Association between restless legs syndrome and sleep quality in Peruvian medical students

Abstract

Objective

To evaluate the association between restless legs syndrome (RLS) and sleep quality in Peruvian medical students.

Methods

Cross sectional study with a secondary data analysis. The study included Peruvian medical students surveyed in 2020. The outcome was sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI), and the exposure variable was RLS assessed with the International Restless Legs Syndrome Study Group (IRLSSG) scale. To address the research question, we employed Poisson regression models with robust variance.

Results

We analyzed information from 3139 medical students (61.1% female, median age 22.3 years). 15.3% experienced symptoms of Restless Legs Syndrome (RLS), and 77.2% had poor sleep quality. The prevalence of poor sleep quality was higher in female participants (80.0%) and those with symptoms of anxiety (92.8%), depression (91.6%), and severe nomophobia (86.3%). In the multivariable model, the presence of RLS symptoms was associated with poor sleep quality (prevalence ratio: 1.05, 95% CI 1.01 - 1.09, p < 0.013).

Conclusion

We found a high prevalence of poor sleep quality, notably associated with RLS. Other factors associated with poor sleep quality were the academic year of study, anxiety, depression, and nomophobia.

Introduction

Restless legs syndrome (RLS) is a chronic neurological condition characterized by an irresistible need to move the legs to relieve unpleasant sensations such as tingling, prickling, or burning sensations [1]. The International Restless Legs Syndrome Study Group has proposed four criteria for the diagnosis of RLS: frequent leg movements with abnormal sensitivity in the skin of the legs, temporary relief of unpleasant symptoms when moving the legs, onset or worsening of symptoms with rest or not moving the legs, and onset or worsening of symptoms at night [2].

The prevalence of RLS in South America has been reported at approximated 16%, surpassing rates observed in other regions [2]. Furthermore, it is noteworthy that RLS may disproportionately impact individuals experiencing elevated stress levels, a demographic that includes medical students [3].

It has been proposed that RLS would affect sleep quality by causing periodic leg movements before and during sleep [4]. Poor quality of sleep is manifested through sleep interruptions, difficulties in falling asleep, frequent awakenings during the night, and excessive daytime sleepiness [5]. This condition affects the quality of life as it can trigger a variety of physical and psychological problems such as anxiety, depression, fatigue, memory, and concentration problems [6]. It is estimated that the global prevalence of inadequate sleep quality is 52.7% among medical students, with Peru reporting a prevalence of up to 83.9% for inadequate sleep quality [7], which appears to be higher compared to other groups of university students and the general population [8]. This could be due to several particular challenges faced by medical students, such as academic overload, the need to meet clinical practice requirements, exposure to high-stress situations, and lack of time for personal activities [9].

Periodic leg movements can occur during sleep or relaxed wakefulness, the latter in more severe forms when Restless Legs Syndrome (RLS) is present [8]. An association between RLS and sleep disturbances is suspected due to the increase in these leg movements during sleep, but the evidence supporting this hypothesis is scarce [10] and heterogeneous, particularly among medical students, [11,12] with small studies [13] and a lack of control for potential confounding variables [11,13]. Given the high prevalence of poor sleep quality among medical students, evaluating this association is necessary to gather information with which preventive and therapeutic interventions can be developed. Thus, the aim of this study was to evaluate the association between Restless Legs Syndrome and sleep quality in Peruvian medical students.

Methods

Study design

This cross-sectional study conducted a secondary analysis of data derived from the “Nomophobia and its associated factors in Peruvian medical students” project. The primary study was a cross-sectional analytical study aimed at identifying the factors associated with nomophobia among medical students in Peru. It was conducted in 38 medical schools and surveyed 3,139 students [14].

Participants and procedures

In Peru, the human medicine degree studies extend over seven years, with the final year dedicated to a practical rotation is known as internship. In 2020, there were an estimated 30,000 medical students in Peru, spread across 46 universities throughout the country [15].

This study targeted adult medical students (aged 18 and above) in Peru who voluntarily participated and confirmed their enrollment in a human medicine career. Exclusion criteria encompassed students who did not possess a mobile phone in the month in which the survey was performed.

Convenience sampling was employed in the primary study, utilizing an online survey conducted through Google Forms. The primary study collected data in two stages between June 2020 and March 2021. This was done virtually through social media platforms (Facebook, WhatsApp) because universities in Peru held online classes during the pandemic to minimize the risk of contagion.

