The relationship between perfectionism and quality of sleep: A cross-sectional study among Sudanese medical students

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Elbadawi, Amr A. Mubasher, Alaa A. Abdulgalil, Mohamed H. Fadul, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4164935/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Perfectionism is characterized by the pursuit of perfection, the imposition of unreasonably high standards for performance, and a constant state of self-criticism of one's actions. Perfectionism leading to depression, OCD, and anxiety can affect the quality of sleep, leading to less productivity and less involvement in one's daily activities. One of the most affected groups is medical students who are more likely to develop sleep-deprived lifestyles; this can be due to the stressful environment of medical school and the perceived high academic load. This study aims to address the association between perfectionism among medical students and sleep quality. Method : The study utilized an analytical and facility-based cross-sectional study conducted in March 2023 at the Faculty of Medicine, University of Khartoum, Sudan. We used two validated questionnaires which are: The Frost Multidimensional Perfectionism Scale (F-MPS and the Pittsburgh Sleep Quality Index (PSQI). Data was collected using an online self-administered questionnaire via social media platforms. Analysis has been done using SPSS version 21 by descriptive statistics, univariate analysis, and regression. Results: 233 medical students were included in the study. Almost 56% of them were females. Almost 60% of the sample suffered from poor sleep quality. There weren't any significant mean differences observed in gender or age regarding perfectionism and sleep quality. Only two domains of perfectionism were found to be significantly associated with sleep quality:” concerns over mistakes and doubts of action” and “concern with parent expectation and evaluation”( P < 0.01 for both domains). There was a positive and significant association between the total perfectionism scale and sleep quality(r = 0.222, P < 0.01). Conclusion : There is growing evidence of the association between sleep quality and perfectionism. Our study highlighted this association among medical students. We found that there was a small positive and significant association between total the perfectionism scale and sleep quality. But neither gender nor academic year showed to be contributing to this association. So our study demonstrates the effect of perfectionism in disturbing the sleep quality unbiased by either gender or academic year with potential clinical and therapeutic applications. These findings can benefit the medical students in the University of Khartoum and other medical students. Perfectionism sleep quality Sudan Medical students Figures Figure 1 Background Perfectionism The personality condition known as perfectionism is characterised by the pursuit of perfection, the imposition of unreasonably high standards for performance, and a constant state of self-criticism of one's actions( 1 ). Perfectionism was subclassified into adaptive (positive) and maladaptive (negative) which share the same dimensions and subscales. The difference between the two is that negative perfectionists tend to have less tolerance for being less than perfect, and they experience symptoms with greater intensity. This was found to be linked to concern over mistakes, doubts about actions, and socially prescribed perfectionism( 2 ) . Dimensions of perfectionism are associated with a wide spectrum of psychopathological conditions, including depression( 3 ), OCD( 4 ), anxiety disorders( 5 ), and eating disorders ( 6 ). Moreover, dimensions of perfectionism are correlated with somatic symptoms; a higher socially prescribed perfectionism was associated with longer pain duration ( 7 ). Sleep Quality According to the Encyclopedia of Behavioral Medicine, sleep quality is defined as “one’s satisfaction with the sleep experience, integrating aspects of sleep initiation, sleep maintenance, quantity, and refreshment upon awakening”. Quality of life is linked with sleep quality. A study conducted in Korea reported that quality of life is correlated with poor sleep quality ( 8 ). Many consequences can result from impaired sleep, including somatic symptoms such as obesity ( 9 ), coronary heart disease ( 10 ), exhaustion, daytime dysfunction, excessive sleepiness, fatigue ( 11 ), and road traffic crashes ( 12 ). As for medical students, sleeping in lecture halls is quite common in universities. A study conducted in Malaysia revealed that daytime sleepiness is highly prevalent in medical schools ( 13 ). The link between perfectionism and sleep quality Perfectionism has been prominent when studying sleep quality. There is a growing body of literature reviewing the association between perfectionism and sleep quality. A study conducted in Portugal revealed that university students with higher levels of socially prescribed perfectionism develop sleep disturbances ( 14 ). According to the study, perfectionistic behaviours such as concerns, doubts about actions, and parental criticism were linked to poor sleep quality. Previous studies on this association have reached different conclusions; some studies- support the hypothesis that perfectionism is correlated with sleep disturbances ( 14 ), while other studies have shown a negative correlation ( 15 ). Which in turn leads to an inconclusive view of the correlation. The importance of studying perfectionism comes from the fact that certain perfectionistic behaviours, such as “concerns about actions” contribute negatively to the quality of life and satisfaction ( 16 ). Perfectionism can affect the quality of sleep ( 14 ), leading to less productivity and less involvement in one's daily activities. Medical students are more likely to develop sleep-deprived lifestyles ( 13 ); this can be due to the stressful environment of medical school and the perceived high academic load. In Sudan, being a medical physician is accompanied by a special social stereotype, which pressures students to remodel into a successful, perfect socially prescribed stereotype. The University of Khartoum is the most elite in Sudan, ranking first among Sudanese universities according to Webometrics statistics and standards ( 17 ). Getting accepted to the university’s medical school is highly competitive since it accepts only the highest secondary school degrees( 18 ). As a result, the majority of students are among the top ranks nationally. The majority of students in this faculty have high standards for themselves, especially in academics and other professional, personal, and social aspects. This creates a competitive and selective environment. Such students may have experienced pressure to meet high standards since childhood and may struggle with self-acceptance in the face of failure, leading to anxiety and sleep disturbances. The present study was designed to test the hypothesis that perfectionism is related to sleep disturbances among medical students at the university, to examine gender differences, the associations between perfectionism subscales (high personal standards, concern with mistakes, concern with precision, concern with parental expectations), and sleep quality. Despite the growing literature on perfectionism, students at the University of Khartoum have paid little attention to its effects. This study aims to increase knowledge and contribute to future research in Sudan. Materials and Methods Study design, setting, and study population This was an analytical institution-based cross-sectional study, exploring the connection between perfectionism and sleep quality among MBBS-enrolled medical students at the University of Khartoum in 2023. The University of Khartoum is currently ranked 1st in Sudan and 2310th in the world, according to the 2022 overall rankings. It has also been ranked in the top 50% in 21 academic topics. The ranking was conducted by EdU Rank and is based on three factors: research performance, nonacademic reputation, and the impact of 36 notable alumni( 18 ). The research performance was evaluated by a proprietary algorithm that analyzed 5,830 publications and 96,433 citations( 19 ). A total of 2281 medical students were enrolled at the University of Khartoum in 2023. The study included students of all academic levels and genders. Sampling techniques A total of 2281 undergraduate medical students were considered for the research study. A sample size of 233 students was selected using an online sample size calculator engine( 25 ), with a confidence level of 95% and a precision level of 0.05. Simple random sampling was used to select students from each batch based on population proportion. A 75% estimated response rate was added, resulting in a final sample size of 439 students. Data collection This research relied on primary data collected through a structured online questionnaire