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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 36  |  Issue : 2  |  Page : 60-64

Effect of COVID-19 on sleep pattern, mobile usage, and serum melatonin level among 1st-year medical students


Department of Physiology, RIMS, Imphal, Manipur, India

Date of Submission25-Dec-2021
Date of Decision30-Apr-2022
Date of Acceptance28-Jun-2022
Date of Web Publication16-Nov-2022

Correspondence Address:
Dr. Jayshree Phurailatpam
Department of Physiology, RIMS, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jms.jms_150_21

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  Abstract 


Background: The COVID-19 pandemic has enforced a new norm in the world with maximum dependence on technology in day-to-day living as well as the academic atmosphere. Globally, students are profoundly affected but more specifically medical students are subjected to immense stress, which is bound to affect their sleep and thus the sleep-regulating hormone, melatonin. Young medical students right at the entry to their professional career have, therefore, been hit by the changing scenario with most classes becoming online and increasing dependence on technological gadgets such as smartphones and laptops.
Aims and Objectives: The purpose of the study was to determine the sleep pattern of 1st-year medical students, survey their mobile phone use, and to estimate their serum melatonin levels during the COVID-19 pandemic.
Materials and Methods: This cross-sectional study was done in a Northeast India Medical Institute using standard questionnaires, Pittsburgh's Sleep Quality Index (PSQI) and Problematic Mobile Phone Usage Questionnaire among medical students and estimating their early morning serum melatonin level by ELISA assay.
Statistical Analysis: Data collected were entered in SSPS version 21 and analyzed using descriptive measures, and statistical significances were set at P < 0.05.
Results: One hundred and one students (Male: 49 and Female: 52) in the age range of 18–23 years responded to the study which recorded poor sleep quality in 53.5% and good sleep in 46.5%. Poor sleep quality as indicated by PSQI score >5 was reported in 63.5% of females and 42.9% of males which was statistically significant (P = 0.04). Out of these poor sleepers, 66.7% of males and 54.5% of females reported mobile phone usage for more than 2 up to 6 h. Comparatively, poor sleep quality was reported in only 19% of male students as compared to 27% of females among those using mobiles beyond 6 h. Besides, 14% of males and 18% of females among poor sleepers reported using mobiles <2 h. Further, in 80 respondents (Male: 40 and Female: 40) randomly selected for estimation of their early morning sample, serum melatonin level was estimated as 99.25 ± 72.07 pg/ml in males and 109.76 ± 84.54 pg/ml in females.
Conclusion: Nearly 2/3rd of poor sleeper, 1st-year medical male students use mobiles for 2–6 h daily during the pandemic while Only ½ of the females do. However, among those poor sleepers using mobiles beyond 6 h daily, females outnumbered males. Estimated Serum smelatonin levels were also relatively higher than those reported in nonpandemic studies.

Keywords: COVID pandemic, medical students, mobile phone use, Serum Melatonin, sleep quality


How to cite this article:
Hnamte L, Phurailatpam J, Laishram M. Effect of COVID-19 on sleep pattern, mobile usage, and serum melatonin level among 1st-year medical students. J Med Soc 2022;36:60-4

How to cite this URL:
Hnamte L, Phurailatpam J, Laishram M. Effect of COVID-19 on sleep pattern, mobile usage, and serum melatonin level among 1st-year medical students. J Med Soc [serial online] 2022 [cited 2022 Dec 1];36:60-4. Available from: https://www.jmedsoc.org/text.asp?2022/36/2/60/361282




  Introduction Top


The ongoing COVID-19 pandemic[1] has drastically affected the world, disrupting academia, disturbing the economy, and severely affecting the physical, psychological, and emotional well-being of individuals across the globe. Almost all types of communication and undertakings have become contactless, and the technical use of appliances such as smartphones, computers, and Internet has become a necessity.

Sleep, an essential and important physiological aspect of human survival, has been significantly affected by both the pandemic as well as the uncertainties[2] that it brought. More dependence on technological appliances has their own advantages but also an accompanying toll on the sleep quality as well as the physical and emotional well-being of individuals. Extensive mobile phone use exposes humans to a radiofrequency electromagnetic fields (RF-EMFs) of 30 kHz–300 GHz during signal transmission[3] with possible adverse effects on health such as sleep, EEG,[4] blood pressure, and melatonin secretion.[5] Changing sleep patterns also indicate varying levels in the sleep-regulating hormone, melatonin.[6] Melatonin is secreted from the pineal gland, a key regulator of the central circadian rhythm that controls many important physiological functions in the human body.

