Association Between Sleep Quality, Perceived Stress, and Body Mass Index Among Medical Students at Pontificia Universidad Católica del Ecuador During the Second Academic Term of 2024–2025

Abstract

Background: Sleep quality is a key determinant of physical and mental health, influencing metabolic, cognitive, and neuroendocrine processes. Medical students are particularly vulnerable to poor sleep quality and high stress levels due to academic demands, which may impact their nutritional status, reflected by body mass index (BMI). However, evidence integrating these variables in local contexts remains limited. Objective: To determine the association between sleep quality and perceived stress with BMI in medical students at the Pontificia Universidad Católica del Ecuador during the second academic period of 2024–2025. Methods: An analytical cross-sectional study was conducted in 269 medical students from the second, sixth, and tenth semesters. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), perceived stress through the Perceived Stress Scale (PSS-14), and BMI was calculated from measured weight and height. Variables were categorized and analyzed using Pearson’s chi-square test to determine associations, with a significance level of p < 0.05. Results: A high prevalence of poor sleep quality was observed (91.45%). Additionally, 95.1% of students reported some level of perceived stress. Regarding nutritional status, 68.8% had normal BMI, while 27.9% presented overweight or obesity. A statistically significant association was found between BMI and sleep quality (χ² = 4.60; p = 0.032), with a higher prevalence of poor sleep among students with overweight/obesity (97.3%). Similarly, a significant association was identified between BMI and perceived stress (χ² = 5.86; p = 0.016), with higher stress levels more frequent in students with excess weight. Conclusions: There is a significant association between sleep quality, perceived stress, and BMI in medical students. These findings suggest a multidimensional interaction in which poor sleep and high stress are related to altered nutritional status. Comprehensive institutional strategies addressing sleep hygiene, stress management, and healthy lifestyle promotion are recommended to improve student well-being.