self-administered to medical students at the University of Khartoum. The questionnaire designed for this study explored perfectionism traits and sleep patterns, providing first-hand insights for focused analysis. A self-administered anonymous online questionnaire designed with Google Forms, and sent via Telegram and WhatsApp was completed by 233 medical students, for a response rate of 71%. Most of the participants were from the 2nd and 3rd years. We did not have any batches in the 5th year at the time of data collection. Due to delays, this batch is still in its fourth year. Study instruments Frost Multidimensional Perfectionism Scale (F-MPS) Perfectionism was measured using the Frost Multidimensional Perfectionism Scale (F-MPS). The full F-MPS is a 35-item scale containing six subscales: doubts about action (four items; for example, "I usually have doubts about the simple everyday things I do"), concern over mistakes (nine items; for example, "I should be upset if I make a mistake"), parental expectations (five items; for example, "My parents wanted me to be the best at everything"), parental criticism (four items; for example, "My parents never tried to understand my mistakes''). Personal standards (seven items: for example. "I expect higher performance in my daily tasks than most people''), and organization (six items; for example, "I am an organized person")( 20 ). Each item is answered using a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). Good internal consistency and convergent validity with other measures of perfectionism have been demonstrated for the F-MPS within community and clinical samples of adults ( 20 , 21 ). The factor structure of the F-MPS has been somewhat variable across samples( 22 ). The Pittsburgh Sleep Quality Index (PSQI) Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). This self-administered questionnaire assesses the quality of sleep during the previous month and contains 19 self-rated questions yielding seven components: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Each component is scored from 0 to 3, yielding a global PSQI score between 0 and 21, with higher scores indicating lower quality of sleep. The PSQl is useful for identifying good and poor sleepers( 23 ). A global score greater than 5 indicates poor sleep quality with a sensitivity of 89.6% and specificity of 86.5%( 24 ). Statistical analysis plan The data collected from the participants were initially cleaned and analyzed using SPSS version 21. Descriptive statistics were used to show the frequency, mean, and standard deviations of the sociodemographic factors against the total perfectionism scale(Frost Multidimensional Perfectionism Scale) and sleep quality scale(for the global Pittsburgh Sleep Quality Index scale). Independent T-test were used to compare perfectionism and sleep quality between males and females, while ANOVA was used to compare the same outcome variables between groups during the academic year. Pearson correlation was used to study the correlation between the perfectionism scale domains and the sleep quality scale domain. Binomial logistic regression was performed for sociodemographic factors and perfectionism scale scores against sleep quality as the outcome variable. A p-value of p < 0.05 was considered significant Results Sociodemographic data of the participants The questionnaires were collected from 233 medical students from the University of Khartoum. The mean age was 19.73 years. Almost 56.7% of the participants were females representing more than half of the participants. Most of the participants were in their 2 nd and 3 rd years (38.6% and 30.5%, respectively). (Further details are provided in Table 1 ). As shown in Table 1, there were no significant differences between males and females regarding perfectionism or sleep quality (P values = 0.430 and 0.108 respectively), or academic year (P values = 0.875 and 0.981 respectively). However, it was reported that females tend to have higher means across the two scales than males. The association between perfectionism and sleep quality The Frost multidimensional perfectionism scale is composed of 4 domains. The Pittsburgh Sleep Quality scale is composed of 7 components. As illustrated in Figure 1, almost 60% of the participants suffered from poor sleep quality. When Pearson correlation was used to detect associations between perfectionism and the global Pittsburgh Sleep Quality Index, only 2 domains were found to be significantly associated with sleep quality: concerns about mistakes and doubts about action (r =0.270, P<0.01) and concern about parental expectations and evaluations (r =0.233, P<0.01). Naturally, there was a small, positive, and significant association between the total perfectionism score and sleep quality (r =0.222, P<0.01). The only sleep quality scale component that was significantly affected by all perfectionism domains was the 5 th component (sleep disturbance component). The total perfectionism score was found to be significantly correlated with the 1 st ,2 nd ,5 th and 7 th domains of the Sleep Quality Scale(P <0.05). (further details are provided in Table 2 ). Binary logistic regression was performed for sex, age, academic year, and FMPS domain score, with sleep quality as the outcome variable. The model was fit with Omnibus tests, which yielded a chi-square of 24.694 and a P value of 0.006(statistically significant). The Hosmer and Lemeshow test was not significant (P=0.539). No significant values were detected in the model (further details are provided in Table 3 ). Table 1: The sociodemographic characteristics of the participants and the univariate analysis of the perfectionism scale and sleep quality scale scores (n=233) The characteristics Frequency (%) Total perfectionism Scale Total sleep quality Scale P value 1 P value 2 Mean SD* Mean SD* Age 19.73^ Gender: Male Female 132(56.7%) 101(43.3%) 108.05 110.04 19.249 18.86 6.12 6.79 3.06 3.19 0.430 0.108 Academic Year***: 1 st year 2 nd Year 3 rd Year 4 th year 6 th year 48(20.6%) 90(38.6%) 71(30.5%) 5(2.1%) 19(8.2%) 110.40 109.60 108.14 114.60 106.53 17.65 18.44 20.78 12.76 20.61 6.79 6.56 6.27 6.00 6.47 3.30 3.22 2.10 1.58 3.44 0.875** 0.918** *Standard deviation,**ANOVA between groups,*** we did not have any batch at the 5 th year at the time of data collection, 1 P values for total Frost Multidimensional Perfectionism Scale, 2 P values for the global Pittsburgh Sleep Quality Index score, and^ represent the meanstandard deviation Table 2: The table shows the characteristics of perfectionism domains from FMPS and their correlation with sleep quality compounds using Pearson correlation across the participants (n=233) The domain Mean SD^ 1* 2* 3* 4* 5* 6* 7* Pearson Correlation of Total PQSI scale Concern over mistakes and doubts about action 38.02 9.70 .175 *** .181 *** .033 .064 .172 *** -.068 .285 *** 0.270*** Concern with parents' expectations and evaluation 26.61 6.018 .122 .211 *** .013 .085 .190 *** .003 .199 *** 0.233*** Excessively high Personal Standard 23.23 4.72 .008 .067 -.012 -.081 .191 *** -.144 ** .072 0.030 Concern with Precision, order and organization 21.32 4.49 -.001 .047 .038 -.091 .181 *** -.122 .012 0.011 Total FMPS Score 109.18 2.044 .130 ** .187 *** .027 .018 .238 *** -.098 .229 *** 0.222*** ^Standard deviation,*Pearson correlation coefficient for different components of PGSI scale, ** P value less than 0.05,*** P value less than 0.01 Table 3: Binomial logistic regression for sociodemographic factors and perfectionism domains taking sleep quality status as an outcome variable (n=233) Variables Standard error Wald Degree of freedom Odd ratio P value 95% Confidence Interval for Odd ratio Lower Upper Academic year(ref=1st year) 1.222 4 .874 2 nd year .446 1.088 1 .628 .297 .262 1.505 3 rd year .671 .785 1 .552 .376 .148 2.055 4 th year 1.291 .497 1 .403 .481 .032 5.053 5 th year 1.075 .389 1 .511 .533 .062 4.205 Gender(ref=female) Male .300 .139 1 1.118 .710 .621 2.015 Age .148 .435 1 1.103 .509 .824 1.476 Total FMPS scale a .039 .129 1 .986 .720 .914 1.064 FMPS domains: Concern over mistakes and doubts about action .044 3.444 1 1.086 .063 .995 1.185 Concern with parents' expectations and evaluation .050 1.107 1 1.054 .293 .955 1.163 Excessively high personal standards .069 .404 1 .957 .525 .837 1.095 Constant 2.774 1.254 1 .045 .263 Ref=reference category. a Frost Multidimensional Perfectionism Scale Discussion This study assessed the relationship between perfectionism and sleep quality among students at the University of Khartoum, Faculty of Medicine. The data were collected from undergraduate students of the Faculty of Medicine, University of Khartoum with a mean age of 19.73 years. The percentages of males and females in the sample were 43.3% and 56.7% respectively, and a study conducted in Portugal also showed a female majority in the sample (62%)( 26 ). Most of the participants were in their 2nd and 3rd years (38.6% and 30.5% respectively) There were no significant differences