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      Relationship between chronotype and quality of sleep in medical students at the Federal University of Paraiba, Brazil

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          Abstract

          Objective

          The aim of this study was to identify chronotypes of medical students at the Federal University of Paraíba (UFPB) and its relationship to quality of sleep, daytime sleepiness, age, sex and season of birth.

          Methods

          The final sample consisted of 221 students, assessed by four questionnaires: demographic questionnaire, Morningness–Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality lndex (PSQI) and Epworth Sleepiness Scale (ESS).

          Results

          There was a statistically significant difference between groups with respect to chronotypes and PSQI score ( p<0.0005), but not with excessive daytime sleepiness. A significant negative correlation was found between the scores of MEQ and PSQI (rho=−0.3, p<0.0005), demonstrating that the greater the eveningness, the worse the sleep quality. It was observed that 51.6% of students were classified as indifferent chronotype, 61.5% had poor quality of sleep, while 42.1% had excessive daytime sleepiness. Sex and season at birth did not differ between chronotypes.

          Conclusion

          These findings demonstrate that the evening chronotype was associated with poor quality of sleep in medical students, but not with increased daytime sleepiness, with potential impairment to their academic performance and quality of life.

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          Most cited references45

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          Circadian preference, sleep and daytime behaviour in adolescence.

          Flavia Giannotti, Flavia Cortesi, Teresa Sebastiani … (2002)
          The aim of this study was to determine the relationship between circadian preferences, regularity of sleep patterns, sleep problems, daytime sleepiness and daytime behaviour. As a part of an epidemiological survey on sleep in a representative sample of Italian high-school students, a total of 6631 adolescents, aged 14.1-18.6 years, completed the School Sleep Habits Survey, a comprehensive questionnaire including items regarding sleep, sleepiness, substance use, anxiety and depressed mood, use of sleeping pills, school attendance and a morningness/eveningness scale. The sample consisted of 742 evening-types (315 males and 427 females; mean age 17.1 years) and 1005 morning-types (451 males and 554 females; mean age 16.8 years). No significant sex differences were found for morningness/eveningness score. Eveningness was associated with later bedtime and wake-up time, especially on weekends, shorter time in bed during the week, longer weekend time in bed, irregular sleep-wake schedule, subjective poor sleep. Moreover, evening types used to nap more frequently during school days, complained of daytime sleepiness, referred more attention problems, poor school achievement, more injuries and were more emotionally upset than the other chronotype. They referred also greater caffeine-containing beverages and substances to promote sleep consumption. Our results suggest that circadian preference might be related not only to sleep pattern, but also to other adolescent behaviours.
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            The epidemiology of morningness/eveningness: influence of age, gender, ethnicity, and socioeconomic factors in adults (30-49 years).

            Noémie Travier, Sarah-Jane Paine, Philippa Gander (2006)
            The Horne and Ostberg Morningness/Eveningness Questionnaire (MEQ) is widely used to differentiate between morning and evening types, but there is very little epidemiological evidence about the distribution of MEQ chronotypes in the general population. The purpose of the present study was to simultaneously investigate the influence of demographic, socioeconomic, and work factors on the distribution of morningness/eveningness. A New Zealand version of the MEQ was mailed to 5000 New Zealand adults, ages 30 to 49 years, who were randomly selected from the electoral rolls (55.7% response rate). A total of 2526 questionnaires were included in the analyses. According to the Horne and Ostberg classification, 49.8% of the total population was classified as morning type compared to 5.6% having an evening-type preference. However, using new cutoffs for middle-aged working adults described by Taillard et al. (2004), 24.7% of the population was morning type and 26.4% was evening type. After controlling for ethnicity, gender, and socioeconomic deprivation, participants ages 30 to 34 years were more likely to be definitely evening type (odds ratio [OR] = 1.59, p < 0.05) and less likely to be morning type (moderately morning type, OR = 0.59, p < 0.01, or definitely morning type, OR = 0.59, p < 0.05) compared to those ages 45 to 49 years. Work schedules were also important predictors of chronotype, with night workers more likely to be definitely evening type (OR = 1.49, p = 0.05) and the unemployed less likely to be moderately morning type (OR = 0.64, p < 0.05) compared to other workers. Evening types were 2.5 times more likely to report that their general health was only poor or fair compared to morning types (p < 0.01). This study confirms that the original criteria of Horne and Ostberg (1976) are not useful for classifying chronotypes in a middle-aged population. The authors conclude that morningness/eveningness preference is largely independent of ethnicity, gender, and socioeconomic position, indicating that it is a stable characteristic that may be better explained by endogenous factors.
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              Morningness-eveningness, chronotypes and health-impairing behaviors in adolescents.

