Poor Sleep Quality is Independently Associated With Executive Dysfunction Among Future Physicians: A Multinational Cross-sectional Analysis of +1600 Undergraduates in Egypt and Sudan
Nada Ashraf Al-Shafey1, Mohamed I. Mohamed1, Abdulrhman Helal2, Elaf Ahmed Basha3, Mostafa Nemr Ahmed4, Rahaf Attia M. Zakzouk5, Zahra Farid Serag6, Aamena Ibrahim Alsayed Mohammed Darwish6, Mustafa Youssef Mohamed Ahmed7, Zeyad Metwally El-Tokhy2, Mohamed Ahmed Shokry2, Magdy Mostafa Anber8, Nasser A. Abdelall9
1Alexandria University, Faculty of Medicine, Alexandria, Egypt, 2Faculty of Medicine, Benha University, Benha, Egypt, 3Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan, 4Faculty of Medicine, Cairo University, Cairo, Egypt, 5Faculty of Medicine, Menoufia University, Shibin al Kawm, Egypt, 6Faculty of Medicine, Al-Azhar University, Cairo, Egypt, 7South valley university, Faculty of medicine, Qena, Egypt, 8Tanta University Hospital, 9Department of Neurology, Louisiana State University School of Medicine, New Orleans, LA
Objective:
To examine the prevalence and determinants of poor sleep quality and its association with executive functioning among undergraduate medical students in low-resource settings.
Background:
Adequate sleep is essential for optimal cognitive performance, particularly executive functioning. However, the relationship between sleep quality and executive domains remains insufficiently studied among medical students in low- and middle-income countries.
Design/Methods:
An analytical cross-sectional study was conducted among 1,679 medical undergraduates from health-related faculties in Egypt (n = 1,057) and Sudan (n = 622). Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Behavior Rating Inventory of Executive Function–Adult Version (BRIEF-A). Spearman’s partial correlations, controlling for confounders, assessed associations between global PSQI scores and BRIEF-A T-scores. Binary logistic regression identified predictors of poor sleep quality.
Results:
Overall, 71.9% of participants reported poor sleep quality, with prevalence significantly higher among Egyptian students (65%) compared with Sudanese students (35%; p = 0.005). The multivariate model identified insignificant infrequency, inconsistency, and negativity, suggesting the validity of the collected responses. Independent predictors of poor sleep quality included chronic illness (OR = 1.69), financial stress (OR = 1.62), greater daily screen time (OR = 1.18), and higher caffeine intake (OR = 1.20), while longer sleep duration was protective (OR = 0.64). Executive domains most strongly associated with poor sleep included inhibitory control (OR = 1.036), emotional regulation (OR = 1.019), and planning/organization (OR = 1.02). By moderation analysis, sleep quality exerted a stronger impact on inhibition, working memory, behavioral regulation, and metacognition among male students (interaction p < 0.05), signifying males being more sensitive to sleep quality impairments.
Conclusions:
Poor sleep quality is widespread among medical students in Egypt and Sudan and is modestly linked to executive dysfunction. Interventions to improve sleep hygiene are urgently needed, with attention to gender-specific vulnerabilities, to safeguard cognitive and academic performance among future physicians.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.