Prevalence Of Sleep Disorders Among Medical Students Of Lahore and Their Correlation with Obesity

Introduction: An adequate amount of good-quality sleep is essential for optimal physical and mental health. Sleep disorders affecting sleep duration and quality result in several clinical conditions, including stress and obesity. Medical students are prone to sleep related disorders due to highly stressful academic demands and clinical practices. Aims & Objectives: This study was carried out to investigate prevalence of sleep disorders among medical students of Lahore and their correlation with overweight and obesity. Place and Duration of Study: The participants were medical students from Central Park Medical College and Allama Iqbal Medical College, Lahore. Duration of study was from 8 th August 2022 to 24 th October 2022. Material & Methods: Data was obtained from 424 participants, by using a simple random sampling technique. A structured questionnaire was used to collect information about the symptoms of five sleep disorders as well as the participants' height and weight .For data analysis SPSS version 26 was used, a p-value of (cid:148) 0.05 was considered significant. Results: This research demonstrated a noteworthy correlation between insufficient sleep and increased BMI, leading to overweight and obesity. However, sleep disorders causing reduced sleep quality did not have a significant impact on BMI. Conclusion: According to this study, sleep disturbances are quite common among medical students of Lahore and higher BMI is associated with insomnia.


INTRODUCTION
Sufficientsleep of good quality is required for the optimal functioning of the human mind and body.For adults, the American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) currently suggest seven or more hours of sleep per night in order to maintain good health 1,2 .Studies have shown that adequate quantity and good quality sleep are instrumental in restoring andmaintaining cognitive and psychomotor performance and mental and physical health 3- 6 .There is growing interest in studying sleep disordersbecause sleepiness and fatigue are epidemics leading to various health issues 7 .Insomnia is one type of sleep disorder in which individuals struggle to fall or stay asleep even when given the chance, resulting in at least three times a week in a month of sleep deprivation.Breathing disorders such as sleep apnea, in which breathing stops several times in a state of sleep [8][9][10][11][12] .Similarly, nightmares are usually prevalent in young children i.e. 20.6% to 26.5% and rare in adults, ranging from 1% to 4% in the general adult population 13,14 .Narcolepsy is a type of sleep disorder in which people experience unnecessary sleepiness during daytime and a tendency to doze off during lectures, work, or drive despite feeling rested after waking up.Prevalence was found to 17.88% 15,16 .A neurological disorder called restless legs syndrome is associated with poor quality of sleep.This neurological disorder causes unpleasant sensations in the legs and an irresistible urge to move the legs during sleep.This condition impacts sleep quantity and quality with delayed sleep onset, maintenance, insomnia, fatigue, sleepiness, reduced concentration, and depression 17 .Studies have shown that less than 7 hours of sleep per night results in unhealthy weight gain and obesity compared to adults who sleep 7 hours or more per night 18 .Sleep disorders

INTRODUCTION
Globally, acute generalized peritonitis ranks among the top surgical emergencies 1 .It is more common in Third World nations.The prevalence of perforation is low (0.6% -4.9%) in developed nations but high (33% -63%) in West Africa 2 .554 persons were discovered to have peritonitis in a study that took place over three years in India 3 .Researchers in Pakistan have conducted studies with similar methods, with one study reporting 650 cases in a just 9 months 4 .Most cases of peritonitis are caused by a gastrointestinal perforation or anastomotic leak 5 .In the case of peritonitis, anaerobes and gramnegative organisms are mostly responsible for sepsis and morbidity due to the overactive inflammatory cascade brought on by the release of endotoxins 5 .Clinical evidence is used to identify peritonitis.Diagnosis can be achieved via upright plain x-ray of the abdomen, USG, or CT scan.This is often done through diagnostic laparoscopy nowadays 6 .Resuscitation, diagnosis, prompt exploration, treatment of the underlying cause, and extensive surgical peritoneal lavage have always been the cornerstones of peritonitis therapy regimens (IOPL) 7,8 .Regular IOPL is performed to lessen bacterial contamination and burden.Even though large volumes of normal saline are used in IOPL, the rates of sepsis, wound infection, and mortality remain alarmingly high.Another method negatively impact appetite and metabolic rate.By directly impacting the hypothalamus 19,20 .It leads to increased calorie intake in waking hours, increased appetite hormone ghrelin and decreased levels of the satiety-inducing hormone leptin 21 .Obesity is a severe health concern globally, with significant consequences on public health.The obesity pandemic coincides with the modern lifestyles, physiological and psychological stress factors that enhance cortisol production.Obesity and sleep disorders link and magnify one other in a vicious cycle created by overeating and sleep deprivation 22 .Sleep disorders are quite common among the medical students due to high stress levels and poor sleep quality due to the physically, mentally, and emotionally challenging academic commitments, long study hours, frequent examinations and clinical duties and unhealthy lifestyle choices due to these commitments, such as social isolation 23 .Irregular sleep patterns such as disruption, restriction, and lack of sleep due to the demanding educational responsibilities of medical studies lead to insomnia and obstructive sleep apnea syndrome (OSAS) 1 .Information about the sleep disorders and obesity among the young Pakistani population is scarce, especially concerning the emergence of symptoms in medical students.So the aim of this study is to assess prevalence of different sleep disorders among medical students of Lahore and their correlation with overweight and obesity.

