Running head: SLEEP QUALITY AND TEST PERFORMANCE

The Relationship between Sleep Quality and Test Performance among Occupational Therapy Graduate Students Yara Bezgina, Jessica Fong, Anthea K. Mourselas, Meredith Petrillo, William E. Unger and Rachel E. Zimmerman Touro University of Nevada

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Abstract The relationship between sleep quality and test performance among 25 first year occupational therapy graduate students is explored in the current study. Quality of sleep is measured by the Pittsburgh Sleep Quality Index (PSQI) while test performance is assessed by scores on four anatomy exams. Poor quality of sleep has long been thought to negatively impact student performance in school. The results indicated a lack of correlation between the two variables, which is discussed in further detail.

SLEEP QUALITY AND TEST PERFORMANCE

The Relationship between Sleep Quality and Test Performance on Occupational Therapy Graduate Students The relationship between the sleep patterns of students and academic performance has been a topic of much research in recent years. As the importance of exam scores, achievement tests results, and grade point averages are increasingly emphasized in the lives of students, the quality of sleep that students experience while in school carries relevance. Sleep is necessary in some form in order to have the high levels of cognitive functioning to perform well in various academic areas. Some research has demonstrated the timing of sleep and waking up in the morning is more strongly correlated to academic performance than is the total hours of sleep (Eliasson et al., 2009). Though Eliasson et al. (2009) found timing of sleep and waking habits to be important indicators of academic performance, additional research has found importance in the quality of sleep obtained. In a large study of college-aged students Gilbert and Weaver (2010) found that students were getting an average of 7.2 hours of sleep nightly. Though fairly close to the 8 hour recommendation, poor quality of sleep was experienced by many of these students. Interestingly, a significant relationship between poor quality of sleep and low grade point average was found in female students but not male students (Gilbert & Weaver, 2010). In fact, findings in a sample of medical students indicate that abnormal sleep habits were slightly more noticeable in the female students (Abdulghani et al., 2012). In general, medical students routinely getting less than 6 hours of nightly sleep were found to have lower grade point averages than those students getting 6-10 hours of sleep. Furthermore, BaHammam et al. (2012) measured sleeping and waking habits among medical students to assess the relationship with

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academic performance. Results demonstrated that decreased sleep duration, late bedtimes, and increased amounts of daytime sleepiness negatively affected grade point averages. In addition to considering academic exams and grade point averages, research has also indicated the relationship between lack of sleep and divergent thinking processes. Horne (1988) found that subjects who experienced one night of sleep loss performed substantially worse on tasks that required word fluency, creativity, and flexibility of the thought process. These findings should be considered when examining the students academic performance in relation to their sleep habits, as many academic exams require divergent thinking abilities. Though it is considered to be somewhat common knowledge that a certain amount of sleep is necessary for optimal academic performance, it is possible that college and graduate students lack formal education on how to achieve proper sleep hygiene. Brown, Buboltz, and Soper (2006) found that many college students were not routinely getting 8 hours of sleep. The Sleep Treatment and Education Program for Students (STEPS) was implemented among first year college students to educate on the importance and ways to improve sleep hygiene. Brown et al. (2006) found that the students who were exposed to the 6 week long STEPS showed overall better sleep hygiene after completion of the program. Although there have been several studies exploring the relationship of sleep quality and academic performance, research has focused on either undergraduate or medical students. Further research is needed to examine the nature of sleep quality and exam scores in accelerated graduate programs, such as two year occupational therapy programs.

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Theoretical Framework The Restoration Theory (RT), which states that sleep is a necessary physiological function for biological processes, was used for the basis of this study. Since cognitive functioning is an important biological process, and is thought to be required for effective test taking, this theory is appropriate for the purposes of this study. Hypothesis The present study assesses the effect of the quality of sleep of first year occupational therapy graduate students and scores on anatomy exams. Anatomy is traditionally considered to be one of the more difficult subjects within the occupational therapy program. We expect that high quality of sleep, as measured by the PSQI will positively impact scores obtained on the anatomy exams. On the same note, we predict that students who experience poor quality of sleep will exhibit lower exam scores. Methods Study Design The present study is of a correlational and non-experimental nature. The association between the two variables of sleep quality and test performance is compared in the current study, and these variables were not manipulated. Procedure The subjects were asked to complete an online survey within a week at their own convenience, to fill out a self-assessment on their quality of sleep and test performance. The first section of the survey included brief demographic questions about age and gender. The next

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section included four questions asking the participant to report his or her anatomy scores in numerical values. The first set of self-reported anatomy scores included the first and second written anatomy exams, which were each out of 78 points total. The second set of self-reported anatomy scores were for the first and second practical exams, which were out of a possible 28 points each. The written exam combination score of 60 or higher on each exam is considered high academic performance. The practical exam combination score of 20 or higher on each exam is considered high academic performance. The comprehensive score included the average of all four exams combined. If the participant had an 80 or higher their academic performance was high; anything below an 80 would result in poor academic performance. Participants and Setting The study was conducted in the school of Occupational Therapy at Touro University Nevada. The group of participants was acquired by convenience sampling from occupational therapy cohort of 2014. The group comprised of 25 (7 male, 18 female) healthy students in the age group of 22-35 years old. Instruments The self-assessment used in the study included Pittsburgh Sleep Quality Index (PSQI) which is a questionnaire assessing sleep quality and sleep disturbances over 4 weeks duration. Nineteen questions of the PSQI test made up seven different parts of the test assessing the following seven components of sleep: sleep quality, sleep latency, sleep duration, habits and sleep efficiency, sleep disturbances, sleeping medication, and daytime dysfunction. The sum of the scores for the questions of all seven components yielded one global score. A global score of

