Sleep Quality and Educational Performance in Undergraduate Medical Students: A Systematic Review and Narrative Synthesis

Abstract

Background: Background: Sleep quality is a crucial determinant of cognitive functioning, memory consolidation, emotional regulation, and overall well-being. Undergraduate medical students frequently experience poor sleep quality due to demanding academic schedules, examination stress, clinical exposure, and lifestyle-related factors. Growing evidence suggests that inadequate sleep quality may adversely affect educational performance; however, findings across studies remain heterogeneous.  Objective: To systematically review and narratively synthesize global evidence regarding sleep quality among undergraduate medical students and its association with educational performance. Methods: A systematic review and narrative synthesis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched for studies published between January 2000 and December 2025. Observational studies assessing sleep quality among undergraduate medical students and reporting educational performance outcomes were included. Data regarding study characteristics, sleep quality measures, prevalence of poor sleep quality, educational outcomes, and associated factors were extracted and synthesized narratively. Results: A total of 34 studies involving approximately 23,400 undergraduate medical students from 20 countries met the inclusion criteria. Poor sleep quality was reported in 35.8% to 79.4% of participants, with an overall weighted prevalence of 59.8%. Most studies demonstrated a significant association between poor sleep quality and lower grade point averages (GPAs), poor examination scores, impaired concentration, reduced learning efficiency, and increased academic stress. Excessive daytime sleepiness, irregular sleep schedules, and insomnia symptoms were frequently associated with adverse educational outcomes. Academic workload, examination anxiety, smartphone use before bedtime, social media engagement, and poor sleep hygiene emerged as major determinants of poor sleep quality. Conclusion: Poor sleep quality is highly prevalent among undergraduate medical students and is consistently associated with poor educational performance. Interventions aimed at improving sleep hygiene and promoting healthy sleep behaviors may contribute to enhanced academic outcomes and student well-being.