The data collection occurred in two stages. In the first stage, a Facebook page was created to promote the research project. An open invitation was extended to all medical students in Peru through posters distributed in private Facebook groups for medical students, as well as through paid Facebook ads specifically targeting medical students in Peru. In the second stage, 23 students from various medical schools were recruited through networks within the Scientific Society of Medical Students of Peru. The recruited students attended a 45-minute virtual meeting, where they were trained to contact students from their respective universities.

In order for the students to participate in the survey, they first had to provide their informed consent. As an incentive, all students who completed the survey were given free access to a Google Drive folder with a collection of resources from medical courses. The survey is available in S1 File.

To develop our study, we accessed the database in April 2023 and conducted the analyses and reporting of results on the same date.

Variables and measures

Our outcome (dependent variable) of interest was sleep quality. This variable was measured with the Pittsburgh Sleep Quality Index (PSQI) [16]. The PSQI is the most widely used measure for assessing sleep quality, useful for epidemiological studies and easy to complete [17]. A weakness is that different factorial structures have been found in the samples where it has been applied [17]. The 19 PSQI items are grouped into 7 components: sleep duration, sleep disturbance, sleep latency, daytime dysfunction due to sleepiness, sleep efficiency, overall sleep quality, and sleep medication use. Each component is evaluated using a scale ranging from 0 to and the overall rating is derived from the cumulative scores of the components, with an overall score ranging from 0 to 21, and a higher score reflecting poorer sleep quality. Individuals scoring from 0 to 5 points were deemed to have adequate sleep quality, while those scoring 6 to 21 points were classified as poor sleep quality [18]. The study utilized the Peruvian-validated version, which demonstrated optimal internal consistency, as evidenced by a Cronbach’s alpha of 0.81 [19]. In our sample, the Cronbach’s alpha was 0.75.

The RLS was the exposure of interest (independent variable). To measure RLS symptoms, the scale based on the criteria of the International Restless Legs Syndrome Study Group (IRLSSG) was used. This scale consists of 3 items with scores ranging from 0 to 3 points. The items ask: 1. Do you have a feeling of discomfort or discomfort in your legs, with the urgency or need to move them? 2. Do these discomforts occur only at rest and improve with movement? 3. Are they worse in the evening than in the morning? The variable was categorized according to the following criteria: no presence of symptoms of RLS ( < 3 points) and presence of RLS ( = 3 points), since a positive response to the 3 items indicates the presence of RLS [20]. This measure has a sensitivity of 100% and specificity of 88% in a Spanish version [21].

Confounding variables. Additional variables considered for the analysis included: age (in tertiles), sex (male or female), university financing (public or private), year of study (first, second, third, fourth or fifth), university location (cities according to urbanity), engagement in physical activity (yes or no), practicing a sport (yes or no), anxiety symptoms (yes or no), depression symptoms (yes or no) and nomophobia symptoms (no nomophobia, mild nomophobia, moderate nomophobia or severe nomophobia).

To assess anxiety and depression symptoms, the Hopkins Symptom Checklist-25 (HSCL-25) was employed [22]. HSCL-25 is widely used for both clinical and epidemiological, self-administered, easy-to-use for participants and researchers and simple of interpretation [23]. It does not provide a clinical diagnosis; it only assesses early symptoms of anxiety and depression [23]. This checklist comprises 25 items, with 10 focusing on anxiety and 15 on depression. Responses are rated on a 4-point Likert scale, ranging from 1 (“not at all”) to 4 (“a lot”). If participants has an average score above 1.75 on the anxiety or depression subscales of the HSCL-25, they are considered to have possible symptoms of anxiety or depression, respectively [24]. The HSCL has been validated in Spanish in an adult Peruvian population, demonstrating satisfactory internal consistency (anxiety, Cronbach’s alpha =  0.81; and depression, Cronbach’s alpha =  0.86) [24]. This study used the version of the Peruvian Ministry of Health [25]. For our sample, Cronbach’s alpha was 0.90 for anxiety and 0.93 for depression.