First-year medical students right at the entry to their professional career are usually subjected to stress as they undergo a transitional phase from a comfortable schooling environment to a more demanding medical atmosphere. The pandemic has also imposed upon the students, more than usual an increased dependence on modern technology such as mobile phones, tablets, laptops, and computers, as most classes become online to Adapt to the changing scenario. However, melatonin secretion is suggestively sensitive to electric, magnetic, and EMF influences,[7] excessive use of smartphones may result in its deviation from the normal physiological levels. Thus, this study is undertaken to evaluate the probable alterations in sleep, melatonin secretion, and mobile phone use in young medicos in the technology-dependence learning environment enforced by the global COVID-19 pandemic.

Aims and objectives

The study was developed with the primary aim to assess mobile phone usage among 1st-year medical students in a North East Indian Medical Institute during the COVID-19 pandemic and to evaluate their sleep quality and measure their early morning serum melatonin level. An attempt will be made to correlate the hours of mobile phone usage and how sleep as well as serum melatonin is affected during the pandemic.


  Materials and Methods Top


This is a cross-sectional study carried out in the Department of Physiology, RIMS, Imphal, designed to address the first wave of the COVID-19 pandemic during the winter months of October 2020 to January 2021. The study population consisted/targeted all the 1st-year MBBS students (2019 batch) and included those who are consented to participate during the pandemic. Those with prior insomnia, stress, anxiety, depression, or other mental disorders and those who have consumed a diet rich in melatonin in the last 3 days were excluded from the study.

The study tools consisted of standard questionnaires, Pittsburgh's Sleep Quality Index[8] (PSQI) for sleep assessment and Problematic Mobile Phone Usage Questionnaire[9] to assess mobile phone usage which were administered and recorded online to minimize contact during the pandemic. Morning blood samples were collected between 8 and 10 am with proper precautions, and serum melatonin was quantified using the melatonin ELISA technique (Catalogue No. BA E-3300, LDN Immunoassays and Services, Germany).

Statistical analysis

All responses to the questionnaires and s melatonin levels estimated were entered into IBM SPSS version 21 (IBM, Armonk, New York, USA) and analyzed using descriptive statistics such as mean, mean rank, percentage, and standard deviation. Association between study parameters was calculated using Chi-square, t-test, and Spearman correlation and significance level set at P < 0.05.

Ethical issues

Written informed consent was obtained from each patient before recruiting for the study. Confidentiality was strictly maintained. Ethical approval was obtained from the Institutional Ethics Committee, RIMS, Imphal, before the start of the study.


  Results Top


One hundred and one students (Male: 49 and Female: 52) in the age range of 18–23 years participated in the study. The hours of mobile phone use as reported by them are stratified into four groups: <2 h (low users), 2–4 h and 4–6 h (moderate users), and >6 h (high users), as shown in [Table 1]. Out of the respondents, equal numbers of males and females (40 each totaling up to 80) were selected and further assessed for quantification of serum melatonin levels.
Table 1: Gender distribution and hours of mobile phone use among respondents

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[Table 2] depicts the number of hours of mobile phone use and the association with the hours of sleep as reported by the participants. The mean rank of sleep hours in low users (<2 h of mobile use) was 24.83 in males comparable to females at 26.29. For those reporting mobile use for 2–4 h and 4–6 h, the mean rank of sleep hours was slightly more in females as compared to males. Interestingly, high user males using more than 6 h were calculated to have more mean ranks of sleep hours than females of the same group.
Table 2: Association of hours of phone use and hours of sleep among males and females

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The study recorded good sleep in 46.5% and poor sleep quality in 53.5% [Table 3]. Poor sleep quality as indicated by PSQI score >5 was reported in 63.5% of females and 42.9% of males which was statistically significant (P = 0.04). Out of these poor sleepers, 66.7% of males and 54.5% of females were moderate users (phones usage >2 h–6 h). Comparatively, in high users (>6 h use), poor sleep quality was reported in only 19% of male students as compared to 27% of females. Besides, 14% of males and 18% of females among poor sleepers were from the low user group (mobile use <2 h).
Table 3: Association between sleep quality index and hours of phone use stratified by gender

