatehabits

8. Background
cont..
Frequently,sleephygieneisneglected,ortheyare
unabletousepropercopingmechanisms,resultingin
disturbingconsequencesthatcouldimpacttheirlivesas
adults.(Bragan,2023)
Assleepisconsideredanessentialpartofourdaily
livesandplaysacrucialroleinmaintainingphysicaland
mentalhealth.Sufficientsleepismandatoryfor
maintainingcognitivefunctionsandoverallwell-being.

9. Problem
statement
Becauseadmissiontomedicalschoolrequireshigh
academicandprofessionalachievement,itisregarded
asoneofthemostdemandingprofessions.Asaresult,
stressandpsychologicalstateareimportantfactorsthat
mightimpairsleepqualityandquantity(Freemanetal.,
2020),(López-Muciñoetal.,2022),andmedicalstudents
asagroupareparticularlystressed.Itisexpectedthat
theyarepronetonumerousformsofsleepproblems.
Sleepdisruptionisdescribedasapandemicinthe
populationofmedicalstudentscomparedtothegeneral
population(Seoaneetal.,2020),withparticularreports
offallingasleeplateandhavingdifficultyinitiatingsleep,
aswellassleepingfewerhours(Yassinetal.,
2020),(Seoaneetal.,2020),(Meeretal.,2022).

10. Problem statement
cont..
Duetothedemandingnatureofmedicalschoolandthe
possibleconsequencesofpoorsleeponoutcomesin
academics,clinicalcare,andmentalhealth,sleepquality
isacrucialconcernformedicalstudents.Highacademic
demands,longstudyandclinicalhours,andother
factorsthatcancausesleepdisturbancesandsleep
disordersarefacedbymedicalstudents(Jahramietal.,
2020,Jahramietal.,2019).

11. Problem statement
cont..
Poorsleephygienecanhaveanadverseeffecton
patientcareandsafetybyloweringcognitivefunction,
judgment,andclinicalabilities.Additionally,sleep
disordersanddisturbancescanworsenmentalhealth
conditionslikedepression,anxiety,andburnoutaswell
asraisetheriskofdevelopingchronicillnesseslike
diabetesandcardiovasculardisease.Theimportanceof
sleephealthinmedicalstudentscanenhancetheir
performanceintheclassroomandintheclinic,enhance
generalwellbeing,andhaveabeneficialimpactonfuture
healthcareoutcomes(Jahramietal.,2020,Jahramietal.,
201

12. Justification of the
study
Becausemedicalstudentsareexposedtoasignificant
levelofpressureduetoacademicdemands.Theirsleep
patternischaracterizedbyinsufficientsleepduration,
delayedsleeponset,andoccurrenceofnapping
episodesduringtheday.Thesesleeppatternswill
disturbtheirwell-beingsleepinesslater,whichwillguide
themtomultiplesleepissues.Accordingtoseveral
worldwidestudies,highprevalenceratesindicate
serioussleepdisordersamongmedicalstudentsgroup
whichwillresultinaundesirableconsequencesthat
wouldaffectbadlytothecommunityasawhole,
becausemedicalstudentisthecornerstonewhowill
participatetoenhancepeople'shealth.

13. objectives
02

14. General
objectives
Tofindtheprevalenceofsleepqualityanddaytime
sleepinessamong randomly selectedmedical
undergraduatestudentsinAl-RaziandScienceand
Technologyuniversities.

15. Specific
objective's
To increase the rate of awareness among educated
people regarding sleep and some of its disorders.
To find the relationship between the demographic data
and excessive daytime sleepiness
To identify the relation between the demographic data
and sleep quality
To clarify the rate of sleep problems among medical
students

16. 03
Research methodology

17. Study Setting
Thisstudywasconductedattwoprominentprivate
universitiesinSana'a,Yemen:
AlraziUniversityandtheUniversityofScienceand
Technology(UST).Theseinstitutionswerespecifically
chosenduetotheirrecognitionasthetoptwo
universitiesinYemen,accordingtotheWebometrics
rankinginJanuary2024.Bothuniversitiesoffermedical
andmedicalscienceprograms,makingthemideal
settingsforinvestigatingsleeppatternsamongthis
specificstudentpopulation.