Nomophobia symptoms were measured using the Nomophobia Questionnaire (NMP-Q) [26]. The NMP-Q comprises 20 items and four factors: “not being able to access information”, “giving up convenience”, “not being able to communicate” and “loss of connection”. The questionnaire uses a Likert scale with a scoring range of 7 points, from 1 (“strongly disagree”) to 7 (“strongly agree”), resulting in a total score falling between 20 and 140 points. The following cut-off points were applied for interpreting the NMP-Q questionnaire: absence (a score of 20), mild (greater than 20 but less than 60), moderate (a score of 60 or higher but less than 100) and severe (a score of 100 or higher). A systematic review found that the NMP-Q demonstrates excellent internal consistency, with strong structural validity across its four-factor model [27]. In this study, the Spanish version of the NMP-Q was employed, having undergone validation and exhibiting satisfactory internal consistency (Cronbach’s alpha values ranged from 0.78 to 0.92) [28]. In our sample, Cronbach’s alpha was 0.88 for the factor “not being able to access information”, 0.87 for “giving up convenience”, 0.95 for “not being able to communicate”, and 0.93 for “loss of connection”.

Data analysis

We performed the statistical analysis using the Stata v17 software. First, for the descriptive analysis, frequencies and percentages were employed. Second, in the bivariate analysis, the sleep quality was associated with the rest of the variables, using the Chi-square statistical test. Third, for the multivariable analysis, Poisson regression models with robust variance were used to calculate prevalence ratios (PR) with their respective 95% confidence intervals (95% CI). We used this regression model since the frequency of inadequate sleep quality was high so using logistic regression (i.e., calculating odds ratios) could overestimate the objective association [29]. It is essential to emphasize that only the estimate of the association between RLS and sleep quality should be interpreted, while the estimates for the confounding variables should not be considered [30]. Those variables exhibiting a statistically significant association with the outcome (p < 0.05) were subsequently included in the adjusted regression model.

Ethics

This study received ethical approval from the Universidad Peruana de Tacna, Peru (Approval record: 99/FACSA/UI). Participation was voluntary and all the informants provided an informed consent. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Results

Data of 3139 medical students were analyzed. Most of the participants were women (61.1%) and the median age was 22.3 years (25th percentile - 75th percentile: 20 - 24 years). Around half of them (50.8%) studied at a private university, and around one-third (29.9%) were in their fifth year of studies. Anxiety and depression symptoms were identified in 34.8% and 42.8% respectively. Additionally, 15.3% presented RLS symptoms, while 77.2% had poor sleep quality (Table 1).

[Figure omitted. See PDF.]

A higher prevalence of poor sleep quality was found in female participants (80.0%) and those who presented symptoms of anxiety (92.8%), depression (91.6%), and severe nomophobia (86.3%) (p < 0.001). On the other hand, a lower prevalence of poor sleep quality was found in those who did physical activity (72.4%) and practiced an sport (73.3%) (p < 0.001). There was a higher prevalence of inadequate sleep quality in those who had RLS symptoms (87.9%) compared to those who did not have RLS symptoms (75.3%), and this difference was significant (p < 0.001) (Table 2).

[Figure omitted. See PDF.]

In the crude regression analysis, restless legs syndrome was associated with sleep quality (PR: 1.17, 95% CI 1.12 - 1.21, p < 0.001). After adjusting for sex, age, type of university, year of study, university location, doing physical activity, practicing a sport, anxiety, depression and nomophobia symptoms, the association between RLS and sleep quality remained significant (PR: 1.05, 95% CI 1.01 - 1.09, p < 0.013) (Table 3).

[Figure omitted. See PDF.]

Discussion

This is the first study to evaluate the relationship between restless legs syndrome and sleep quality among medical students, with a larger sample size than that used in previous research. Findings showed that students with RLS symptoms had a 5% higher prevalence of poor sleep quality than those without RLS. Moreover, the prevalence of poor sleep quality was very high (77.2%).

Regarding the high prevalence of poor sleep quality, previous studies have found similar results. Two systematic reviews, which conducted their searches in 2018, reported prevalences of 55.0% [8] and 52.7% [31] for poor sleep. Although it did not include Peruvian studies, one of them found that America was the second region with the highest prevalence (59.9%) [31]. The high prevalence reported in our study may be due to high demands of the medical education, lack of learning strategies, or certain behaviors such as procrastination, which translate into few hours of sleep [32].