between males and females regarding perfectionism scales and sleep quality scales (P values = 0.430 and 0.108 respectively) or for different academic years (P values = 0.875 and 0.981 respectively). This reflects that the effect of perfectionism on sleep quality is not affected by gender or academic year. However, it was reported that females tend to have greater means across the two scales (FMPS and PSQI) than males, Which is in line with a previous study conducted in the USA that revealed that women were more likely than men to be perfectionists (72% of women versus 65% of men)( 27 ). Regarding sleep quality, nearly 60% of the sample suffered from poor sleep quality, Which is a very high percentage when compared to a study conducted in Malaysia in which 16.1% of a sample of medical students in Malaysia reported poor sleep quality( 13 ). In the present study, only two domains of perfectionism were found to be significantly associated with sleep quality, The first domain was “concern over mistakes and doubts about actions” (r = 0.270, P < 0.01) which is in agreement with a study conducted in England that reported antly associated with doubts about actions (r = 0.22, P = 0.04)(28). The second perfectionism domain that was associated with sleep quality in the current study concerned parents’ expectations and evaluations (r = 0.233, P < 0.01). Our data revealed that there was a small positive and significant association between the total perfectionism scale score and sleep quality (r = 0.222, P < 0.01). This indicates that as perfectionism increases, sleep quality decreases, Which is in line with a study conducted in Portugal that revealed small positive correlations between total perfectionism and poor sleep quality(29). And two other studies conducted in China(30,31). Another study in Switzerland revealed that perfectionism was directly associated with poor sleep, but this association was not significant(32). The only sleep quality component that was affected by all the FMPS four perfectionism domains was the 5th domain (sleep disturbance). However, total perfectionism was found to be significantly associated with the 1st “subjective sleep quality”, 2nd “sleep latency”, 5th “sleep disturbance” and 7th “daytime dysfunction” domains of the Sleep Quality Scale, Which is consistent with a study conducted in China that revealed that perfectionism was significantly correlated with all domains except for the 3rd “sleep duration” and 7th “daytime dysfunction” domains of the PSQI (30). Binary logistic regression was performed for sex, age, academic year, and FMPS domain score, with sleep quality as the outcome variable. No significant values were detected in the model. Strengths and Limitations This is the first study among Sudanese medical students at the Faculty of Medicine - University of Khartoum, to explore the relationship between perfectionism and quality of sleep. The strength of this study is its consideration of different factors that may contribute to therapeutic applications. Collecting data for this research has been challenging due to the ongoing war. The Internet was interrupted in most areas as a result of the current war which made it difficult to gather data. Additionally, the research questionnaire was lengthy which further contributed to the shortage of the research sample. Conclusion According to our study, there were no significant mean differences detected in either gender or academic years regarding perfectionism and sleep quality. However, females had a greater perfectionism score than males. Moreover, nearly 60% of the participants experienced poor sleep quality. Out of all the domains of perfectionism, only two were found to have a significant link with sleep quality: concern about mistakes and doubts about actions and concern about parents' expectations and evaluation. All domains of perfectionism led to sleep disturbance and were significantly associated with the 1st, 2nd, 5th, and 7th domains of the sleep quality scale. University of Khartoum medical students may benefit from these findings, as they can demonstrate the effect of perfectionism in disturbing sleep quality unbiased by either gender or academic year with potential clinical and therapeutic applications. Abbreviations F-MPS Frost Multidimensional Perfectionism Scale PSQI Pittsburgh Sleep Quality Index SPSS Statistical package of social sciences OCD Obsessive-compulsive disorder MBBS Bachelor of Medicine and Bachelor of Surgery Declarations Ethics approval and consent to participate Ethical clearance was granted from the ethical committee of the community medicine department at Khartoum University, Faculty of Medicine. Informed consent was given by each participant to participate in the study. Consent for publication Not applicable. Data availability The dataset used and analyzed during this study is available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding The authors did not receive any financial or material support. Acknowledgement: We acknowledge all the respondents for their time in participating in this study. Author Contributions: MHE : conceptualization, methodology and study design, data Analysis, results and data interpretation, manuscript drafting, revision and proofreading. AAM : literature review, data collection, questionnaire design, conceptualization, data analysis, manuscript drafting, revision and proofreading. AAA : literature review, data collection, questionnaire design, conceptualization, methodology and study design, manuscript drafting, revision and proofreading. AM : literature review, data collection, conceptualization, methodology and study design, manuscript drafting. NE : literature review, data collection, conceptualization, manuscript drafting. RM : literature review, data collection, conceptualization, manuscript drafting. WAM : literature review, data collection, conceptualization. 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Elbadawi","email":"data:image/png;base64,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","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"H.","lastName":"Elbadawi","suffix":""},{"id":285917679,"identity":"1540ea84-08f1-4140-9a82-3f4666db5fa8","order_by":1,"name":"Amr A. Mubasher","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Amr","middleName":"A.","lastName":"Mubasher","suffix":""},{"id":285917680,"identity":"d5ddaeee-a407-4239-990b-a7fde1e58728","order_by":2,"name":"Alaa A. Abdulgalil","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Alaa","middleName":"A.","lastName":"Abdulgalil","suffix":""},{"id":285917681,"identity":"ec8114b8-bb93-45e7-bd21-375ac20c173a","order_by":3,"name":"Mohamed H. Fadul","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"H.","lastName":"Fadul","suffix":""},{"id":285917682,"identity":"edb0d64c-8b2d-4bef-9366-1c32ef420495","order_by":4,"name":"Nafisa Elameen Nimir Elameen","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Nafisa","middleName":"Elameen Nimir","lastName":"Elameen","suffix":""},{"id":285917683,"identity":"5098e2a1-c451-49b3-ac49-acd485cebdf4","order_by":5,"name":"Ragad Magdi Mohammed Elamin","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Ragad","middleName":"Magdi Mohammed","lastName":"Elamin","suffix":""},{"id":285917684,"identity":"9acbedf9-6c11-4818-9242-9212a8421f30","order_by":6,"name":"Waad A. Mohamed","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Waad","middleName":"A.","lastName":"Mohamed","suffix":""},{"id":285917685,"identity":"6a8b01f4-dc00-4a2e-8758-4d4223b1a568","order_by":7,"name":"Aya Mujtaba Taha Alsaid","email":"","orcid":"","institution":"Faculty of Medicine, University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Aya","middleName":"Mujtaba Taha","lastName":"Alsaid","suffix":""}],"badges":[],"createdAt":"2024-03-25 17:32:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4164935/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4164935/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53957210,"identity":"09249652-f2a5-4438-876d-979a222fb8d6","added_by":"auto","created_at":"2024-04-02 17:35:21","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":120436,"visible":true,"origin":"","legend":"\u003cp\u003eThe figure shows the proportion of good sleep quality to poor sleep quality across the participants (N=233)\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4164935/v1/692aa8ff3a465c689b2155f5.jpeg"},{"id":60096163,"identity":"c7d8e0b1-457f-4d89-9776-9881bcab5ff2","added_by":"auto","created_at":"2024-07-11 17:37:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":806501,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4164935/v1/c90702fb-d446-4b6e-bf01-9570869fe160.