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Sleep quality and stress: gender differences

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Original Article

SLEEP QUALITY AND STRESS: GENDER DIFFERENCES

Qualidade do sono e estresse: diferenças entre os

gêneros

Gema Mesquita1, Evelise Aline Soares2, Miriam Monteiro de Castro Graciano3, Patricia Costa dos Santos
da Silva4, Claudia Umbelina Baptista Andrade5, Rubens Reimão6

ABSTRACT

INTRODUCTION: The aim is to assess the relationship among the variables school performance (grades and
absences), stress, and sleep quality in a group of adolescent high-school students. METHOD: a cross-sectional,
descriptive study involving 160 adolescents of both genders, aged 15-18 y, studying at high school in the
city of Alfenas, Minas Gerais State, Brazil, was conducted. Data collection used the following instruments: 1)
Pittsburgh Sleep Quality Index (PSQI); 2) Lipp’s Stress Symptoms Inventory for Adults (LSSI); 3) Student school
reports. RESULTS: The study sample comprised 65.63% female subjects. Mean school performance was 0.64
for the female group (F) and 0.60 for the male group (M), p = 0.04. Mean number of absences were 28.1
(F) and 30.3 (M), p = 0.7440. Concerning stress symptoms, 65.71% (F) and 29.09% (M) were classified
as stressed whereas 34.29% (F) and 70.91% (M) reported no stress symptoms (p < 0.001). Quality of sleep
scores were 6.0 (F) and 5.3 (M), p = 0.27, while 68.57% (F) and 61.82% (M) reported poor sleep on the
sleep classification. CONCLUSION: Female subjects had higher grades overall and greater diligence in school
activities but reported more stress symptoms and worse sleep quality.
KEY WORDS: adolescents; school performance; sleep; sleep quality; stress.

1
Sleep Medicine Advanced Research Group, Division of Clinical Neurology, Hospital das Clinicas, University of São Paulo
School of Medicine (USP), São Paulo, SP, Brazil; University José do Rosário Vellano (UNIFENAS), MG, Brazil; Center for
Investigation in Pediatrics, University of Campinas (UNICAMP), Campinas, SP, Brazil.
2,3,4,5
University José do Rosário Vellano (UNIFENAS), MG, Brazil.
6
Sleep Medicine Advanced Research Group, Division of Clinical Neurology, Hospital das Clinicas, University of São Paulo
School of Medicine (USP), São Paulo, SP, Brazil.

Study carried out as part of the Center for Investigation in Pediatrics, University of Campinas , Campinas, SP, Brazil.

Correspondence: Dr. Rubens Reimão

Av. Indianópolis, 2784 - CEP 04062-003 São Paulo, SP, Brasil - reimaorubensneuro@yahoo.com

_____________________________________________________________________________ 15
NEUROBIOLOGIA, 74(3-4) jul./dez., 2011 ___________________________________________

RESUMO:

INTRODUÇÃO: o objetivo é relacionar as variáveis: aproveitamento escolar (notas e faltas), estresse e qualidade
do sono em um grupo de adolescentes. MÉTODO: estudo transversal, descritivo, entre 160 adolescentes de
ambos os gêneros, entre 15 a 18 anos, estudantes do ensino médio na cidade de Alfenas, Minas Gerais, Brasil.
Utilizou-se dos instrumentos: 1) Índice de Qualidade de Sono de Pittsburgh (IQSP); 2) Inventário de Sintomas
de Stress para Adultos de Lipp (ISSL); 3) Boletins dos alunos. RESULTADOS: Dentre os participantes 65,63%
são do gênero feminino. No aproveitamento escolar observaram-se médias 0,64 para o grupo feminino (F) e
0,60 para o Masculino (M) p = 0,04. Quanto ao número de faltas têm-se as médias 28,1 (F) e de 30,3 (M)
p = 0,7440. Em relação à sintomatologia de stress 65,71% (F) e 29,09% (M) foram classificados estressados
e 34,29% (F) e 70,91% (M) não apresentaram sintomas estresse ( p < 0,001). Referente à qualidade do sono
observou-se a média de 6,0 (F) e de 5,3 (M) p = 0,27, na classificação do sono 68,57% (F) e 61,82% (M)
relataram não dormir bem. CONCLUSÃO: As mulheres apresentam notas mais elevadas e maior assiduidade,
maior sintomatologia de estresse e pior qualidade do sono.
PALAVRAS-CHAVE: adolescentes; aproveitamento escolar; estresse; qualidade do sono; sono.