Furthermore, it is necessary to highlight that our data was collected during the COVID-19 pandemic, which exacerbated the sleep problems of students, including insomnia, early awakening, and difficulty falling asleep [33]. In this context, individuals, such as medical students, were forced to change their lifestyles and adapt to virtual environments, which were rarely used before the pandemic in Peruvian universities [34]. In Peru, medical students in their final years of study typically undergo their academic training primarily in hospitals; however, due to the COVID-19 pandemic, access to hospitals was restricted. Additionally, to curb the spread of the virus, access to universities was limited. As a result, all classes transitioned to virtual formats, a practice uncommon in Peruvian universities before the pandemic [34]. This situation could have decreased the quality of sleep and increased insomnia among medical students, potentially impacting not only their academic performance but also their overall health [35].

We found that those who had RLS had worse sleep quality. Only four studies have evaluated this association in medical students, two of which were conducted in Türkiye. The first one, carried out in a hospital with sixth-year students and resident physicians, developed a multivariable model in which no association was found between both variables [12], while in the second study, also conducted in Turkey, only a simple bivariate analysis was performed, and a significant association was found [35]. It is important to highlight that the sample sizes in these studies were 341 and 402, respectively, [12,35] while in our study 3139 medical students were included.

The third study was conducted on health sciences students (n = 148) in Saudi Arabia, of which almost 50% were medical students [13]. A significant correlation was found between RLS symptoms and sleep quality; however, multivariable analyzes were not performed [13]. Finally, the fourth study was conducted on 256 health students in Peru, including medical students, and reported that the odds of sleeping poorly in those who had restless legs syndrome were 5 times higher than in those who did not have the syndrome, but the association was not statistically significant [11]. Although an association was found in our study, the difference between those who present RLS and those who do not is very small (5%). Therefore, more research may be necessary for more conclusive results, especially in this population. In other populations, such as pregnant women [20], this association has been studied with robust models, and significant results have been found.

The limitations of this study should be considered. First, a non-probabilistic convenience sampling was performed, so the subject selection may not be representative of the population. Second, self-report measures were used for assessing RLS, sleep quality, and some covariates (depression, anxiety, and nomophobia). In response to this, validated and adapted measures were used. To address the potential social desirability bias that could arise from the use of these instruments, participants were informed that the survey was anonymous, and their information was confidential. Third, this is a cross-sectional study, so the temporal cause-effect relationship of the variables of interest cannot be verified. Fourth, other variables that could influence in the association of interest, such as stress and the use of psychoactive substance, were not included.

In conclusion, our study performed in Peruvian medical students revealed a prevalent issue of poor sleep quality, notably associated to RLS. Additionally, factors such as the academic year of study, anxiety, depression, and nomophobia were identified as variables linked to this diminished sleep quality.

Supporting information

S1 File. Study survey.

https://doi.org/10.1371/journal.pone.0320008.s001

(DOCX)

S2 File. Study database.

https://doi.org/10.1371/journal.pone.0320008.s002

(XLSX)

References

1. 1. Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, et al. Restless legs syndrome. Nat Rev Dis Primers. 2021;7(1):80. pmid:34732752

* View Article

* PubMed/NCBI

* Google Scholar

2. 2. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165(11):1286–92. pmid:15956009

* View Article

* PubMed/NCBI

* Google Scholar

3. 3. Goecke TW, Schnakenberg P, Frensch M, Chechko N. Restless legs syndrome during pregnancy and 12 weeks postpartum and its links to cardiovascular diseases, stressful life events, and psychiatric history. J Clin Med. 2020;9(9):3046. pmid:32967350

* View Article

* PubMed/NCBI

* Google Scholar

4. 4. Japaridze G, Kasradze S, Maisuradze L, Popp R, Wetter T. The Retless Leggs syndrome (review). Georgian Med News. 2018;285:74–81.

* View Article

* Google Scholar

5. 5. Goel N, Rao H, Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2009;29(4):320–39. pmid:19742409

* View Article

* PubMed/NCBI

* Google Scholar

6. 6. Lee S, Kim JH, Chung JH. The association between sleep quality and quality of life: a population-based study. Sleep Med. 2021;84:121–6. pmid:34147026

* View Article

* PubMed/NCBI

* Google Scholar

7. 7. Olarte-Durand M, Roque-Aycachi JB, Rojas-Humpire R, Canaza-Apaza JF, Laureano S, Rojas-Humpire A, et al. Mood and sleep quality in Peruvian medical students during COVID-19 pandemic. Rev Colomb Psiquiatr. 2024;53(1):47–54. pmid:34903900

* View Article

* PubMed/NCBI

* Google Scholar

8. 8. Jahrami H, Dewald-Kaufmann J, Faris MA-I, AlAnsari AMS, Taha M, AlAnsari N. Prevalence of sleep problems among medical students: a systematic review and meta-analysis. J Public Health (Berl). 2019;28(5):605–22.