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between perfectionism and quality of sleep: A cross-sectional study among Sudanese medical students","fulltext":[{"header":"Background","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003ePerfectionism\u003c/h2\u003e \u003cp\u003eThe personality condition known as perfectionism is characterised by the pursuit of perfection, the imposition of unreasonably high standards for performance, and a constant state of self-criticism of one's actions(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Perfectionism was subclassified into adaptive (positive) and maladaptive (negative) which share the same dimensions and subscales. The difference between the two is that negative perfectionists tend to have less tolerance for being less than perfect, and they experience symptoms with greater intensity. This was found to be linked to concern over mistakes, doubts about actions, and socially prescribed perfectionism(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) .\u003c/p\u003e \u003cp\u003eDimensions of perfectionism are associated with a wide spectrum of psychopathological conditions, including depression(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), OCD(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), anxiety disorders(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), and eating disorders (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Moreover, dimensions of perfectionism are correlated with somatic symptoms; a higher socially prescribed perfectionism was associated with longer pain duration (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSleep Quality\u003c/h2\u003e \u003cp\u003eAccording to the Encyclopedia of Behavioral Medicine, sleep quality is defined as \u0026ldquo;one\u0026rsquo;s satisfaction with the sleep experience, integrating aspects of sleep initiation, sleep maintenance, quantity, and refreshment upon awakening\u0026rdquo;. Quality of life is linked with sleep quality. A study conducted in Korea reported that quality of life is correlated with poor sleep quality (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Many consequences can result from impaired sleep, including somatic symptoms such as obesity (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), coronary heart disease (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), exhaustion, daytime dysfunction, excessive sleepiness, fatigue (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and road traffic crashes (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). As for medical students, sleeping in lecture halls is quite common in universities. A study conducted in Malaysia revealed that daytime sleepiness is highly prevalent in medical schools (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eThe link between perfectionism and sleep quality\u003c/h2\u003e \u003cp\u003ePerfectionism has been prominent when studying sleep quality. There is a growing body of literature reviewing the association between perfectionism and sleep quality. A study conducted in Portugal revealed that university students with higher levels of socially prescribed perfectionism develop sleep disturbances (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). According to the study, perfectionistic behaviours such as concerns, doubts about actions, and parental criticism were linked to poor sleep quality. Previous studies on this association have reached different conclusions; some studies- support the hypothesis that perfectionism is correlated with sleep disturbances (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), while other studies have shown a negative correlation (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Which in turn leads to an inconclusive view of the correlation.\u003c/p\u003e \u003cp\u003eThe importance of studying perfectionism comes from the fact that certain perfectionistic behaviours, such as \u0026ldquo;concerns about actions\u0026rdquo; contribute negatively to the quality of life and satisfaction (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Perfectionism can affect the quality of sleep (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), leading to less productivity and less involvement in one's daily activities.\u003c/p\u003e \u003cp\u003eMedical students are more likely to develop sleep-deprived lifestyles (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e); this can be due to the stressful environment of medical school and the perceived high academic load. In Sudan, being a medical physician is accompanied by a special social stereotype, which pressures students to remodel into a successful, perfect socially prescribed stereotype.\u003c/p\u003e \u003cp\u003eThe University of Khartoum is the most elite in Sudan, ranking first among Sudanese universities according to Webometrics statistics and standards (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Getting accepted to the university\u0026rsquo;s medical school is highly competitive since it accepts only the highest secondary school degrees(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). As a result, the majority of students are among the top ranks nationally. The majority of students in this faculty have high standards for themselves, especially in academics and other professional, personal, and social aspects. This creates a competitive and selective environment. Such students may have experienced pressure to meet high standards since childhood and may struggle with self-acceptance in the face of failure, leading to anxiety and sleep disturbances.\u003c/p\u003e \u003cp\u003eThe present study was designed to test the hypothesis that perfectionism is related to sleep disturbances among medical students at the university, to examine gender differences, the associations between perfectionism subscales (high personal standards, concern with mistakes, concern with precision, concern with parental expectations), and sleep quality. Despite the growing literature on perfectionism, students at the University of Khartoum have paid little attention to its effects. This study aims to increase knowledge and contribute to future research in Sudan.\u003c/p\u003e \u003c/div\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, setting, and study population\u003c/h2\u003e \u003cp\u003eThis was an analytical institution-based cross-sectional study, exploring the connection between perfectionism and sleep quality among MBBS-enrolled medical students at the University of Khartoum in 2023. The University of Khartoum is currently ranked 1st in Sudan and 2310th in the world, according to the 2022 overall rankings. It has also been ranked in the top 50% in 21 academic topics. The ranking was conducted by EdU Rank and is based on three factors: research performance, nonacademic reputation, and the impact of 36 notable alumni(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The research performance was evaluated by a proprietary algorithm that analyzed 5,830 publications and 96,433 citations(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). A total of 2281 medical students were enrolled at the University of Khartoum in 2023. The study included students of all academic levels and genders.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSampling techniques\u003c/h2\u003e \u003cp\u003eA total of 2281 undergraduate medical students were considered for the research study. A sample size of 233 students was selected using an online sample size calculator engine(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), with a confidence level of 95% and a precision level of 0.05. Simple random sampling was used to select students from each batch based on population proportion. A 75% estimated response rate was added, resulting in a final sample size of 439 students.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eThis research relied on primary data collected through a structured online questionnaire self-administered to medical students at the University of Khartoum.\u003c/p\u003e \u003cp\u003eThe questionnaire designed for this study explored perfectionism traits and sleep patterns, providing first-hand insights for focused analysis.\u003c/p\u003e \u003cp\u003eA self-administered anonymous online questionnaire designed with Google Forms, and sent via Telegram and WhatsApp was completed by 233 medical students, for a response rate of 71%. Most of the participants were from the 2nd and 3rd years. We did not have any batches in the 5th year at the time of data collection. Due to delays, this batch is still in its fourth year.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStudy instruments\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eFrost Multidimensional Perfectionism Scale (F-MPS)\u003c/h2\u003e \u003cp\u003ePerfectionism was measured using the Frost Multidimensional Perfectionism Scale (F-MPS).