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Further, in the 80 respondents (Male: 40 and Female: 40) selected for assessment of their early morning sample, serum melatonin level was estimated as 99.25 ± 72.07 pg/ml in males and 109.76 ± 84.54 pg/ml in females [Table 4]. On further stratification and correlation with the hours of mobile phone use among the respondents irrespective of gender [Table 5], it was found that the mean serum melatonin level was 125.26 ± 85.80 pg/ml in low users, decreasing significantly with increasing use of mobile phones to only 85.06 ± 78.24 pg/ml in high users.
Table 4: Association of gender with mean serum melatonin levels

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Table 5: Hours of phone use versus serum melatonin levels

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  Discussion Top


COVID-19 emerged as a highly infectious disease for the first time in December 2019 in Wuhan (Hubei, China) and spread so rapidly that the WHO declared it a pandemic on March 11, 2020.[1] The uncertainties, fear, anxiety, and economic disaster caused worldwide[2] have disrupted normal lifestyles globally resulting in overt dependence on modern technologies for communication, transactions, education, and all other activities.

The American Academy of Sleep Medicine and Sleep Research Society recommended an amount of sleep >7 h/night regularly for optimal health in adults. However, gadgets such as mobile phones, tablets, laptops, and computers have become essential ways for communication and information in such times of pandemic for individuals and students in particular, as they became an important medium for continuing academic activities online at home. However, the sudden reduction in outdoor activities and social interactions among people is bound to impact their nighttime sleep and daily activity.[10]

Sleep–wake cycle is governed by the central circadian clock[11] located in the suprachiasmatic nuclei of the hypothalamus through its hormone, melatonin.[4] The pineal gland secretes melatonin, a key modulator of the circadian rhythm in the human body. Melatonin is mostly secreted at night and its levels begin to rise in the evening, reaching its peak between 2 and 5 am in adults.[12] It is regarded as sensitive to electric, magnetic, and EMF influences.

The present study addressed the quality of sleep, duration of mobile phone use, and levels of melatonin in 1st-year-medical students during the COVID-19 pandemic in a north eastern region of India. Using PSQI, we found that 53.5% of students reported poor sleep quality while 46.5% had good sleep quality which is comparable to studies conducted using the same questionnaire by Akçay and Akçay[13] where 59.7% had poor sleep quality and 40.3% had good sleep quality.

In high user group, poor sleep quality was seen more in females than males (3:2), comparable to studies conducted by Kawada et al.[14] It may be because girls are more socially and emotionally attached to family and friends than boys. This extended use of mobile may lead to poor quality sleep and insomnias in this group.

It is of interest to note that around 15% of poor sleepers irrespective of gender belong to the low user group, suggesting the existence of stressors other than mobile phones in times of pandemics like the current one to decrease the sleep quality of the students.

When we analyzed serum melatonin levels in the study, we found the mean values in both genders to be higher than those reported by Shrivastava and Saxena[15] in morning samples of medical students. It might have resulted from the influence of the geographical location as well as the seasonal variations with significantly less amount of daylight available and longer nights of the cold winter months in the region during which the study was carried out.

The obvious reduction in the melatonin levels with increasing exposure to mobile phones may be due to the effect of RF-EMF emitted by the gadgets as they have been suggested to probably alter the cerebral blood flow[16] and electrical brain activity, including that of the pineal gland, thus influencing the melatonin rhythm. The circadian rhythmic melatonin production which is high during the night and low during the day is reportedly influenced by visible portion of electromagnetic spectrum, i.e., light,[17] as well as nonvisible extremely low-frequency EMF, both of which depresses the conversion of serotonin to melatonin within the pineal gland.[18]

Limitations of the study

Melatonin quantification could not be done in all cases due to financial constraints and the COVID situation restricted the recruitment of more study participants. Moreover, pre-COVID data were not available for comparison for all study parameters (melatonin levels, mobile uses, and sleep quality).


