Sleep quality across the medical career continuum: a cross-sectional study

Sleep disturbances are common among medical students and resident physicians, yet few studies have assessed sleep quality across medical training. This study compared sleep quality, daytime sleepiness, perceived stress, and pre-sleep behaviors across stages of medical education and residency, using non-medical students as controls. This cross-sectional study included 300 participants in six groups: internal medicine residents, surgical residents, interns, clinical medical students, preclinical medical students (years 1–3, before clinical clerkships), and non-medical controls (undergraduates enrolled in non-medical faculties at the same university). Sleep quality, daytime sleepiness, and perceived stress were assessed using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Perceived Stress Scale (PSS – 14). Sociodemographic characteristics, lifestyle factors, screen use before sleep and in bed, eating before sleep, and monthly on-call shifts among residents were recorded. Group comparisons, correlation analyses, subgroup analyses, and multivariable logistic regression were performed. Poor sleep quality, defined as PSQI > 5, was present in 71.7% of participants and differed across groups ( p = 0.029). PSQI and ESS scores varied between groups (both p < 0.001), whereas PSS-14 scores did not ( p = 0.448). PSQI scores were higher in interns and resident groups than in controls (all adjusted p ≤ 0.002). Among residents, surgical trainees had higher PSQI and ESS scores than internal medicine residents ( p = 0.035 and p = 0.008), and monthly on-call shifts correlated with PSQI scores (ρ = 0.275, p = 0.010). In the age-adjusted multivariable model, interns (aOR 3.12, 95% CI 1.12–8.70), internal medicine residents (aOR 3.58, 95% CI 1.29–9.90), and preclinical medical students (aOR 6.49, 95% CI 1.59–26.55) had higher odds of poor sleep quality than controls, whereas age was not independently associated with poor sleep quality. Poor sleep quality is prevalent across medical training and associated with modifiable pre-sleep behaviors and training-related factors, supporting interventions targeting sleep hygiene, screen use in bed, late-night eating, and on-call burden.