\u003c/p\u003e \u003cp\u003eThe full F-MPS is a 35-item scale containing six subscales: doubts about action (four items; for example, \"I usually have doubts about the simple everyday things I do\"), concern over mistakes (nine items; for example, \"I should be upset if I make a mistake\"), parental expectations (five items; for example, \"My parents wanted me to be the best at everything\"), parental criticism (four items; for example, \"My parents never tried to understand my mistakes''). Personal standards (seven items: for example. \"I expect higher performance in my daily tasks than most people''), and organization (six items; for example, \"I am an organized person\")(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEach item is answered using a 5-point Likert-type scale ranging from 1 (strongly disagree) to 5 (strongly agree). Good internal consistency and convergent validity with other measures of perfectionism have been demonstrated for the F-MPS within community and clinical samples of adults (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The factor structure of the F-MPS has been somewhat variable across samples(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe Pittsburgh Sleep Quality Index (PSQI)\u003c/h2\u003e \u003cp\u003eSleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). This self-administered questionnaire assesses the quality of sleep during the previous month and contains 19 self-rated questions yielding seven components: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, use of sleep medications, and daytime dysfunction. Each component is scored from 0 to 3, yielding a global PSQI score between 0 and 21, with higher scores indicating lower quality of sleep. The PSQl is useful for identifying good and poor sleepers(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). A global score greater than 5 indicates poor sleep quality with a sensitivity of 89.6% and specificity of 86.5%(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis plan\u003c/h2\u003e \u003cp\u003e The data collected from the participants were initially cleaned and analyzed using SPSS version 21. Descriptive statistics were used to show the frequency, mean, and standard deviations of the sociodemographic factors against the total perfectionism scale(Frost Multidimensional Perfectionism Scale) and sleep quality scale(for the global Pittsburgh Sleep Quality Index scale). Independent T-test were used to compare perfectionism and sleep quality between males and females, while ANOVA was used to compare the same outcome variables between groups during the academic year. Pearson correlation was used to study the correlation between the perfectionism scale domains and the sleep quality scale domain. Binomial logistic regression was performed for sociodemographic factors and perfectionism scale scores against sleep quality as the outcome variable. A p-value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSociodemographic data of the participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe questionnaires were collected from 233 medical students from the University of\u0026nbsp;Khartoum. The mean age was 19.73 years. Almost 56.7% of the\u0026nbsp;participants\u0026nbsp;were females representing more than half of the participants. Most of the participants were\u0026nbsp;in their\u0026nbsp;2\u003csup\u003end\u003c/sup\u003e and 3\u003csup\u003erd\u003c/sup\u003e years (38.6% and 30.5%, respectively). (Further details are provided in \u003cstrong\u003eTable 1\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eAs shown in \u003cstrong\u003eTable 1,\u0026nbsp;\u003c/strong\u003ethere were no significant differences between males and females regarding perfectionism\u0026nbsp;or sleep quality (P values = 0.430 and 0.108 respectively),\u0026nbsp;or academic year (P values = 0.875 and 0.981 respectively). However, it was reported that females tend to have higher means across the two scales\u0026nbsp;than males.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe association between perfectionism and sleep quality\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Frost multidimensional perfectionism scale is composed of 4 domains. The Pittsburgh Sleep Quality scale is composed of 7 components. As illustrated in \u003cstrong\u003eFigure 1,\u0026nbsp;\u003c/strong\u003ealmost 60% of the\u0026nbsp;participants\u0026nbsp;suffered from poor sleep quality. When Pearson correlation was used to detect associations between\u0026nbsp;perfectionism\u0026nbsp;and the global Pittsburgh\u0026nbsp;Sleep\u0026nbsp;Quality\u0026nbsp;Index, only 2 domains were found to be significantly associated with sleep quality:\u0026nbsp;concerns\u0026nbsp;about\u0026nbsp;mistakes and doubts\u0026nbsp;about\u0026nbsp;action (r =0.270, P\u0026lt;0.01) and\u0026nbsp;concern\u0026nbsp;about\u0026nbsp;parental expectations and evaluations (r =0.233, P\u0026lt;0.01). Naturally, there was a small, positive, and significant association between the total perfectionism\u0026nbsp;score\u0026nbsp;and sleep quality (r =0.222, P\u0026lt;0.01). The only sleep quality scale component that\u0026nbsp;was\u0026nbsp;significantly affected by all perfectionism domains was the 5\u003csup\u003eth\u003c/sup\u003e component (sleep disturbance component). The total perfectionism score was found to be significantly correlated with the 1\u003csup\u003est\u003c/sup\u003e,2\u003csup\u003end\u003c/sup\u003e,5\u003csup\u003eth\u003c/sup\u003e and 7\u003csup\u003eth\u003c/sup\u003e domains of the Sleep Quality Scale(P \u0026lt;0.05). (further details are provided in \u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eBinary logistic regression was performed for sex, age, academic year, and FMPS domain score, with sleep quality as the outcome variable. The model was fit with Omnibus tests, which yielded a chi-square of 24.694 and a P value of 0.006(statistically significant). The Hosmer and Lemeshow test was not significant (P=0.539). No significant values were detected in the model (further details are provided in \u003cstrong\u003eTable 3\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u0026nbsp;\u003c/strong\u003eThe sociodemographic characteristics of the participants and the univariate analysis\u0026nbsp;of the\u0026nbsp;perfectionism scale and sleep quality scale scores (n=233)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\" style=\"margin-right: calc(3%); width: 97%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.385232744783305%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.53290529695024%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.150882825040128%\" colspan=\"2\" valign=\"top\" style=\"width: 26.4195%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal perfectionism Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.619582664526483%\" colspan=\"2\" valign=\"top\" style=\"width: 20.4313%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal sleep quality Scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.556982343499197%\" rowspan=\"2\" valign=\"top\" style=\"width: 11.5274%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.754414125200642%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.627450980392158%\" valign=\"top\" style=\"width: 13.9659%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.49019607843137%\" valign=\"top\" style=\"width: 14.8216%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.313725490196077%\" valign=\"top\" style=\"width: 11.898%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.568627450980394%\" valign=\"top\" style=\"width: 9.6066%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.352564102564102%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003e19.73^\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.698717948717949%\" valign=\"top\" style=\"width: 13.9659%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\" style=\"width: 14.8216%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.935897435897436%\" valign=\"top\" style=\"width: 11.898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.814102564102564%\" valign=\"top\" style=\"width: 9.6066%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"top\" style=\"width: 11.5274%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.737179487179487%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.352564102564102%\" valign=\"top\"\u003e\n \u003cp\u003eGender:\u003cbr\u003e\u0026nbsp;Male\u003cbr\u003e\u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e132(56.7%)\u003c/p\u003e\n \u003cp\u003e101(43.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.698717948717949%\" valign=\"top\" style=\"width: 13.9659%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e108.05\u003c/p\u003e\n \u003cp\u003e110.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\" style=\"width: 14.8216%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19.249\u003c/p\u003e\n \u003cp\u003e18.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.935897435897436%\" valign=\"top\" style=\"width: 11.898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.12\u003c/p\u003e\n \u003cp\u003e6.