* View Article

* Google Scholar

9. 9. Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK. The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health. 2017;7(3):169–74. pmid:28756825

* View Article

* PubMed/NCBI

* Google Scholar

10. 10. Bonakis A, Androutsou A, Koloutsou M-E, Vagiakis E. Restless Legs Syndrome masquerades as chronic insomnia. Sleep Med. 2020;75:106–11. pmid:32858348

* View Article

* PubMed/NCBI

* Google Scholar

11. 11. Díaz-Flores IK. Asociación entre el sindrome de piernas inquietas y la calidad de sueño en internos de ciencias de la salud del hospital militar central durante el mes de junio del año 2016. Rev Fac Med Humana. 2017;17(4). [cited 2023 May 8]. http://revistas.urp.edu.pe/index.php/RFMH/article/view/1213.

* View Article

* Google Scholar

12. 12. Ergin N, Kılıç BB, Ergin A, Varlı S. Sleep quality and related factors including restless leg syndrome in medical students and residents in a Turkish university. Sleep Breath. 2022;26(3):1299–307. pmid:34410581

* View Article

* PubMed/NCBI

* Google Scholar

13. 13. Aljaffer MA, Alrajhi AM, Basamad SW, Alhothaly SK. Restless Leg Syndrome in dormitory and its relationship with sleep quality. J Pharm Res Int. 2021;33(60B):1281–90.

* View Article

* Google Scholar

14. 14. Copaja-Corzo C, Aragón-Ayala CJ, Taype-Rondan A . Nomophobia and its associated factors in Peruvian medical students. Int J Environ Res Public Health. 2022;19(9):5006. pmid:35564400

* View Article

* PubMed/NCBI

* Google Scholar

15. 15. Gestión N. Sunedu empezará la evaluación de la carrera de medicina en cinco universidades | PERU. Gestión. 2019. [cited 2023 Oct 1]. https://gestion.pe/peru/sunedu-empezara-evaluacion-carrera-medicina-cinco-universidades-273925-noticia/

16. 16. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. pmid:2748771

* View Article

* PubMed/NCBI

* Google Scholar

17. 17. Fabbri M, Beracci A, Martoni M, Meneo D, Tonetti L, Natale V. Measuring subjective sleep quality: a review. Int J Environ Res Public Health. 2021;18(3):1082. pmid:33530453

* View Article

* PubMed/NCBI

* Google Scholar

18. 18. Manzar MdD, Moiz JA, Zannat W, Spence DW, Pandi-Perumal SR, BaHammam AS, et al. Validity of the Pittsburgh sleep quality index in indian university students. Oman Med J. 2015;30(3):193–202.

* View Article

* Google Scholar

19. 19. Royuela A, Fernández J. Propiedades clinimetricas de la versión castellana del cuestionario de Pittsburgh. Vigilia-Sueño. 1997;9:81–94.

* View Article

* Google Scholar

20. 20. Dunietz GL, Lisabeth LD, Shedden K, Shamim-Uzzaman QA, Bullough AS, Chames MC, et al. Restless Legs syndrome and sleep-wake disturbances in pregnancy. J Clin Sleep Med. 2017;13(7):863–70. pmid:28633715

* View Article

* PubMed/NCBI

* Google Scholar

21. 21. Persi GG, Martín MC, Etcheverry JL, Parisi VL, Gatto EM. Sensibilidad y especificidad de un cuestionario en castellano autoadministrado para la identificación del síndrome de piernas inquietas en el contexto de estudios poblacionales⋆. Neurol Argent. 2013;5(4):237–40.

