SLEEP DEPRIVATION IN MEDICAL STUDENTS AND THE RISK OF ANXIETY DISORDERS

Abstract

Introduction: Sleep deprivation, poor sleep quality, insomnia, and circadian disruption are highly prevalent among medical students and frequently coexist with anxiety symptoms. The demanding characteristics of medical education may intensify this association through academic pressure, irregular schedules, night-time digital behavior, reduced recovery time, and limited access to confidential psychological care.   Objective: The main objective was to evaluate the association between sleep deprivation and anxiety symptoms or anxiety disorders among medical students. Secondary objectives were to characterize the principal sleep disturbances, examine relevant behavioral and academic factors, compare different sleep exposures, assess the certainty of evidence, and identify implications for clinical practice and medical education.   Methods: PubMed, Scopus, Web of Science, the Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP were searched for studies published within the preceding five years. Human studies evaluating sleep duration, sleep quality, insomnia, chronotype, or sleep-related impairment together with anxiety outcomes in medical students were eligible. Study selection, data extraction, risk-of-bias assessment, narrative synthesis, and GRADE evaluation were planned according to PRISMA principles.   Results and Discussion: Twenty studies were included. Poor sleep quality, insomnia symptoms, short sleep duration, evening chronotype, smartphone addiction, and fear of missing out were consistently associated with greater anxiety symptom burden. The findings were reproduced across several countries and academic stages, but considerable heterogeneity was observed in sleep definitions, anxiety instruments, populations, and statistical analyses. Most studies were cross-sectional and used self-administered screening questionnaires, resulting in low certainty regarding causality and the incidence of formally diagnosed anxiety disorders.   Conclusion: Sleep disturbance and anxiety symptoms frequently coexist among medical students and should be assessed reciprocally. Medical schools should combine confidential mental-health services, sleep-health education, digital-behavior interventions, curriculum and scheduling review, and access to individualized evidence-based treatment. Prospective studies and randomized trials are required to determine whether improving sleep prevents or reduces clinically significant anxiety.