1 Department of Human Behaviour, School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.
2 University of Sydney, School of Public Health. Sydney, NSW, Australia.
Aust N Z J Psychiatry. 2018 Jan;52(1):39-46. doi: 10.1177/0004867417716543. Epub 2017 Jun 26.
Medical training brings with it multiple stressors, including demanding workloads in highly competitive environments, with well-documented impact on psychiatric morbidity. This study evaluated the impact of sleep-related factors on psychological wellbeing, cognitive task performance and academic standing in medical students.
A total of 59 undergraduate medical students took part in this cross-sectional study over two consecutive days. Participants responded to questionnaires about their physical and psychological health, sleep, functioning and academic performance at the initial visit. Participants then wore an ambulatory bioharness overnight (to derive heart rate variability measures), before returning to complete a computerised battery of cognitive tasks. A sleep diary was completed for the next 7 days.
Poor sleep quality in the month preceding assessment correlated with psychological distress ( p < 0.001) and reduced nocturnal heart rate variability ( p = 0.007). Psychological distress also correlated with reduced nocturnal heart rate variability ( p = 0.031) and less refreshing sleep during the monitoring week ( p < 0.001), but not with sleep timing parameters. A greater increase in heart rate variability during the transition from awake to sleep significantly predicted better spontaneous cognitive performance ( p = 0.021). Better academic standing was predicted by consistently short, less refreshing sleep (all p < 0.001), along with earlier bedtimes ( p = 0.004) and greater psychological wellbeing ( p = 0.009).
Unrefreshing, short-duration sleep and psychological distress are prevalent in medical students during university training and were associated with reduced nocturnal parasympathetic autonomic activity. Achieving higher academic grades was associated with high psychological wellbeing despite consistently short, unrefreshing sleep. The long-term repercussions of such sleep behaviours on later professional functioning remain unclear, warranting further research.
医学培训带来了多种压力源，包括在竞争激烈的环境中承担繁重的工作量，这对精神发病率有很好的记录。本研究评估了睡眠相关因素对医学生心理健康、认知任务表现和学业成绩的影响。
共有 59 名本科医学生参加了这项连续两天的横断面研究。参与者在初次就诊时回答了关于身体和心理健康、睡眠、功能和学业表现的问卷。然后，参与者佩戴可移动的生物传感器过夜（以获得心率变异性测量值），然后返回完成计算机化的认知任务电池。接下来的 7 天填写睡眠日记。
评估前一个月的睡眠质量差与心理困扰（p<0.001）和夜间心率变异性降低（p=0.007）相关。心理困扰也与夜间心率变异性降低（p=0.031）和监测周期间睡眠恢复不佳（p<0.001）相关，但与睡眠时间参数无关。从清醒到睡眠过渡时心率变异性增加幅度较大，可显著预测自发认知表现更好（p=0.021）。学业成绩较好与睡眠时间始终较短、睡眠恢复不佳（均 p<0.001）、早睡（p=0.004）和心理健康状况较好（p=0.009）相关。
在大学培训期间，医学生普遍存在睡眠不恢复、持续时间短和心理困扰，并且与夜间副交感神经活动减少有关。尽管睡眠时间始终较短、睡眠恢复不佳，但获得较高的学业成绩与较高的心理健康状况相关。这种睡眠行为对以后职业功能的长期影响尚不清楚，需要进一步研究。