MATERIAL AND METHODS
A cross sectional study was conducted to evaluate the prevalence of sleep disorders and their association with BMI among medical students of Lahore.Data was collected from two medical colleges of Lahore i.e. ).The average weight of the students was 62.9 ± 13.3 (in kgs) whereas the average weight of the students before they went to medical college was 61.5 ± 13.5 (in kgs).The difference between the weights of medical students was compared by using the non-parametric Wilcoxon signed rank test.There was a statistically significant difference between average weights (pvalue = 0.00).The average BMI was 22.7±4.5 .
There exists statistically significant difference between the mean BMI of the students with and without insomnia (Table - The difference between average BMI among medical students with and without insomnia was statistically significant, therefore the relation of insomnia with BMI, waist circumference, age, weight before joining medical college and current weight and height was observed using binary logistic regression.The Hosmer and Lemeshow test revealed that the model accurately reflected the data.BMI was significant factor for insomnia.The odds of insomnia are 4.49 times high for increased BMI (Table -2 27 Insomnia is prevalent in 25.5% of the students and have a positive correlation between Insomnia and obesity.Students who have Insomnia were significantly overweight or obese.However, the other sleep disorders were really distributed among the students irrespective of their weight.Statistically, we found no difference in weight between the students suffering from narcolepsy, restless leg syndrome, nightmares and sleep apnea.In contrast to our findings a study done in Kuwait showed that sleep disturbance and deprivation may play indirectly roles in the emergence of metabolic disorders, such as type 2 diabetes and obesity 28 .Independent of age and sex, we discovered a statistically significant correlation between sleep quality and obesity.Acti-graph data provided additional support for the population-wide independent relationship between sleep duration and BMI (p 0.001) 28 .In addition to this, 88 participants from King George's Medical University were chosen for the purpose of a cross-sectional investigation and found that mean sleep quality (mean PSQI SD) was low among people with grade I and II obesity.This study also showed that short sleep duration (SD (h) 6 h/day) is associated with a higher likelihood of being overweight and obese 29 .On the other hand, a research conducted on Chinese college students found no relationship between sleeplessness and obesity 30 .
Central Park Medical College and Allama Iqbal Medical College.Ethical approval was taken from Institutional Review Board of Central Park Medical College, Lahore on 4 th January, 2023 (IRB No: CPMC/IRB.No/1376).Data was collected from medical students aged between 21.3 ±1.6 SD in years irrespective of their gender and their class of study.The calculated sample size was385 keeping the confidence level at 95% and margin of error to be 5%.Structured Questionnaire focused on symptoms of five sleep disorders and the participants' height, weightand waist circumference.Five sleep disorders included Insomnia, Sleep apnea, Narcolepsy and Nightmaresand Restless leg syndrome.Data was collected from 424 participants by random sampling technique.Written informed consent was taken from participants and their identity was not revealed during or after any part of the study.Using criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM V) and the International Classification of Sleep Disorders (ICSD), participants were determined to have one of the five sleep disorders (Chung et al., 2015).For data analysis SPSS version 26 was used.RESULTS

: Average BMI Of Medical Students With And Without Sleep Disorder (N=424) *P-value less than or equal to 0.05 statistically significant
1).