18. Study Setting
cont..
Sana'a,thecapitalcityofYemen,servesasthecountry's
primaryhubformedicaleducation.Assuch,itattractsa
diverserangeofstudentsfromvariousregions,offering
arepresentativesampleforthisstudy.Datacollection
occurredthroughoutthe2024academicyear,spanning
multiplesemesterstocapturevariationsinacademic
demandsandclinicalrotations.

19. Study Setting
cont..
AlraziUniversityandUSTwerestrategicallyselected
duetotheirreputationsforacademicexcellenceand
potentiallydistincteducationalenvironmentscompared
tootherinstitutions.Thestructuredcurriculuminboth
universities,whichtypicallycombinestheoretical
coursework,laboratorysessions,andclinicalrotations,
presentsademandingacademiccontext.Thisrigorous
environment isconducivetostudyingsleep
disturbancesamongmedicalandmedicalscience
students,offeringpotentialinsightsintohow
institutionalfactorsmayinfluencesleephealth.

20. Study design
A descriptive, cross-sectional study was used.
Study duration
This study through three months from February 1
st
to 1
st
April, 2024.

21. Study Population
Thestudypopulationconsistedofundergraduatemedical
andmedicalsciencestudentsenrolledatAlraziUniversity
andtheUniversityofScienceandTechnology(UST)in
Sana'a,Yemenduringtheacademicyear2024.Participants
werespecificallyselectedfromtwodistinctgroups:
Undergraduatestudentsintheirpre-clinicalyears,who
hadnotyetbegunclinicalinternships.
Undergraduatestudentsintheirfinalyear,actively
engagedinclinicalinternships.

22. Study Population
cont..
This targeted selection aimed to capture the experiences of
students at two critical junctures in their medical education:
before and during the intense demands of clinical training. By
comparing these groups, the study sought to identify
potential differences in sleep patterns and contributing
factors based on the level of clinical exposure and academic
workload.
To ensure a representative sample within each group, a
stratified random sampling technique was employed,
considering factors such as gender and field of study
(medicine or medical science).

23. Sampling study and sample
size
Thesamplesizeforthisstudywascalculatedusingthe
StevenK.Thompsonequation,takingintoconsiderationthe
totalnumberofactivestudentsenrolledinmedicaland
medicalscienceprogramsatbothAlraziUniversityandthe
UniversityofScienceandTechnology.Theeligiblepopulation
comprisedstudentsagedbetween17and35yearsold.
Thecalculatedsamplesizewas363students.Toaccountfor
potentialnon-responseorincompletedata,anadditional15%
wasaddedtothesamplesize,resultinginatotalof418
studentstargetedforrecruitment.

24. Sampling study and sample size
cont..
Astratifiedrandomsamplingtechniquewasemployedto
ensureproportionaterepresentationfrombothuniversities
andacrossdifferentacademicyearsandspecializations.The
strataweredefinedbasedonthefollowingfactors:
University(AlraziUniversityorUniversityofScienceand
Technology)
AcademicYear(Pre-clinicalorclinicalinternshipyear)
Specialization(Medicineormedicalscience)

25. Sampling study and sample size
cont..
Withineachstratum,participantswererandomlyselected
usingacomputer-generatedrandomizationlist.Thismethod
ensuredadiverseandrepresentativesampleofthetarget
population,allowingformeaningfulcomparisonsacross
differentsubgroupsandenhancingthegeneralizabilityofthe
findings.
Thetotalparticipants(363)werecollectedbyconvenience
samplingtechnique

26. The inclusion criteria were included:
InclusionCriteria:
Undergraduatestudentsenrolledineithermedicalormedical
scienceprogramsatAlraziUniversityortheUniversityof
ScienceandTechnology(UST)duringtheacademicyear
2024.
Studentsintheirpre-clinicalyearsorfinalyear(clinical
internshipyear).
Age18yearsorolder.
Willingandabletoprovideinformedconsenttoparticipatein
thestudy.

