Empirical Research Questions
The Impact of Sleep Patterns on the Academic Performance of
Undergraduate Students at St. George’s University.
The Effect of Private Tutoring on CSEC Exam Performance Among
Secondary School Students in Grenada.
The Influence of Lecturers’ Feedback Styles on Student Motivation
and Academic Performance at SGU.
Sleep is considered a vital biological process among many people that facilitates
cognitive, emotional, and physical functioning, all of which are important for student success
within higher education. Within nursing education, sleep becomes increasingly important due
to the rigorous demands of academics, long clinical hours, and psychological stress of the
students within this population. Much research examines the relationships between sleep
duration, sleep quality, and academic performance, particularly in high-stakes assessment
climates during midterm and final exams. This literature review examines the findings from
peer-reviewed studies and systematic reviews to explore how the quality and quantity of sleep
patterns affect the academic performance of nursing students in relation to university exam
performance.
Sleep duration is among the most commonly researched topics to understand the
impact on students' performance today. Many studies have shown that not getting the right
amount of sleep, generally considered anything less than six to seven hours a night, severely
impacts academic performance. According to Hershner and Chervin (2014), they identified
that a reduction in sleep among college students is correlated with poor concentration, slower
cognitive processing, and impaired memory, which inhibits a higher level of success rate on
examinations. In another study, Gilbert and Weaver (2010) determined that students who
routinely received less than six hours of sleep performed significantly lower on examinations
than students who slept seven to nine hours. They concluded that there is a direct relationship
between sleep and performance on examinations. Thus, nursing students are particularly at
risk for sleep deprivation during exam week, as they may need to balance academic
coursework with clinical practice.
While sleep duration is necessary, research suggests that sleep quality may be even
more critical in academic performance. Sleep quality encompasses sleep continuity, depth,
and restorative value. Lemma et al. (2014) demonstrated that poor sleep quality was a
stronger predictor of low academic performance than short sleep duration, indicating that
fragmented or restless sleep can undermine cognitive effectiveness regardless of total hours
slept. Furthermore, research based on Lund et al. (2009) pinpoints that sleep disturbances,
such as frequent awakenings and difficulty falling asleep, strongly correlate with reduced
exam scores in nursing and medical students. These findings suggest that interventions to
improve sleep quality, such as sleep hygiene education, may be as necessary as encouraging
longer sleep duration.
As mentioned prior, nursing students who prepare for mid-term and final exams,
generally around these times, can find them very challenging, as stress and anxiety can
worsen issues with sleep. Additionally, it is noted that nursing students reported significantly
more insomnia symptoms, decreased sleep time, and increased nocturnal awakenings during
exam weeks compared to baseline weeks. Sleep was significantly associated with exam
performance and psychological distress (Al-Khani et al., 2019). Similarly, Surani et al. (2015)
found that poor sleep quality is a significant predictor of test anxiety, creating a cycle in
which poor sleep quality, caused by stress, affects students' exam outcomes. The connection
between stress, sleep, and exam success illustrates the importance of holistic support for
high-stakes assessment students.
The education of nursing students encompasses unique situations that differentiate its
students from other students at large universities. The rigorous academic requirements and
clinical placements, combined with shift work, lead to chronic sleep restriction and erratic
sleep-wake patterns. According to Gallego-Gómez et al. (2021), nursing students who
reported irregular schedules show poorer sleep quality and a significantly lower grade point
average than those who reported regular schedules. Clinical rotations often require early start
times, limiting students’ ability to rest and prepare confidently during examinations. Given
the structural demands of nursing education, it is evidence-based that nursing students are at
an increased risk for sleep-related academic performance compared to their peers, particularly
during periods of increased study loads, such as during midterms and finals.
A review by Lo et al. (2016) indicated that insufficient sleep and poor sleep quality
are consistently linked with diminished academic performance across higher education
populations, with the most potent effects observed among students in health-related
disciplines. Similarly, as Gaultney (2010) mentioned, there is an estimated amount of just
over 27% of college students at risk for at least one sleep disorder who were significantly
more likely to report poor academic outcomes. Therefore, these findings highlight the
significant concerns of sleep problems among students, the particular vulnerability of nursing
students, and what they are subjected to.
Finally, researchers have studied ways to address sleep challenges among nursing
students, but there is still limited research. The studies suggest that sleep hygiene education,
stress management, and organization of academic schedules improve both sleep quality and
academic performance. Therefore, it is understandable why Kang and Chen (2009) found that
a structured sleep hygiene program improved nursing students' sleep quality and cognitive
functioning, resulting in enhanced exam scores compared to control groups. More research is
warranted, but the interventions suggest that students have promising avenues to mitigate the
adverse effects of sleep disruption during academic periods.
In summary, findings in the literature review consistently reveal that both sleep
duration and sleep quality impact the academic performance of nursing students. Limited
sleep, disrupted sleep, and stress-induced insomnia become particularly prevalent during
midterm or final examinations when cognitive demands are high. Unique academic and
clinical obligations further heighten the risks for nursing students, before ultimately putting
them in a unique population particularly at-risk for negative academic consequences due to
poor sleep. The evidence highlights the need for institutional support, educational
interventions, and individual efforts to develop healthy sleep habits surrounding exams and
high-stakes assessments.