  Conclusion Top


Medical students during the COVID pandemic significantly reported poor sleep quality which may likely affect their academic performance. An association with their sleep quality and excessive use of the mobile phone was found which seems to affect the females more during the COVID pandemic. Moreover, there is a negative correlation with hours of mobile use and melatonin levels. Further studies assaying melatonin levels at different times of the day and season and its association with exact quantification of the EMF emitted by mobile phones are warranted to establish the probable mechanism for disturbance in the circadian rhythm of sleep and melatonin so that resultant health hazards be minimized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Health Topic. Regional Office for Europe: World Health Organisation. Corona Virus Disease (COVID-19) Outbreak; [4 Screens]. Source; c2021. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19. [Last updated on 2021 Aug 01; last accessed on 2021 Oct 30].  Back to cited text no. 1
    
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Pitlik SD. COVID-19 compared to other pandemic diseases. Rambam Maimonides Med J 2020;11. doi:10.5041/RMMJ.10418.  Back to cited text no. 2
    
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Maier M, Blakemore C, Koivisto M. The health hazards of mobile phones. BMJ 2000;320:1288-9.  Back to cited text no. 3
    
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Loughran SP, Wood AW, Barton JM, Croft RJ, Thompson B, Stough C. The effect of electromagnetic fields emitted by mobile phones on human sleep. Neuroreport 2005;16:1973-6.  Back to cited text no. 4
    
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Jarupat S, Kawabata A, Tokura H, Borkiewicz A. Effects of the 1900 MHz electromagnetic field emitted from cellular phone on nocturnal melatonin secretion. J Physiol Anthropol Appl Human Sci 2003;22:61-3.  Back to cited text no. 5
    
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Touitou Y, Reinberg A, Touitou D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption. Life Sci 2017;173:94-106.  Back to cited text no. 6
    
7.
Wood AW, Loughran SP, Stough C. Does evening exposure to mobile phone radiation affect subsequent melatonin production? Int J Radiat Biol 2006;82:69-76.  Back to cited text no. 7
    
8.
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;28:193-213.  Back to cited text no. 8
    
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Billieux J, Van Der Linden M, Rochat L. The role of impulsivity in actual and problematic use of the mobile phone. Appl Cogn Psychol 2008;22:1195-210.  Back to cited text no. 9
    
10.
Altena E, Baglioni C, Espie CA, Ellis J, Gavriloff D, Holzinger B, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. J Sleep Res 2020;29:e13052.  Back to cited text no. 10
    
11.
Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol 2018;175:3190-9.  Back to cited text no. 11
    
12.
Nogueira LM, Sampson JN, Chu LW, Yu K, Andriole G, Church T, et al. Individual variations in serum melatonin levels through time: Implications for epidemiologic studies. PLoS One 2013;8:e83208.  Back to cited text no. 12
    
13.
Akçay D, Akçay BD. The effect of mobile phone usage on sleep quality in adolescents. JNBS 2018;5:13-7.  Back to cited text no. 13
    
14.
Kawada T, Kataoka T, Tsuji F, Nakade M, Krejci M, Noji T, et al. The relationship between a night usage of mobile phone and sleep habit and the circadian typology of Japanese students aged 18-30 yrs. Psychology 2017;8:892-902.  Back to cited text no. 14
    
15.
Shrivastava A, Saxena Y. Effect of mobile usage on serum melatonin levels among medical students. Indian J Physiol Pharmacol 2014;58:395-9.  Back to cited text no. 15
    
16.
Huber R, Treyer V, Borbély AA, Schuderer J, Gottselig JM, Landolt HP, et al. Electromagnetic fields, such as those from mobile phones, alter regional cerebral blood flow and sleep and waking EEG. J Sleep Res 2002;11:289-95.  Back to cited text no. 16
    
17.
Heo JY, Kim K, Fava M, Mischoulon D, Papakostas GI, Kim MJ, et al. Effects of smartphone use with and without blue light at night in healthy adults: A randomized, double-blind, cross-over, placebo-controlled comparison. J Psychiatr Res 2017;87:61-70.  Back to cited text no. 17
    
18.
Reiter RJ. Static and extremely low frequency electromagnetic field exposure: Reported effects on the circadian production of melatonin. J Cell Biochem 1993;51:394-403.  Back to cited text no. 18
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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