27. The exclusion criteria were included
Studentswithdiagnosedsleepdisorders(e.g.,insomnia,
sleepapnea).
Studentscurrentlytakingmedicationsknowntoaffectsleep
(e.g.,sedatives,stimulants).
Studentswithsignificantmedicalconditionsthatmay
interferewithsleep(e.g.,chronicpain,respiratoryproblems).
Studentswhoareunableorunwillingtocompletethestudy
questionnaires.
Allstudentswhohavenotfulfilledtheinclusioncriteria.

28. Data collection methods
Datawerecollectedthroughacombinationofin-person
interviewsandself-administeredquestionnaires.Thismixed-
methodsapproachallowedforthegatheringofboth
quantitativeandqualitativedatatoprovideacomprehensive
understandingofsleeppatternsandassociatedfactors
amongmedicalandmedicalsciencestudents.

29. Data collection tools
Self-administrationstructuredinterviewquestionnaire.
Aself-administeredstudyquestionnairewasdevelopedfrom
previousstudiesandorganizationguidelinessuchas
(BuysseDJ,ReynoldsCF,3rd,MonkTH,BermanSR,Kupfer
DJ,1989),(JohnsMW.1991)

30. This questionnaire consists of
three parts :
PartI: DemographicCharacteristics:Thatcovered
UniversityName,SpecialtyName,Gender,Residentialstatus,
Age(inyears),Levelofeducationetc...
PartII:TheEpworthSleepinessScale(ESS)isavalidated
toolforassessingdaytimesleepiness.
PartIII:ThePittsburghSleepQualityIndex(PSQI)isa
validatedtoolforassessingsleepqualityovera1month
periodwhichincludes7components,withaglobalPSQI
score>5beingindicativeofpoorSQ

31. ThePittsburghSleepQualityIndex(PSQI)isavalidatedtoolfor
assessingsleepqualityovera1monthperiodwhichincludes23
components,withaglobalPSQIscore>5beingindicativeofpoor
SQ,andtheEpworthSleepinessScale(ESS)isavalidatedtoolfor
assessingdaytimesleepiness(BuysseDJ,ReynoldsCF,3rd,
MonkTH,BermanSR,KupferDJ,1989),(JohnsMW.1991).
Validity and reliability of the tools :

32. ThePSQIisaself-ratedquestionnairethatassessessleepquality
anddisturbancesovera1-monthperiod.Itconsistsof24individual
items&questionsthatgeneratesevencomponentscores:
subjectivesleepquality,sleeplatency,sleepduration,habitual
sleepefficiency,sleepdisturbances,useofsleepingmedication,
anddaytimedysfunction.Thesecomponentscoresarethen
summedtoyieldaglobalPSQIscore,rangingfrom0to21,with
higherscoresindicatingpoorersleepquality.Aglobalscoreof5or
moreisgenerallyconsideredindicativeofpoorsleepquality.
Validity and reliability of the tools con..

33. TheEpworthSleepinessScale(ESS)isabriefself-
administeredquestionnairethatmeasuresdaytimesleepiness.
Itconsistsofeightitemsthatassessaperson'slikelihoodof
dozingofforfallingasleepinvarioussituations,suchassitting
andreading,watchingTV,orsittinginactiveinapublicplace.
Eachitemisratedonascaleof0to3,withhigherscores
indicatinggreatersleepiness.ThetotalESSscorerangesfrom
0to24,withscoresof10ormoregenerallyconsidered
indicativeofexcessivedaytimesleepiness.
TheESSisasimpleandeffectivetoolforidentifyingindividuals
whomaybeatriskforsleep-relatedaccidentsorimpaired
performanceduetoexcessivedaytimesleepiness.Itis
commonlyusedinbothresearchandclinicalsettingsto
assesssleepinesslevelsandmonitortreatmentoutcomes.