* View Article

* Google Scholar

22. 22. Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacol Bull. 1973;9(1):13–28. pmid:4682398

* View Article

* PubMed/NCBI

* Google Scholar

23. 23. Rodríguez-Barragán M, Fernández-San-Martín MI, Clavería-Fontán A, Aldecoa-Landesa S, Casajuana-Closas M, Llobera J, et al. Validation and psychometric properties of the Spanish version of the Hopkins symptom checklist-25 scale for depression detection in primary care. Int J Environ Res Public Health. 2021;18(15):7843. pmid:34360136

* View Article

* PubMed/NCBI

* Google Scholar

24. 24. Morote Rios R, Hjemdal O, Martinez Uribe P, Corveleyn J. Life stress as a determinant of emotional well-being: development and validation of a Spanish-Language Checklist of Stressful Life Events. Health Psychol Behav Med. 2014;2(1):390–411. pmid:25750790

* View Article

* PubMed/NCBI

* Google Scholar

25. 25. Ministerio de Salud. Atención de Víctimas de Violencia. Derechos de Las Personas: Guía Práctica Para Uso en Servicios de Emergencia y Consulta Externa. 2010. https://www.gob.pe/institucion/minsa/informes-publicaciones/314088-atencionde-victimas-de-violencia-derechos-de-las-personas-guia-practica-para-uso-en-servicios-de-emergencia-y-consulta-externa.

26. 26. Yildirim C, Correia A-P. Exploring the dimensions of nomophobia: development and validation of a self-reported questionnaire. Comput Hum Behav. 2015;49:130–7.

* View Article

* Google Scholar

27. 27. Jahrami H, Saif Z, Trabelsi K, Bragazzi NL, Vitiello MV. Internal consistency and structural validity of the nomophobia questionnaire (NMP-Q) and its translations: a systematic review with meta-analysis. Heliyon. 2023;9(4):e15464. pmid:37128316

* View Article

* PubMed/NCBI

* Google Scholar

28. 28. León-Mejía A, Calvete E, Patino-Alonso C, Machimbarrena JM, González-Cabrera J. Nomophobia Questionnaire (NMP-Q): factorial structure and cut-off points for the Spanish version. Adicciones. 2020;33(2):137–48.

* View Article

* Google Scholar

29. 29. Thompson ML, Myers JE, Kriebel D. Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done? Occup Environ Med. 1998;55(4):272–7. pmid:9624282

* View Article

* PubMed/NCBI

* Google Scholar

30. 30. Westreich D, Greenland S. The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am J Epidemiol. 2013;177(4):292–8. pmid:23371353

* View Article

* PubMed/NCBI

* Google Scholar

31. 31. Rao W-W, Li W, Qi H, Hong L, Chen C, Li C-Y, et al. Sleep quality in medical students: a comprehensive meta-analysis of observational studies. Sleep Breath. 2020;24(3):1151–65. pmid:32072469

* View Article

* PubMed/NCBI

* Google Scholar

32. 32. Carranza Esteban RF, Mamani-Benito O, Castillo-Blanco R, Caycho-Rodríguez T, Villafuerte de la Cruz AS, Dávila Villavicencio R. Effect of emotional exhaustion on satisfaction with studies and academic procrastination among Peruvian university students. Front Educ. 2023;8. [cited 2024 Mar 1. ]. https://www.frontiersin.org/articles/10.3389/feduc.2023.1015638

* View Article

* Google Scholar

33. 33. Lin YN, Liu ZR, Li SQ, Li CX, Zhang L, Li N, et al. Burden of Sleep Disturbance During COVID-19 Pandemic: A Systematic Review. Nat Sci Sleep. 2021;13:933–66. pmid:34234598

* View Article

* PubMed/NCBI

* Google Scholar

34. 34. Mishra J, Panigrahi A, Samanta P, Dash K, Mahapatra P, Behera MR. Sleep quality and associated factors among undergraduate medical students during COVID-19 confinement. Clin Epidemiol Glob Health. 2022;15:101004. pmid:35291700

* View Article

* PubMed/NCBI

* Google Scholar

35. 35. Sarıaydın M, Günay E, Ünlü M. Frequency of restless legs syndrome and relationship between depression, anxiety and sleep quality among medical school students. Tuberk Toraks. 2018;66(3):217–23. pmid:30479229

* View Article

* PubMed/NCBI

* Google Scholar

Citation: Paredes-Angeles R, Copaja-Corzo C, Taype-Rondan A (2025) Association between restless legs syndrome and sleep quality in Peruvian medical students. PLoS ONE 20(3): e0320008. https://doi.org/10.1371/journal.pone.0320008

About the Authors:

Rubí Paredes-Angeles

Roles: Conceptualization, Data curation, Formal analysis, Validation, Writing – original draft, Writing – review & editing