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.814102564102564%\" valign=\"top\" style=\"width: 9.6066%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.06\u003c/p\u003e\n \u003cp\u003e3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"top\" style=\"width: 11.5274%;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.737179487179487%\" valign=\"top\"\u003e\n \u003cp\u003e0.108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.352564102564102%\" valign=\"top\"\u003e\n \u003cp\u003eAcademic Year***:\u003c/p\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e year\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e Year\u003c/p\u003e\n \u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e Year\u003c/p\u003e\n \u003cp\u003e4\u003csup\u003eth\u003c/sup\u003e year\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003csup\u003eth\u003c/sup\u003e year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.506410256410255%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e48(20.6%)\u003c/p\u003e\n \u003cp\u003e90(38.6%)\u003c/p\u003e\n \u003cp\u003e71(30.5%)\u003c/p\u003e\n \u003cp\u003e5(2.1%)\u003c/p\u003e\n \u003cp\u003e19(8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.698717948717949%\" valign=\"top\" style=\"width: 13.9659%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e110.40\u003c/p\u003e\n \u003cp\u003e109.60\u003c/p\u003e\n \u003cp\u003e108.14\u003c/p\u003e\n \u003cp\u003e114.60\u003c/p\u003e\n \u003cp\u003e106.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\" style=\"width: 14.8216%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17.65\u003c/p\u003e\n \u003cp\u003e18.44\u003c/p\u003e\n \u003cp\u003e20.78\u003c/p\u003e\n \u003cp\u003e12.76\u003c/p\u003e\n \u003cp\u003e20.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.935897435897436%\" valign=\"top\" style=\"width: 11.898%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.79\u003c/p\u003e\n \u003cp\u003e6.56\u003c/p\u003e\n \u003cp\u003e6.27\u003c/p\u003e\n \u003cp\u003e6.00\u003c/p\u003e\n \u003cp\u003e6.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.814102564102564%\" valign=\"top\" style=\"width: 9.6066%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.30\u003c/p\u003e\n \u003cp\u003e3.22\u003c/p\u003e\n \u003cp\u003e2.10\u003c/p\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003cp\u003e3.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.538461538461538%\" valign=\"top\" style=\"width: 11.5274%;\"\u003e\n \u003cp\u003e0.875**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.737179487179487%\" valign=\"top\"\u003e\n \u003cp\u003e0.918**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Standard deviation,**ANOVA between groups,*** we did not have any batch at the 5\u003csup\u003eth\u003c/sup\u003e year at the time of data collection, \u003csup\u003e1\u003c/sup\u003eP values for total Frost Multidimensional Perfectionism Scale, \u003csup\u003e2\u003c/sup\u003eP values for the global Pittsburgh Sleep Quality Index score, and^ represent the meanstandard deviation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u0026nbsp;\u003c/strong\u003eThe table shows the characteristics of perfectionism domains from FMPS and their correlation with sleep quality compounds using\u0026nbsp;Pearson correlation across the participants (n=233)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"786\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.124681933842239%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD^\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.633587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.506361323155216%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.450381679389313%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePearson\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCorrelation of Total PQSI scale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eConcern over mistakes and doubts about action\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e38.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.124681933842239%\" valign=\"top\"\u003e\n \u003cp\u003e9.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.633587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e.175\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e.181\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.506361323155216%\" valign=\"top\"\u003e\n \u003cp\u003e.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.172\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e-.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.285\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.450381679389313%\" valign=\"top\"\u003e\n \u003cp\u003e0.270***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eConcern with\u0026nbsp;parents\u0026apos;\u0026nbsp;expectations and evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e26.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.124681933842239%\" valign=\"top\"\u003e\n \u003cp\u003e6.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.633587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e.211\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.506361323155216%\" valign=\"top\"\u003e\n \u003cp\u003e.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.190\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.199\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.450381679389313%\" valign=\"top\"\u003e\n \u003cp\u003e0.233***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eExcessively high Personal Standard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e23.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.124681933842239%\" valign=\"top\"\u003e\n \u003cp\u003e4.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.633587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.506361323155216%\" valign=\"top\"\u003e\n \u003cp\u003e-.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e-.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.191\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e-.144\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.450381679389313%\" valign=\"top\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eConcern with Precision, order and organization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e21.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.124681933842239%\" valign=\"top\"\u003e\n \u003cp\u003e4.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.633587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e-.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.506361323155216%\" valign=\"top\"\u003e\n \u003cp\u003e.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e-.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.181\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e-.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.450381679389313%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.666666666666668%\" valign=\"top\"\u003e\n \u003cp\u003eTotal FMPS Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e109.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.124681933842239%\" valign=\"top\"\u003e\n \u003cp\u003e2.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.633587786259542%\" valign=\"top\"\u003e\n \u003cp\u003e.130\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.379134860050891%\" valign=\"top\"\u003e\n \u003cp\u003e.187\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.506361323155216%\" valign=\"top\"\u003e\n \u003cp\u003e.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.238\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.26972010178117%\" valign=\"top\"\u003e\n \u003cp\u003e-.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.16030534351145%\" valign=\"top\"\u003e\n \u003cp\u003e.229\u003csup\u003e***\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.450381679389313%\" valign=\"top\"\u003e\n \u003cp\u003e0.222***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e^Standard deviation,*Pearson correlation coefficient for different components of PGSI scale, ** P value less than 0.05,*** P value less than 0.01\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u0026nbsp;\u003c/strong\u003eBinomial logistic regression for sociodemographic factors and perfectionism domains taking sleep quality status as an outcome variable (n=233)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"715\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandard error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWald\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDegree of freedom\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdd ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.496503496503497%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval for Odd ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.714285714285715%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.28571428571429%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eAcademic year(ref=1st year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e1.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e1.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.297\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e1.505\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e2.