Long-term Altered Sleep-wake Cycle Results in Increased Stress Levels and Poor Stress Adaptation Capacity in Medical Students: A Scoping Review

Aims and objectives: Since the medical curriculum is very wide and difficult, sleep duration in medical students is reduced significantly as they are under vast academic pressure.As a result, sleeping habits get disturbed.These reduced hours of sleep and nighttime awakening influence their stress adaptation capacity, i.e., the ability of the young individuals to adapt to changing stress in the environment.So, because of this disturbed sleep-wake cycle and a lot of stressors around, it is found that the medical students have an increased level of stress.With this background, this scoping review aims to collect the relevant literature on disturbed sleep patterns causing a high level of stress in students pursuing medicine.The hypothesis of this review is that disturbed sleep circadian timing may lead to increased stress levels because both the stress and sleep are closely related to the hypothalamic -pituitary -adrenal axis.Methods: Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) guidelines are used to perform this scoping review.We have selected the articles published until February 2025.First, we selected the articles, then added the authors' names, populations studied, years of publication, methods applied and lastly the results.The analysis comprised 10 studies from different countries.All studies were conducted at a medical college, and the participants were medical students.Results: In all ten studies, significantly high stress levels were found, and they were strongly associated with disturbed sleep patterns.Also, no significant association between stress levels and gender was found.This review shows a significant association between poor sleep quality and stress in medical students.In almost all studies, the level of stress was more than 50%, and the sleep quality is also found to be very poor.The average sleep hours, which should be at least more than 6 hours, were found to be less than 5 hours in most of the studies.Conclusion: This review clearly indicates the need to relieve stress in medical students, and to explain the importance of good sleep.The majority of students pursuing medicine are under high academic pressure.They are mentally stressed, and that deteriorates their sleeping patterns.Clinical significance: This review shows a strong association between high levels of psychological stress and a dangerous level of poor sleep quality among students who are pursuing medicine as a future.In order to reduce stress and create a healthy environment, steps should be taken to ensure that clinical care and learning become enthralling for them.