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less than or equal to 5 indicates good sleeping habits and net score equal to five or greater indicates poor sleeping habits. Data Analysis Plan Statistical data obtained as mean and standard deviation was conducted using Statistical Package for the Social Sciences (SPSS) data analysis software. Once the values were imported into SPSS, they were then interpreted by using the scoring method laid out by the PSQI. These combined values formed a final composite score for the PSQI. Next, composite exam scores were determined by averaging the participants scores on their first and second lecture exams, and then averaging the first and second practical exams. These two composite scores were then added together to establish a final test performance score for each participant. The mean and standard deviation were then obtained for both the composite PSQI scores and composite test performance scores. Skewness and kurtosis were both within normal limits. As a last step of data analysis, a Pearsons correlation was taken to determine the relationship between composite PSQI and composite performance scores. Results PSQI scores ( performance scores ( 5.58, SD = 1.91) on a scale of 0 (best) to 21 (worst) and the test 89.2, SD = 7.73) were analyzed. Precedent set by the authors of the

PSQI instrument suggest that a sleep score of less than or equal to 5 demonstrate good sleep quality. Results indicated that F (1,23) .13= P=.73, R squared = .01, which demonstrated a lack of statistical significance.

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Discussion This study intended to investigate the relationship between sleep quality and tests scores of occupational therapy students. While a negative correlation between comprehensive performance and PSQI scores is present, the degree to which the relationship exists is not statistically significant. Limitations of the present study include a small sample size composed of far more females than males, which may not be representative of all accelerated graduate school student bodies. Brown et al. (2006) noted that multiple studies have found that women tend to have poorer sleep quality compared to males. Consideration must be given to the fact that 72% (N=18) of our participants were women and the outcome demonstrated that sleep quality was low. If the gender of participants would have been more representative of the general population it could have possibly lowered the PSQI score which would have indicated better sleep quality. Had the PSQI scores indicated good quality of sleep, a stronger correlation might have been presented. Furthermore, since participants were sampled by convenience, the results cannot be generalized to other student populations. Additionally, any past sleep issues or disorders were not taken into account. Several qualities regarding the participants in our study are noteworthy. The sample of students in the present study have already graduated with at least a bachelors degree and have completed rigorous prerequisite courses while maintaining grade point averages above a 3.0. This factor could have influenced the higher academic performance score regardless of sleep quality. Another potential limitation would be that the small sample size is more resilient to the deleterious effects of sleep deprivation. In addition, although the PSQI scores indicated poor sleep quality among the students, on a scale of 0 (best) to 21 (worst), the highest score obtained

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was a 9. If higher scores were present, it might have had a greater effect on academic performance. Due to the nature of self-reported surveys the participants may have felt a social desire bias to over or under report their sleep quality. Further research is required to examine the true nature of the effect between sleep quality and academic performance due to the limitations present in the study. The sample size of our participants should be increased, as well as be more representative of the greater graduate student population in order to asses any correlation between the two variables.

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References Abdulghani, H.M., Alrowais, N.A., Bin-Saad, N.S., Al-Subaie, N.M., Haji, A.M.A, & Alhaqwi, A.I.(2012). Sleep disorder among medical students: Relationship to their academic performance. Medical teacher, 34 Suppl 1. Retrieved from http://www.biomedsearch. com/nih/Sleep-disorder-among-medical-students/22409189.html BaHammam, A. S., Alaseem, A. M., Alzakri, A. A., Almeneessier, A. S., & Sharif, M.M. (2012). The relationship between sleep and wake habits and academic performance in medical students: A cross-sectional study. BMC Medical Education, 12(61), 1-6. Retrieved from http://www.biomed central .com/ content/pdf/1472-6920-61.pdf Brown, F. C., Buboltz, W. C., & Soper, B. (2006). Development and evaluation of the sleep treatment and education program for students (steps). Journal of American College Health, 54(4), 231-237. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16450848 Eliasson A.H., Lettieri C.J., & Eliasson A.H. (2010). Early to bed, early to rise! Sleep habits and academic performance in college students. Sleep Breath,14 (1), 71-75. Retrieved from http://search.proquest.com/docview/871282300 Gilbert, S. P., & Weaver, C. C. (2010). Sleep quality and academic performance in university students: A wake-up call for college psychologists. Journal of College Student Psychology, 24, 295306. DOI: 10.1080/87568225.2010.509245. Horne, J. A. (1988). Sleep loss and divergent thinking ability. Sleep, 11(6), 528-536. Retrieved from http:// www.journalsleep.org/Articles/110604.pdf