Although men and women have equal access
to high school education, gender differences among
high-school students are evident. The number of women
enrolling in school is increasing every year. Results of
a recent study1 suggest a high level of performance
among female students, and also show that females
have higher performance coefficients compared to
males on courses such as pure sciences, technology
and engineering subjects. Women achieve higher
grades, pass the year with shorter remedial periods
for retakes, and respond better to teachers’ demands.2
Studies focused on adolescents 3-6 have found
greater stress symptoms among females than males.
This phenomenon occurs during adolescence because
women are assuming broader roles in society and
are assigned more responsibilities7. Although stress
is inherently a hard concept to measure, studies8,9
characterize adolescence as a phase of strain,
conflict and imbalance requiring adaptive effort, thus
representing a period of higher vulnerability to stress.
The challenges faced in adolescence are rendered
greater because this young group does not possess
the maturity needed to cope with and adapt to these
new roles demanded of them.
Studies by Calais et al.5 on schooling and stress
in various age groups have shown that women have
more stress symptoms compared to men. However,
the factors underlying this difference have yet to be
determined.
Briefly, in response to stress the body releases
greater amounts of cortisol into the bloodstream, a
hormone associated with suppression of REM sleep,
increased superficial sleep, difficulties falling asleep
and remaining in a sleep state.9-13 One of the main
effects of stress is a reduction in the quantity and
quality of sleep. 6,8
Evidence in the literature shows that adolescents
generally experience sleep disorders, and that
females tend to have poorer sleep quality compared
with males. 6,8,15,16
However, studies13,14,15,16 show that lack of
sleep predisposes individuals to emotional changes
and that the effect of poor quality sleep triggers
daytime sleepiness, followed by fatigue, mental
confusion, tension, behavioral disturbances, memory
lapses and mental stress, all of which increase
proportionally to the extent of sleep restrictions.6,8,15-18
These effects were described by Fredriksen et al19 in