34. ThePSQIconsistsof24individualitems&questionsthat
generatesevencomponentscores:subjectivesleepquality,sleep
latency,sleepduration,habitualsleepefficiency,sleep
disturbances,useofsleepingmedication,anddaytime
dysfunction.Thesecomponentscoresarethensummedtoyielda
globalPSQIscore,rangingfrom0to21,withhigherscores
indicatingpoorersleepquality.Aglobalscoreof5ormoreis
generallyconsideredindicativeofpoorsleepquality.
Scoring System

35. TheESSconsistsofeightitemsthatassessaperson'slikelihood
ofdozingofforfallingasleepinvarioussituations,suchassitting
andreading,watchingTV,orsittinginactiveinapublicplace.
Eachitemisratedonascaleof0to3,withhigherscores
indicatinggreatersleepiness.ThetotalESSscorerangesfrom0
to24,withscoresof10ormoregenerallyconsideredindicativeof
excessivedaytimesleepiness.
Scoring System cont..

36. Beforeinitiatingthemaindatacollectionprocess,apilotstudywas
conductedwith15%ofthetotalsamplesize(approximately63
students).Thepilotstudyservedseveralpurposes:
TimingEstimation:Todeterminetheaveragetimerequiredfor
participantstocompleteboththeinterviewandquestionnaire.
Pilot Study :

37. SuitabilityAssessment:Toevaluatetheclarityandrelevanceofthe
questions,aswellasthefeasibilityofthedatacollectionprocedures.
ChallengeAnticipation:Toidentifyanypotentialchallengesorissues
thatcouldariseduringthemaindatacollectionphase,allowingfor
adjustmentsandrefinementstothemethodology.
Note:Thepretestwasexcludedfromthefinalstudysample.
Pilot Study cont..

38. Apackagedcomputeranalysisprogram,StatisticalPackagefor
theSocialScience(SPSS21.0)wasusedforstatistical
analysisofthisdata.
Descriptivestatisticswereusedtointerpretthedemographic
data,anddescriptivemeasures,includingfrequency,the
percentageforcategoricalvariables,andthemeanand
standarddeviationfornumericalvariables.
Tofindtheassociationbetweenpoorsleepquality&excessive
daytimesleepinesslevelanddemographiccharacteristics
wereusedchi-squaretestforcategoricaldata,andaP-value≤
0.05wasconsideredsignificant.
Data Processing and Analysis

39. Approvalofthestudywasobtainedbeforethestudyfromthe
ethicalcommitteeoftheFacultyofMedicineandHealth
SciencesofAl-RaziUniversity.
AcoverletterwassenttotheAlraziUniversity&theUniversityof
ScienceandTechnology(UST)toobtainapprovaltoconduct
thisstudy.
Thepurposeandbenefitsofthestudywereexplainedto
participants.
Theinformedwrittenandverbalconsentwastakenfromall
participantsinthisstudy.
Allstudentsalsohavetherighttoaccepttoparticipateorto
withdrawfromthestudy.
Ethical Considerations

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41. PercentFrequency
44.1160Alrazi university
55.9203Science and
Technology
university
100.0363Tota

42. Ethical Considerations
Frequency Percent
Female 188 51.8
Male. 175 48.2
Total 363 100.0

43. Ethical Considerations
Freuency
q
percentt
Anesthesia 12 3.3
Dentistry 72 19.8
Diagnostic Radiology 13 3.6
Medical Laboratories 21 5.8
Medicine-MBBS 109 30.0
Midwifery 19 5.2
Nursing 12 3.3
Nutrition 12 3.3
Optometry 7 1.9
Pharmacy 52 14.3
Physiotherapy 5 1.4
Respiratory Care 12 3.3
Therapeutic Nutrition 17 4.7
Total 363 100.0

44. The distribution of residential
status among respondents (n=363):
Frequency Percent
Alone 35 9.6
With Family 258 71.1
With Friends 70 19.3
Total 363 100.0

45. The distribution of age among respondents
(n=363):
Frequenc
Percent
15-20 years 112 30.9
21-25 years 220 60.6
26-30 years 30 8.3
31-35 years 1 .3
Total 363 100.0