              A Rigo, Tímea Magyaródi, Róbert Urbán (2011)
              The impact of diurnal preferences on health-related behaviors is acknowledged but relatively understudied. The aim of this study was threefold: (1) testing the measurement model of the Hungarian version of the reduced Horne-Östberg Morningness-Eveningness Questionnaire (Hungarian Version of the rMEQ); (2) estimating chronotypes and their prevalence; and (3) analyzing the relationship between morningness-eveningness/chronotypes and health-impairing behaviors, including smoking, alcohol use, and physical inactivity in adolescents. Self-reported data on the Hungarian version of the rMEQ, smoking, alcohol use, and physical inactivity obtained from Hungarian high-school students (ninth grade, N = 2565) were analyzed with confirmatory factor analysis (CFA), latent profile analysis (LPA), structural equation modeling, and analysis of variance (ANOVA). A one-factor model of morningness was supported, which included rising time, peak time, retiring time, and self-evaluation of chronotype. Morningness was significantly associated with a lower likelihood of smoking and alcohol use, and also with a lower level of physical inactivity. Using LPA, the authors identified three chronotypes: intermediate type (50.7%), morning type (30.5%), and evening type (18.8%). Compared to the evening-type participants, intermediate- and morning-type participants were significantly less likely to experiment with smoking, to smoke nondaily, and to smoke daily. Moreover, both intermediate- and morning-type students reported less lifetime alcohol use and less physical inactivity than evening-type students. Chronopsychological research can help to understand the relatively unexplored determinants of health-impairing behaviors in adolescents associated with chronotype.
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                Author and article information

                Contributors
                Gabriela Lemos Negri Rique
                Journal
                Journal ID (nlm-ta): Sleep Sci
                Journal ID (iso-abbrev): Sleep Sci
                Title: Sleep Science
                Publisher: Elsevier
                ISSN (Print): 1984-0659
                ISSN (Electronic): 1984-0063
                Publication date PMC-release: 16 September 2014
                Publication date (Print): June 2014
                Publication date (Electronic): 16 September 2014
                Volume: 7
                Issue: 2
                Pages: 96-102
                Affiliations
                [0005]Department of Internal Medicine, School of Medicine, Federal University of Paraíba, João Pessoa, Brazil
                Author notes
                [* ]Correspondence to: Rua Rita de Alencar C. Luna, no. 72, apt. 403, Brisamar, João Pessoa, PB 58033-080, Brazil. Tel.: +55 83 91886570. riquegln@ 123456gmail.com
                Article
                Publisher ID: S1984-0063(14)00031-5
                DOI: 10.1016/j.slsci.2014.09.004
                PMC ID: 4521651
                PubMed ID: 26483910
                SO-VID: 75bb802f-c317-4907-a531-75a08d8e9604
                Copyright © © 2014 Brazilian Association of Sleep. Production and Hosting by Elsevier B.V.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

                History
                Date received : 28 December 2013
                Date revision received : 26 February 2014
                Date accepted : 28 February 2014
                Categories
                Subject: Original Article

                Keywords: chronobiology phenomena,sleep deprivation,medical students
                Data availability:
                Keywords: chronobiology phenomena, sleep deprivation, medical students

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