16 _____________________________________________________________________________
________________________________________________________________Mesquita, G.; et al.
a study involving 11-14 year-old students, showing
a relationship between sleep loss and emotional
changes with some of these students reporting that
lack of sleep had a major impact on their emotional
state.
Moreover, other studies20,21 show that
adolescents who have insufffiicient sleep are more
predisposed to perform poorly at school. Similarly,
academic performance was found to be negatively
related to greater stress symptoms where , for most
students, stress was considered an unfavorable factor
associated to poor academic performance. 22,23
However, studies in the literature investigating
sleep, stress and school performance in adolescents
are scarce. Against this background, the aim of the
present study was to analyze school performance,
stress and sleep quality among adolescents of both
genders.
METHOD
A descriptive cross-sectional field survey was
carried out in the city of Alfenas, situated in the South
of Minas Gerais state, Brazil.
Two downtown teaching institutions were
involved in the study, namely one public high-school
and one private high-school.
The study sample comprised 160 adolescent
high-school students of both genders in the 15 to 18-
year age bracket.
Instruments employed:
1- Students’ school reports were provided by
the administrators of the colleges and used to collect
and analyze data on absences and grades for the
period spanning from August to November 2004.
2 – Lipp and Guevara’s Stress Symptoms
Inventory for Adults (LSSI).24 The purpose of the LSSI is
to objectively identify stress symptoms and assess the
type of symptoms present (somatic or psychosomatic)
along with the subject’s stress phase (alert, resistance,
quasi-exhaustion and exhaustion). Entailing a four-
_____________________________________________________________________________ 17
phase model, the inventory was validated in 1994
by Lipp and Guevara24 and has been applied in
clinical studies and research.
3- Pittsburgh Sleep Quality Index (PSQI). 25
The PSQI, a reliable instrument, was employed
to quantify sleep quality and is fully standardized and
validated in Portuguese.26 The PSQI assesses sleep
quality over a month period and contains 17 self-
assessment items yielding a global score from 0 to
20, where lower scores indicate better sleep quality.
According to the index, good sleepers are defined as
those obtaining scores of 5 (five) or less.
Ethics Aspects
The study posed no risk to the participants.
Parents or guardians of participating students were
informed of the purpose of the study as well as the
methods to be employed, and signed a Free and
Informed Consent term.
The original project (Process n° 152/2004)
on which the study was based was approved by the
Research Ethics Committee of the Medical Sciences
Faculty (UNICAMP) and fulfilled all regulations of
Resolutions 196/96 and its complements, being
homologated at the General Meeting of the Institutional
Review Board on the 20th July 2004.
The questionnaires were applied to students
within the school class rooms. Students were pledged
confidentiality of data and given freedom of choice to
take part in the investigation.
Statistical Method
The data gathered in this study were tabulated,
organized and stored on an Excel computer
spreadsheet. Data compiled was submitted to
statistical analysis by the Research Board of the
Medical Sciences Faculty of UNICAMP using version
9.1.3 of the SAS (Statistical Analysis System) System
for Windows with Service Pack 3 (SAS Institute Inc,
2002-2003, Cary, NC, USA.27)
NEUROBIOLOGIA, 74(3-4) jul./dez., 2011 ___________________________________________
The level of significance adopted in statistical
tests was set at 5%.
RESULTS
Of subjects interviewed, 65.63% were female
and age was distributed as follows: 43.13% were 15
years; 33.75% 16 ys; 16.88% 17 ys. and 6.25%
were 18 years of age;
With regard to school performance, female
students had a mean of 0.64, standard deviation
of 0.14, and median value of 0.65 whereas male
students had a mean of 0.60, standard deviation of
0.13, and median value of 0.59 (p - value = 0.04)
(Table 1).
With regard to school absences, female
students had a mean of 28.1, standard deviation
of 19.8, median value of 24.0, and minimum value
of 0.0 whereas male students had a mean of 30.3,
standard deviation of 23.9, and median value of
27.0 (p - value = 0.74).
With regard to sleep scores between genders,
values obtained for females were mean of 6.0;
standard deviation of 3.2; median of 5.0; minimum
of 1.0; and maximum of 18.0, whereas results for
males were mean of 5.3; standard deviation of 2.2;
minimum of 1.0; and maximum of 10.0, (p – value =
0.2712) (Table 2).
DISCUSSION:
The findings of the present study corroborate
results of previous studies and raise hypotheses for
further investigation. To our knowledge, this is the first
study to report associations among stress, sleep quality
and school performance between genders in groups
of adolescent high-school students. A major strength
of this study was the use of reliable, validated scales,
widely used in national and international research.
The analysis of school performance by gender
revealed that female students achieve higher grades
compared to male students and also display greater
18 _____________________________________________________________________________
diligence in classes compared to males, findings in-
line with the results of earlier studies1,2. These previous
studies however, did not explore the issue of diligence.
According to Entwistle and Ramsden28, learning is
influenced by dedication and the participation of the
student, and studying has a decisive role in explaining
school success.
Analysing and questioning school performance
between genders, Dal’Igna14 observed that different
meanings establish the relationships of power that
constitute, classify and position girls and boys in
hierarchically different places.
Studies by Entwistle and Ramsden29; Biggs29
1996; and Almeida30 point out that students with
better grades in secondary school enter University
with higher levels of intrinsic motivation and prove
more deeply involved in curricular activities.
Examining the association between stress
and genders (Table 1), reveals that females have
significantly higher stress symptoms compared to male
subjects. This data is similar to that reported by Calais
et al.5, Lipp et al.7, Mesquita and Reimão6, showing
that women are more stressed than men. Calais et al.5
stated that, in terms of stress symptoms, genders differ
not only biologically but also in the way they interact
in social roles. According to Lipp et al.7 , women are
more vulnerable to stress due to biological factors and
the number of social roles they play.
Studies in the literature22,23 have highlighted
that stress negatively impacts school performance.
By contrast, the present study found better school
performance in the more highly stressed female group.
Concerning sleep quality between genders
(Table 2), the current analyses showed that females
had poorer sleep quality compared to males. Previous
studies6,8,15,31-33 investigating sleep complaints, their
repercussions and predominance between genders in
adolescence, have found that a large percentage of
girls complain of poor sleep than boys.
We agree with the point made in the
literature6,17-19 which holds that sleep disorders are
connected with emotional changes, since our data
showed that females have poorer sleep quality
________________________________________________________________Mesquita, G.; et al.
coupled with greater stress symptoms. However, we
do not agree with those studies 20-23 claiming that sleep
problems are linked to worse school performance
because the present study found that girls had poorer
sleep quality yet better school performance.
CONCLUSION
Female subjects outperformed boys at school
while also attained higher grades and greater
diligence. Moreover, the female group had worse
stress symptoms and poorer sleep quality compared
with the boys.
STUDY LIMITATIONS
One of the limitations of this cross-sectional
study was that it involved only two teaching institutions.
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TABLE 1 – Absolute and relative frequency (%) of stress and non-stress reported by adolescents of both genders.
Gender Female Male

n % n %

Stress

Yes 069 65.71 16 29.09

No 036 34.29 39 70.91

TOTAL 105 100.00 55 100.00

p – value < 0.0001

TABLE 2 – Absolute and relative frequency (%) of good and poor sleepers reported by adolescents.
Gender Female Male
n % n %
Good Sleeper
Yes 033 31.43 21 38.18
No 072 68.57 34 61.82
TOTAL 105 100.00 55 100.00
P–value<0.3909

_____________________________________________________________________________ 21
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