Affiliation: EviSalud – Evidencias en Salud, EsSalud, Lima, Peru

Cesar Copaja-Corzo

Roles: Conceptualization, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

E-mail: [email protected]

Affiliations: Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru, Servicio de Infectología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru

ORICD: https://orcid.org/0000-0002-3497-0158

Alvaro Taype-Rondan

Roles: Formal analysis, Investigation, Methodology, Supervision, Writing – review & editing

Affiliations: EviSalud – Evidencias en Salud, EsSalud, Lima, Peru, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru

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References

1. Manconi M, Garcia-Borreguero D, Schormair B, Videnovic A, Berger K, Ferri R, et al. Restless legs syndrome. Nat Rev Dis Primers. 2021;7(1):80. pmid:34732752

2. Allen RP, Walters AS, Montplaisir J, Hening W, Myers A, Bell TJ, et al. Restless legs syndrome prevalence and impact: REST general population study. Arch Intern Med. 2005;165(11):1286–92. pmid:15956009

3. Goecke TW, Schnakenberg P, Frensch M, Chechko N. Restless legs syndrome during pregnancy and 12 weeks postpartum and its links to cardiovascular diseases, stressful life events, and psychiatric history. J Clin Med. 2020;9(9):3046. pmid:32967350

4. Japaridze G, Kasradze S, Maisuradze L, Popp R, Wetter T. The Retless Leggs syndrome (review). Georgian Med News. 2018;285:74–81.

5. Goel N, Rao H, Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2009;29(4):320–39. pmid:19742409

6. Lee S, Kim JH, Chung JH. The association between sleep quality and quality of life: a population-based study. Sleep Med. 2021;84:121–6. pmid:34147026

7. Olarte-Durand M, Roque-Aycachi JB, Rojas-Humpire R, Canaza-Apaza JF, Laureano S, Rojas-Humpire A, et al. Mood and sleep quality in Peruvian medical students during COVID-19 pandemic. Rev Colomb Psiquiatr. 2024;53(1):47–54. pmid:34903900

8. Jahrami H, Dewald-Kaufmann J, Faris MA-I, AlAnsari AMS, Taha M, AlAnsari N. Prevalence of sleep problems among medical students: a systematic review and meta-analysis. J Public Health (Berl). 2019;28(5):605–22.

9. Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK. The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health. 2017;7(3):169–74. pmid:28756825

10. Bonakis A, Androutsou A, Koloutsou M-E, Vagiakis E. Restless Legs Syndrome masquerades as chronic insomnia. Sleep Med. 2020;75:106–11. pmid:32858348

11. Díaz-Flores IK. Asociación entre el sindrome de piernas inquietas y la calidad de sueño en internos de ciencias de la salud del hospital militar central durante el mes de junio del año 2016. Rev Fac Med Humana. 2017;17(4). [cited 2023 May 8]. http://revistas.urp.edu.pe/index.php/RFMH/article/view/1213.

12. Ergin N, Kılıç BB, Ergin A, Varlı S. Sleep quality and related factors including restless leg syndrome in medical students and residents in a Turkish university. Sleep Breath. 2022;26(3):1299–307. pmid:34410581

13. Aljaffer MA, Alrajhi AM, Basamad SW, Alhothaly SK. Restless Leg Syndrome in dormitory and its relationship with sleep quality. J Pharm Res Int. 2021;33(60B):1281–90.

14. Copaja-Corzo C, Aragón-Ayala CJ, Taype-Rondan A . Nomophobia and its associated factors in Peruvian medical students. Int J Environ Res Public Health. 2022;19(9):5006. pmid:35564400

15. Gestión N. Sunedu empezará la evaluación de la carrera de medicina en cinco universidades | PERU. Gestión. 2019. [cited 2023 Oct 1]. https://gestion.pe/peru/sunedu-empezara-evaluacion-carrera-medicina-cinco-universidades-273925-noticia/

16. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. pmid:2748771

17. Fabbri M, Beracci A, Martoni M, Meneo D, Tonetti L, Natale V. Measuring subjective sleep quality: a review. Int J Environ Res Public Health. 2021;18(3):1082. pmid:33530453

18. Manzar MdD, Moiz JA, Zannat W, Spence DW, Pandi-Perumal SR, BaHammam AS, et al. Validity of the Pittsburgh sleep quality index in indian university students. Oman Med J. 2015;30(3):193–202.

