A Mariappan Vijandran, Mukhtar Firdaus
Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
J Clin Psychol. 2025 Jun;81(6):399-409. doi: 10.1002/jclp.23781. Epub 2025 Mar 8.
Sleep problems such as poor sleep quality and insomnia are common issues among medical and paramedical students, which may lead to mental health disorders and impaired academic performance. Despite the availability of different sleep programs and psychological interventions, as well as a few reviews exploring their effects on sleep variables in college students, a systematic review comparing their effectiveness in medical students is still lacking. This systematic review aims to investigate psychological interventions to improve sleep quality and address sleep problems in medical students. Four databases (PubMed, SciDirect, Scopus, and PsycNet) were searched to retrieve original research articles written in English and published from January 1, 2000, to September 30, 2023. Outcome measures were sleep quality, insomnia, sleep behavior, sleep quantity, and sleep-related problems. A total of 19 articles met the inclusion criteria, and 4 categories of interventions were identified (1) sleep hygiene, (2) cognitive behavioral therapy (CBT), (3) a combination of sleep hygiene/CBT with other modalities, and (4) other psychotherapeutic interventions such as progressive muscle relaxation, hypnotherapy, aromatherapy yoga, and mindfulness. Ten studies were randomized control trials, two were quasi-experimental, and the remaining seven were pre- and post-intervention designs (one group only and no control). Overall, both individual CBT and sleep hygiene education led to significant improvement in sleep quality and sleep problems among medical students, but CBT was more effective with consistent positive effects on sleep quality. Nevertheless, significant improvements in sleep quality and sleep-related outcomes were observed in studies combining these psychological interventions. Effective comparisons were limited due to the substantial heterogeneity between the studies. Further research is required to elucidate the type of psychological intervention, optimal mode of delivery, duration, and number of contacts of these interventions, including the moderators to improve sleep quality among medical students.
睡眠质量差和失眠等睡眠问题在医学生和准医学生中很常见，这可能会导致心理健康障碍和学业成绩受损。尽管有不同的睡眠计划和心理干预措施，也有一些综述探讨了它们对大学生睡眠变量的影响，但仍缺乏一项比较它们在医学生中有效性的系统综述。本系统综述旨在研究心理干预措施，以改善医学生的睡眠质量并解决睡眠问题。检索了四个数据库（PubMed、SciDirect、Scopus和PsycNet），以获取2000年1月1日至2023年9月30日期间发表的英文原创研究文章。结果指标包括睡眠质量、失眠、睡眠行为、睡眠时间和与睡眠相关的问题。共有19篇文章符合纳入标准，确定了4类干预措施：（1）睡眠卫生，（2）认知行为疗法（CBT），（3）睡眠卫生/CBT与其他方式的组合，以及（4）其他心理治疗干预措施，如渐进性肌肉松弛、催眠疗法、芳香疗法瑜伽和正念。十项研究为随机对照试验，两项为准实验研究，其余七项为干预前后设计（仅一组且无对照）。总体而言，单独的CBT和睡眠卫生教育都能显著改善医学生的睡眠质量和睡眠问题，但CBT更有效，对睡眠质量有持续的积极影响。然而，在结合这些心理干预措施的研究中，观察到睡眠质量和与睡眠相关的结果有显著改善。由于研究之间存在很大的异质性，有效的比较有限。需要进一步的研究来阐明这些干预措施的心理干预类型、最佳实施方式、持续时间和接触次数，包括改善医学生睡眠质量的调节因素。
