Sudan Journal of Medical Sciences Volume 18, Issue no. 2, DOI 10.18502/sjms.v18i2.13601 Production and Hosting by Knowledge E Research Article Chronotype, Daytime Sleepiness, and Related Factors Effects on Skipping Classroom among Medical Students in Tabuk Turki Aqahtani, Abdulaziz Albalawi, Jalawi Alotaibi, Atheer Alshareef, Tariq Alrasheed, Hyder Mirghani, Iman Mirza, Amerah Alatawi, Hani Albalawi, and Mohammed Sheik Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia ORCID: Hyder Mirghani: http://orcid.org/0000-0002-5817-6194 Abstract Background: Lecture attendance is very critical in medical practice. Good sleep hygiene is crucial for academic performance. Therefore, this research aimed to assess the relationship between daytime sleepiness and the chronotype, and skipping the classroom. Methods: A cross-sectional study was conducted among medical Students in Tabuk from April 2022 to July 2022. Three hundred and thirty-four medical students were randomly selected. A standardized questionnaire based on the daytime sleepiness scale, morningness–eveningness questionnaire, and risk for skipping classrooms was used. The students detailed their sleeping habits for two weeks and then responded to the questionnaire distributed directly by the researchers who attended to solve any difficulties. Results: Out of the 334 students,74.7% skipped the classroom last month. The most common reason for absence was the lecturer directly reading from the slide show (72.8%), followed by late lectures (67.8%), lecturers’ presentation skills (65.6%), and lack of interest (57.9%). Daytime sleepiness was evident in 40.1% of the students and was associated with skipping lectures (Wald, 3.86, P-value, 0.049, and 95% CI, 0.19–0.91). The majority were intermediate chronotypes (66.4%), followed by evening chronotypes (24.2%) with no association with skipping classrooms. Conclusion: Skipping lectures is common among medical students in Tabuk City, Saudi Arabia; the causes were lecture timing, daytime sleepiness, and lecturers’ presentation skills. Most students were an intermediate chronotype that was not associated with classroom absence. Further larger multi-center studies are needed. Keywords: skipping classrooms, medical students, daytime sleepiness, chronotype, Saudi Arabia How to cite this article: Turki Aqahtani, Abdulaziz Albalawi, Jalawi Alotaibi, Atheer Alshareef, Tariq Alrasheed, Hyder Mirghani, Iman Mirza, Amerah Alatawi, Hani Albalawi, and Mohammed Sheik (2023) “Chronotype, Daytime Sleepiness, and Related Factors Effects on Skipping Classroom among Medical Students in Tabuk ,” Sudan Journal of Medical Sciences, vol. 18, Issue no. 2, pages 165–176. DOI 10.18502/sjms.v18i2.13601 Page 165 Corresponding Author: Hyder Mirghani; email: s.hyder63@hotmail.com Received 28 October 2022 Accepted 13 January 2023 Published 30 June 2023 Production and Hosting by Knowledge E Turki Aqahtani et al. This article is distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use and redistribution provided that the original author and source are credited. Editor-in-Chief: Prof. Nazik Elmalaika Obaid Seid Ahmed Husain, MD, M.Sc, MHPE, PhD. http://www.knowledgee.com https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ Sudan Journal of Medical Sciences Turki Aqahtani et al 1. Introduction Despite significant educational advances, traditional lectures are still practiced in med- ical education together with hospital-based clinical training and simulation labs [1]. Lecture attendance, although very critical in medical practice, is widely neglected. The risk factors for absence from the classroom are primarily individual (sleepiness, illness, and inefficiency of lectures in crowded classrooms) [1]. Previous literature showed that interventions at improving the student’s attitude about classroom attendance are beneficial [2]. In addition, absence’s effects on college students’ academic achieve- ment have been previously documented [3, 4]. Acknowledging that it is not possible to memorize everything in Medicine, and the presence of other attractable learning resources (the United States Medical Licensing Examination [USMLE]) might be plausible to absenteeism. However, USMLE’s recent pass/fail adoption may positively influence traditional lecture attendance [5]. The time of activity during the day determines the chronotype of an individual (early chronotype who prefers morning activity, also known as Pearls, intermediate and late chronotype, also known as night Owls) [6]. Early school timing was associated with poor daytime dysfunction in both morning and evening chronotypes [7]. In addition, the evening chronotype during the day (circadian misalignment) achieves less than when working in the evening [8]. Excessive daytime sleepiness, a public health issue, is prevalent among most pop- ulations. Although commonly attributed to lifestyle or laziness, it has been linked to cardiovascular diseases, depression, work errors, and car accidents. Daytime sleepiness is the inability to maintain alertness and wakefulness during major waking day episodes, with unintentional and inappropriate sleep occurring almost every day for at least three months [9, 10]. Excessive daytime sleepiness could lead to fatigue and substantially impair attention and academic achievement. In addition, the Kingdom of Saudi Arabia is a vast country with ethnic, cultural, and environmental diversity. Furthermore, different medical schools use different curricula and timetables, so the studies conducted in the Western World and other regions of Saudi Arabia may not apply to Tabuk, Saudi Arabia. Rique et al. [10] conducted a study among medical students in Brazil and found that daytime sleepiness is not associated with chronotype. On the other hand, a European study found a relationship between evening chronotype and daytime sleepiness [11]. The research hypothesis is that late chronotype might skip lectures due to circadian misalignment and excessive daytime sleepiness. DOI 10.18502/sjms.v18i2.13601 Page 166 Sudan Journal of Medical Sciences Turki Aqahtani et al To the best of my knowledge, no researchers have assessed the relationship between chronotype and daytime sleepiness with skipping class lectures. Thus, this study aims to investigate the same among medical students in Tabuk, Saudi Arabia. 