Relationship Between Academic Stress, Sleep Quality, and Musculoskeletal Pain Among University Students During Examination Periods: A Systematic Evidence Synthesis
DOI:
https://doi.org/10.66687/JMRISKeywords:
Academic Stress, Sleep Quality, Musculoskeletal PainAbstract
Background: University examination periods combine increased academic demand with altered study schedules, prolonged sedentary behavior, psychological stress, and sleep disruption. These factors may interact to increase musculoskeletal symptoms, particularly neck and low-back pain, but the relative contribution of stress and sleep remains incompletely defined. Objective: To synthesize high-quality evidence available through 31 December 2022 concerning the relationships among academic stress, sleep quality, and musculoskeletal pain in university students, with particular emphasis on examination periods.
Methods: A structured systematic evidence synthesis was conducted using peer-reviewed studies published no later than 31 December 2022. References were restricted to Q1 journals in sleep medicine, psychology, public health, pain, ergonomics, and musculoskeletal medicine. Examination-period studies were prioritized. Because direct Q1 studies simultaneously measuring examination stress, sleep quality, and musculoskeletal pain were scarce, evidence was triangulated from examination-period longitudinal studies, undergraduate stress-sleep studies, student musculoskeletal studies, and longitudinal young-adult pain research. Heterogeneous outcomes prevented a valid new pooled effect estimate.
Results: Examination periods were associated with increased perceived stress, poorer sleep quality, and greater daytime dysfunction. A 2022 meta-analysis of 25 undergraduate studies involving 10,065 participants identified a moderate association between stress and poor sleep quality (r=0.39; 95% CI 0.35-0.43), while the pooled stress-insomnia association was r=0.41. Among 339 undergraduate students, 12-month neck and low-back pain prevalences were 54.6% and 49.4%, respectively, and musculoskeletal pain was significantly associated with stress, anxiety, and poor sleep. Longitudinal young-adult data further indicated that baseline stress and non-restorative sleep predicted chronic pain one year later, with adjusted odds ratios of 1.6 and 1.5, respectively. Persistent sleep disturbance was also associated with progressively greater odds of neck pain in longitudinal data.
Conclusion: Evidence available through 2022 supports an interacting stress-sleep-pain model rather than a purely biomechanical explanation for examination-period musculoskeletal symptoms. Examination stress may impair sleep and alter activity patterns, while poor sleep may heighten pain vulnerability. Prospective within-student studies across pre-examination, examination, and post-examination periods are required to establish temporal mediation.
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