46. The distribution of Level of education
among respondents (n=363):
Frequency Percent
First 79 21.8
Second 89 24.5
Third 71 19.6
Fourth 80 22.0
Fifth 22 6.1
Sixth 11 3.0
Internship 11 3.0
Total 363 100.0

47. Chance of dozing
Never slight moderate High
N N % N % N
Sleepiness during sitting and
reading
39 110 30.3%14239.1
%
72
Sleepiness during watching
television
94 153 42.1%8122.3
%
35
Sleepiness during sitting
inactive in a public place
(e.g. a theatre or meeting)
86 108 29.8%10629.2
%
63
Sleepiness during being a
passenger in a car for an
hour without a break
85 92 25.3%9225.3
%
94
Sleepiness when lying down
to rest in the afternoon when
circumstances permit
26 59 16.3%11632.0
%
162
Sleepiness during sitting and
talking to someone
211 122 33.6%205.5% 10
Sleepiness when sitting
quietly after a lunch
41 86 23.7%12333.9
%
113
Sleepiness in a car, while
stopped for a few minutes in
the traffic
177 115 31.7%4612.7
%
25

48. N %
15. "During the past month, what time have you usually gone to bed at night?" could include: Before 9:00 pm 14 3.9%
Between 9:00 pm and
10:00 pm
33 9.1%
Between 10:00 pm and
11:00 pm
56 15.4%
Between 11:00 pm and
midnight
104 28.7%
After midnight 156 43.0%
16. "During the past month, how long (in minutes) has it usually takes you to fall asleep each night?" could include: Less than 15 min 123 33.9%
16-30 min 103 28.4%
31-60 min 68 18.7%
More than 60 min 69 19.0%
17. "During the past month, what time have you usually gotten up in the morning After 7am 115 31.7%
6-7am 143 39.4%
5-6am 73 20.1%
Before 5 am 32 8.8%
18. A -"During the past month, how many hours of actual sleep did you get at night?" Less than 4 hours 38 10.5%
Between 4 and 5 hours 64 17.6%
Between 5 and 6 hours 87 24.0%
Between 6 and 7 hours 93 25.6%
Between 7 and 8 hours 52 14.3%
More than 8 hours 29 8.0%
18. B-"During the past month, how many hours were you in bed?" could include: Less than 4 hours 13 3.6%
Between 4 and 5 hours 35 9.6%
Between 5 and 6 hours 73 20.1%
Between 6 and 7 hours 84 23.1%
Between 7 and 8 hours 88 24.2%

50. Taking medicine to help you sleep
(prescribed or “over the counter”):
Not during
the past
month
Less than once a
week
Once or twice a
week
Three or more times
a week
N % N % N % N %
20-During the past
month, how often have
you taken medicine to
help you sleep
(prescribed or “over the
counter” )?:
18751.5%79 21.8% 59 16.3% 38 10.5%

51. Having trouble of staying awake while driving,
eating meals, or engaging in social activities
Not
during
the past
month
Less than once a
week
Once or twice a
week
Three or more
times a week
N% N % N % N %
21-During the
past month, how
often have you
had trouble
staying awake
while driving,
eating meals, or
engaging in social
activities?
297
81.
8
%
31 8.5% 17 4.7% 18 5.0%

52. Having a problem to keep up enough
enthusiasm to get things done
No problem
at all
Only a very
slight problem
Somewhat of a
problem
A very big
problem
N % N % N % N %
22-During the
past month, how
much of a
problem has it
been for you to
keep up enough
enthusiasm to get
things done?
8022.0%8824.2%123 33.9% 72 19.8%

53. Rating Sleep quality (component one )
Very Bad Fairly Bad Fairly GoodVery Good
N % N % N % N%
23-During the
past month, how
would you rate
your sleep quality
overall?
68 18.7% 46 12.7% 178 49.0%71
19.6
%

54. Ethical Considerations

55. Ethical Considerations

56. Ethical Considerations

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