19. Royuela A, Fernández J. Propiedades clinimetricas de la versión castellana del cuestionario de Pittsburgh. Vigilia-Sueño. 1997;9:81–94.

20. Dunietz GL, Lisabeth LD, Shedden K, Shamim-Uzzaman QA, Bullough AS, Chames MC, et al. Restless Legs syndrome and sleep-wake disturbances in pregnancy. J Clin Sleep Med. 2017;13(7):863–70. pmid:28633715

21. Persi GG, Martín MC, Etcheverry JL, Parisi VL, Gatto EM. Sensibilidad y especificidad de un cuestionario en castellano autoadministrado para la identificación del síndrome de piernas inquietas en el contexto de estudios poblacionales⋆. Neurol Argent. 2013;5(4):237–40.

22. Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacol Bull. 1973;9(1):13–28. pmid:4682398

23. Rodríguez-Barragán M, Fernández-San-Martín MI, Clavería-Fontán A, Aldecoa-Landesa S, Casajuana-Closas M, Llobera J, et al. Validation and psychometric properties of the Spanish version of the Hopkins symptom checklist-25 scale for depression detection in primary care. Int J Environ Res Public Health. 2021;18(15):7843. pmid:34360136

24. Morote Rios R, Hjemdal O, Martinez Uribe P, Corveleyn J. Life stress as a determinant of emotional well-being: development and validation of a Spanish-Language Checklist of Stressful Life Events. Health Psychol Behav Med. 2014;2(1):390–411. pmid:25750790

25. Ministerio de Salud. Atención de Víctimas de Violencia. Derechos de Las Personas: Guía Práctica Para Uso en Servicios de Emergencia y Consulta Externa. 2010. https://www.gob.pe/institucion/minsa/informes-publicaciones/314088-atencionde-victimas-de-violencia-derechos-de-las-personas-guia-practica-para-uso-en-servicios-de-emergencia-y-consulta-externa.

26. Yildirim C, Correia A-P. Exploring the dimensions of nomophobia: development and validation of a self-reported questionnaire. Comput Hum Behav. 2015;49:130–7.

27. Jahrami H, Saif Z, Trabelsi K, Bragazzi NL, Vitiello MV. Internal consistency and structural validity of the nomophobia questionnaire (NMP-Q) and its translations: a systematic review with meta-analysis. Heliyon. 2023;9(4):e15464. pmid:37128316

28. León-Mejía A, Calvete E, Patino-Alonso C, Machimbarrena JM, González-Cabrera J. Nomophobia Questionnaire (NMP-Q): factorial structure and cut-off points for the Spanish version. Adicciones. 2020;33(2):137–48.

29. Thompson ML, Myers JE, Kriebel D. Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done? Occup Environ Med. 1998;55(4):272–7. pmid:9624282

30. Westreich D, Greenland S. The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am J Epidemiol. 2013;177(4):292–8. pmid:23371353

31. Rao W-W, Li W, Qi H, Hong L, Chen C, Li C-Y, et al. Sleep quality in medical students: a comprehensive meta-analysis of observational studies. Sleep Breath. 2020;24(3):1151–65. pmid:32072469

32. Carranza Esteban RF, Mamani-Benito O, Castillo-Blanco R, Caycho-Rodríguez T, Villafuerte de la Cruz AS, Dávila Villavicencio R. Effect of emotional exhaustion on satisfaction with studies and academic procrastination among Peruvian university students. Front Educ. 2023;8. [cited 2024 Mar 1. ]. https://www.frontiersin.org/articles/10.3389/feduc.2023.1015638

33. Lin YN, Liu ZR, Li SQ, Li CX, Zhang L, Li N, et al. Burden of Sleep Disturbance During COVID-19 Pandemic: A Systematic Review. Nat Sci Sleep. 2021;13:933–66. pmid:34234598

34. Mishra J, Panigrahi A, Samanta P, Dash K, Mahapatra P, Behera MR. Sleep quality and associated factors among undergraduate medical students during COVID-19 confinement. Clin Epidemiol Glob Health. 2022;15:101004. pmid:35291700

35. Sarıaydın M, Günay E, Ünlü M. Frequency of restless legs syndrome and relationship between depression, anxiety and sleep quality among medical school students. Tuberk Toraks. 2018;66(3):217–23. pmid:30479229