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003csup\u003eth\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e1.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e5.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003csup\u003eth\u003c/sup\u003e year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e1.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.511\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e4.205\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eGender(ref=female)\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e.621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e1.103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e1.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eTotal FMPS scale\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.914\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e1.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eFMPS\u0026nbsp;domains:\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eConcern over mistakes and doubts about action\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e3.444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e1.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e1.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eConcern with\u0026nbsp;parents\u0026apos;\u0026nbsp;expectations and evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e1.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e1.054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.955\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e1.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eExcessively high personal standards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.957\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e.837\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e1.095\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.93006993006993%\" valign=\"top\"\u003e\n \u003cp\u003e2.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.167832167832168%\" valign=\"top\"\u003e\n \u003cp\u003e1.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.5524475524475525%\" valign=\"top\"\u003e\n \u003cp\u003e.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.391608391608392%\" valign=\"top\" style=\"width: 14.0341%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.104895104895105%\" valign=\"top\" style=\"width: 12.5393%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eRef=reference category.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003e Frost Multidimensional Perfectionism Scale\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the relationship between perfectionism and sleep quality among students at the University of Khartoum, Faculty of Medicine.\u003c/p\u003e \u003cp\u003eThe data were collected from undergraduate students of the Faculty of Medicine, University of Khartoum with a mean age of 19.73 years. The percentages of males and females in the sample were 43.3% and 56.7% respectively, and a study conducted in Portugal also showed a female majority in the sample (62%)(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Most of the participants were in their 2nd and 3rd years (38.6% and 30.5% respectively)\u003c/p\u003e \u003cp\u003eThere were no significant differences between males and females regarding perfectionism scales and sleep quality scales (P values\u0026thinsp;=\u0026thinsp;0.430 and 0.108 respectively) or for different academic years (P values\u0026thinsp;=\u0026thinsp;0.875 and 0.981 respectively). This reflects that the effect of perfectionism on sleep quality is not affected by gender or academic year. However, it was reported that females tend to have greater means across the two scales (FMPS and PSQI) than males, Which is in line with a previous study conducted in the USA that revealed that women were more likely than men to be perfectionists (72% of women versus 65% of men)(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding sleep quality, nearly 60% of the sample suffered from poor sleep quality, Which is a very high percentage when compared to a study conducted in Malaysia in which 16.1% of a sample of medical students in Malaysia reported poor sleep quality(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, only two domains of perfectionism were found to be significantly associated with sleep quality, The first domain was \u0026ldquo;concern over mistakes and doubts about actions\u0026rdquo; (r\u0026thinsp;=\u0026thinsp;0.270, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) which is in agreement with a study conducted in England that reported antly associated with doubts about actions (r\u0026thinsp;=\u0026thinsp;0.22, P\u0026thinsp;=\u0026thinsp;0.04)(28). The second perfectionism domain that was associated with sleep quality in the current study concerned parents\u0026rsquo; expectations and evaluations (r\u0026thinsp;=\u0026thinsp;0.233, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Our data revealed that there was a small positive and significant association between the total perfectionism scale score and sleep quality (r\u0026thinsp;=\u0026thinsp;0.222, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). This indicates that as perfectionism increases, sleep quality decreases, Which is in line with a study conducted in Portugal that revealed small positive correlations between total perfectionism and poor sleep quality(29). And two other studies conducted in China(30,31). Another study in Switzerland revealed that perfectionism was directly associated with poor sleep, but this association was not significant(32). The only sleep quality component that was affected by all the FMPS four perfectionism domains was the 5th domain (sleep disturbance). However, total perfectionism was found to be significantly associated with the 1st \u0026ldquo;subjective sleep quality\u0026rdquo;, 2nd \u0026ldquo;sleep latency\u0026rdquo;, 5th \u0026ldquo;sleep disturbance\u0026rdquo; and 7th \u0026ldquo;daytime dysfunction\u0026rdquo; domains of the Sleep Quality Scale, Which is consistent with a study conducted in China that revealed that perfectionism was significantly correlated with all domains except for the 3rd \u0026ldquo;sleep duration\u0026rdquo; and 7th \u0026ldquo;daytime dysfunction\u0026rdquo; domains of the PSQI (30).\u003c/p\u003e \u003cp\u003eBinary logistic regression was performed for sex, age, academic year, and FMPS domain score, with sleep quality as the outcome variable. No significant values were detected in the model.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis is the first study among Sudanese medical students at the Faculty of Medicine - University of Khartoum, to explore the relationship between perfectionism and quality of sleep. The strength of this study is its consideration of different factors that may contribute to therapeutic applications. Collecting data for this research has been challenging due to the ongoing war. The Internet was interrupted in most areas as a result of the current war which made it difficult to gather data. Additionally, the research questionnaire was lengthy which further contributed to the shortage of the research sample.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to our study, there were no significant mean differences detected in either gender or academic years regarding perfectionism and sleep quality. However, females had a greater perfectionism score than males. Moreover, nearly 60% of the participants experienced poor sleep quality. Out of all the domains of perfectionism, only two were found to have a significant link with sleep quality: concern about mistakes and doubts about actions and concern about parents' expectations and evaluation. All domains of perfectionism led to sleep disturbance and were significantly associated with the 1st, 2nd, 5th, and 7th domains of the sleep quality scale. University of Khartoum medical students may benefit from these findings, as they can demonstrate the effect of perfectionism in disturbing sleep quality unbiased by either gender or academic year with potential clinical and therapeutic applications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eF-MPS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Frost Multidimensional Perfectionism Scale\u003c/p\u003e\n\u003cp\u003ePSQI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Pittsburgh Sleep Quality Index\u003c/p\u003e\n\u003cp\u003eSPSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Statistical package of social sciences\u003c/p\u003e\n\u003cp\u003eOCD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Obsessive-compulsive disorder\u003c/p\u003e\n\u003cp\u003eMBBS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bachelor of Medicine and Bachelor of Surgery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical clearance was granted from the ethical committee of the community medicine department at Khartoum University, Faculty of Medicine. Informed consent was given by each participant to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used and analyzed during this study is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive any financial or material support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge all the respondents for their time in participating in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026nbsp;Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMHE\u003c/strong\u003e: conceptualization, methodology and study design, data Analysis, results and data interpretation, manuscript drafting, revision and proofreading. \u003cstrong\u003eAAM\u003c/strong\u003e: literature review, data collection, questionnaire design, conceptualization, data analysis, manuscript drafting, revision and proofreading. \u003cstrong\u003eAAA\u003c/strong\u003e: literature review, data collection, questionnaire design, conceptualization, methodology and study design, manuscript drafting, revision and proofreading. \u003cstrong\u003eAM\u003c/strong\u003e: literature review, data collection, conceptualization, methodology and study design, manuscript drafting. \u003cstrong\u003eNE\u003c/strong\u003e: literature review, data collection, conceptualization, manuscript drafting. \u003cstrong\u003eRM\u003c/strong\u003e: literature review, data collection, conceptualization, manuscript drafting. \u003cstrong\u003eWAM\u003c/strong\u003e: literature review, data collection, conceptualization.\u003cstrong\u003e\u0026nbsp;MHF:\u003c/strong\u003e Conceptualization , revision and proofreading , Data analysis. All authors reviewed and approved the final version of the manuscript and are responsible for all aspects of the cross-sectional study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHewitt PL, Flett GL, Turnbull-Donovan W, Mikail SF. The Multidimensional Perfectionism Scale: Reliability, Validity, and Psychometric Properties in Psychiatric Samples. Psychol Assess. 1991;3(3):464\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eThomas M, Bigatti S. Perfectionism, impostor phenomenon, and mental health in medicine: a literature review. Int J Med Educ [Internet]. 2020 Sep 28 [cited 2024 Mar 21];11:201\u0026ndash;13. Available from: https://www.ijme.net/archive/11/perfectionism-and-impostor-phenomenon/\u003c/li\u003e\n\u003cli\u003eHewitt PL, Flett GL, Ediger E. Perfectionism and depression: Longitudinal assessment of a specific vulnerability hypothesis. J Abnorm Psychol. 1996;105(2):276\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eFrost RO, Steketee G. 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Available from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-024-05510-y\u003c/li\u003e\n\u003cli\u003eFrost Multidimensional Perfectionism Scale [Internet]. [cited 2024 Mar 21]. Available from: https://psycnet.apa.org/doiLanding?doi=10.1037%2Ft05500-000\u003c/li\u003e\n\u003cli\u003ePsychometric properties of the Frost Multidimensional Perfectionism Scale in a clinical anxiety disorders sample. [Internet]. [cited 2024 Mar 22]. Available from: https://psycnet.apa.org/record/1999-01019-007\u003c/li\u003e\n\u003cli\u003eBurgess AM, Frost RO, DiBartolo PM. Development and Validation of the Frost Multidimensional Perfectionism Scale\u0026ndash;Brief. http://dx.doi.org/101177/0734282916651359 [Internet]. 2016 May 26 [cited 2024 Mar 21];34(7):620\u0026ndash;33. Available from: https://journals.sagepub.com/doi/10.1177/0734282916651359\u003c/li\u003e\n\u003cli\u003eIliescu EA, Coo H, McMurray MH, Meers CL, Quinn MM, Singer MA, et al. Quality of sleep and health‐related quality of life in haemodialysis patients. Nephrol Dial Transplant [Internet]. 2003 Jan 1 [cited 2024 Mar 21];18(1):126\u0026ndash;32. Available from: https://dx.doi.org/10.1093/ndt/18.1.126\u003c/li\u003e\n\u003cli\u003eZhong QY, Gelaye B, S\u0026aacute;nchez SE, Williams MA. Psychometric Properties of the Pittsburgh Sleep Quality Index (PSQI) in a Cohort of Peruvian Pregnant Women. J Clin Sleep Med [Internet]. 2015 [cited 2024 Mar 21];11(8):869\u0026ndash;77. Available from: https://jcsm.aasm.org/doi/10.5664/jcsm.4936\u003c/li\u003e\n\u003cli\u003eSample Size Calculator [Internet]. [cited 2024 Mar 21]. Available from: https://www.calculator.net/sample-size-calculator.html\u003c/li\u003e\n\u003cli\u003eMaia BR, Soares MJ, Pereira AT, Marques M, Bos SC, Gomes A, et al. Affective state dependence and relative trait stability of perfectionism in sleep disturbances. 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Negative perfectionism and sleep quality in Chinese international students under COVID-19 epidemic: A moderated mediation. Front Psychol [Internet]. 2022 Aug 1 [cited 2024 Mar 22];13. Available from: /pmc/articles/PMC9377220/\u003c/li\u003e\n\u003cli\u003eLin RM, Xie SS, Yan YW, Chen YH, Yan WJ. Perfectionism and adolescent sleep quality: The mediating role of repetitive negative thinking. J Health Psychol [Internet]. 2019 Oct 1 [cited 2024 Mar 22];24(12):1626\u0026ndash;36. Available from: https://pubmed.ncbi.nlm.nih.gov/28810410/\u003c/li\u003e\n\u003cli\u003eBrand S, Kirov R, Kalak N, Gerber M, P\u0026uuml;hse U, Lemola S, et al. Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation. Neuropsychiatr Dis Treat [Internet]. 2015 Feb 3 [cited 2024 Mar 22];11:263. Available from: /pmc/articles/PMC4322891/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Perfectionism, sleep quality, Sudan, Medical students","lastPublishedDoi":"10.21203/rs.3.rs-4164935/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4164935/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground :\u003c/h2\u003e \u003cp\u003ePerfectionism is characterized by the pursuit of perfection, the imposition of unreasonably high standards for performance, and a constant state of self-criticism of one's actions. Perfectionism leading to depression, OCD, and anxiety can affect the quality of sleep, leading to less productivity and less involvement in one's daily activities. One of the most affected groups is medical students who are more likely to develop sleep-deprived lifestyles; this can be due to the stressful environment of medical school and the perceived high academic load. This study aims to address the association between perfectionism among medical students and sleep quality.\u003c/p\u003e\u003ch2\u003eMethod :\u003c/h2\u003e \u003cp\u003eThe study utilized an analytical and facility-based cross-sectional study conducted in March 2023 at the Faculty of Medicine, University of Khartoum, Sudan. We used two validated questionnaires which are: The Frost Multidimensional Perfectionism Scale (F-MPS and the Pittsburgh Sleep Quality Index (PSQI). Data was collected using an online self-administered questionnaire via social media platforms. Analysis has been done using SPSS version 21 by descriptive statistics, univariate analysis, and regression.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003e233 medical students were included in the study. Almost 56% of them were females. Almost 60% of the sample suffered from poor sleep quality. There weren't any significant mean differences observed in gender or age regarding perfectionism and sleep quality. Only two domains of perfectionism were found to be significantly associated with sleep quality:\u0026rdquo; concerns over mistakes and doubts of action\u0026rdquo; and \u0026ldquo;concern with parent expectation and evaluation\u0026rdquo;( P\u0026thinsp;\u0026lt;\u0026thinsp;0.01 for both domains). There was a positive and significant association between the total perfectionism scale and sleep quality(r\u0026thinsp;=\u0026thinsp;0.222, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eConclusion :\u003c/h2\u003e \u003cp\u003eThere is growing evidence of the association between sleep quality and perfectionism. Our study highlighted this association among medical students. We found that there was a small positive and significant association between total the perfectionism scale and sleep quality. But neither gender nor academic year showed to be contributing to this association. So our study demonstrates the effect of perfectionism in disturbing the sleep quality unbiased by either gender or academic year with potential clinical and therapeutic applications. These findings can benefit the medical students in the University of Khartoum and other medical students.\u003c/p\u003e","manuscriptTitle":"The relationship between perfectionism and quality of sleep: A cross-sectional study among Sudanese medical students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-02 17:35:16","doi":"10.21203/rs.3.rs-4164935/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27dd2cf2-e2d8-49ad-a6ba-f33ca1e2c0db","owner":[],"postedDate":"April 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-11T17:29:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-02 17:35:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4164935","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4164935","identity":"rs-4164935","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}