2. Materials and Methods A cross-sectional study was conducted among medical students in Tabuk University, Kingdom Saudi Arabia between April and July 2022. Three hundred and thirty-four medical students (second through sixth class) were randomly selected from the Faculty of Medicine by simple random sampling technique. First-year medical students and those on sedative medications were excluded. First-class students were excluded because of the different curriculum. All students who agreed were approached. A standardized questionnaire based on the daytime sleepiness scale, morningness– eveningness questionnaire, and risk for skipping classrooms was used. Participants were invited to sign a written informed consent and then respond to the questionnaire. The students detailed their sleeping habits for two weeks and then responded to the questionnaire distributed directly by the researchers who attended to solve any difficulties. 2.1. Sample size calculation A list of 772 students was obtained from the Deanship of Academic Affairs. A simple random sampling method was used to get the final sample. The sample size was determined using a single population proportion formula with the following assumptions; the magnitude of skipping classroom (P = 50%; no previous study in the study area), 95% UI, and the margin of error (d) = 5%. The minimum sample size was 334 students. 2.2. Classroom skipping assessment 1. Skipping classroom was calculated by the number of skipped lectures or clinical sessions/month or if the student froze the year or was forbidden from the exam- ination due to absence. Finally, a meeting was held with the participants, and all information regarding the research objectives and how to fill out the questionnaire was conveyed to them. 2. This study intended to establish the relationship among the following variables: DOI 10.18502/sjms.v18i2.13601 Page 167 Sudan Journal of Medical Sciences Turki Aqahtani et al 3. Daytime sleepiness 4. Morningness–Eveningness 5. Skipping classroom 2.3. Daytime sleepiness measurement The Epworth sleepiness scale (ESS), a well-validated [11] self-reported questionnaire, was used to assess excessive daytime sleepiness. The scale is an eight components choice question. The questionnaire asks the subjects to rate their probability of falling asleep or dose in eight different situations. Sitting and reading, watching TV, sitting inactive in public places, as a passenger in a car for 1 hr without a break, lying down to rest in the afternoon when circumstances permit, sitting talking to someone, sitting quietly after lunch without alcohol, and in a car, while stopped for a few minutes in traffic. Each question had four choices (no = zero, 1 = mild, 2 = moderate, and 3 = severe) with an aggregate of 0–24. Students who scored ≥10 were considered excessive daytime sleepers [12]. 2.4. Morningness–Eveningness measurement To determine the Morningness–Eveningness, a standardized tool, the Morningness– Eveningness Questionnaire (MEQ), a self-administered validated questionnaire devel- oped by the researchers James A Home and Olov Ostebrg (1976), was used. Its primary purpose is to measure whether a person’s circadian rhythm (biological clock) produces alertness in the morning, evening, or in between [13–15]. The morningness–eveningness questionnaire includes 19 questions, each with five or four components detailing sleep habits with the following scoring: A score of 16– 30 indicating a definite evening, 31–41 moderate evening, 24–58 intermediate, 59–69 moderate morning, and 70–86 definite morning. 2.5. Reasons for skipping lectures Reasons behind skipping lectures included early or late timings and the availability of lectures to students through other sources. In addition, other reasons provided were: below-expectation quality of lectures (e.g., reading directly from the slides or organization of the show), students being uninterested in the topic, the lecturer being DOI 10.18502/sjms.v18i2.13601 Page 168 Sudan Journal of Medical Sciences Turki Aqahtani et al relaxed about attendance, the transportation factor, and student’s perception that the lecture did not benefit them or prepare them for the examination. Open-ended questions were included for other reasons for absence. 2.6. Data analysis Microsoft Excel was used for data gathering, and the Statistical Package for Social Sciences and the Chi-square test were used to compare categorical data. In addition, the binary logistic regression analysis was used for the relationship between various variables. Data were presented as percentages or mean ± SD unless otherwise indi- cated. A P-value of <0.05 was considered significant. 3. Results The study included 334 medical students, aged 19–28 years with a mean age of 24.49 ± 1.92 years. Their cumulative grade average was 4.03 ± 0.76 out of 5, their time to reach the college was 20.15 ± 9.78 min, the daytime sleepiness and chronotype scores were 8.65 ± 4.22 and 47.47 ± 9.11, respectively, and skipping classroom was 2.99 ± 3.46 times (Table 1). Moreover, 67.6% of the participants were women, 80% of the students believed that the lectures positively influence their performance, 77.9% were on the side of optional classrooms, and only 45% will attend classrooms if the video is provided. The most common reason for absence was that the lecturer was directly reading from the slide show (72.8%), followed by late lectures (67.8%), and lecturers’ presentation skills (65.6%). In addition, the open questions mentioned fatigue, menstrual periods, lack of concentration, and long lectures without breaks. Notably, 57.9% of the students were not interested in the lectures, and 74.7% skipped classrooms last month. Daytime sleepiness was evident in 40.1% of the students, and the majority were intermediate chronotypes (66.4%), followed by evening chronotypes (24.2%), while the minority were morning larks (Table 2).In the current study, women were younger than men (22.19 ± 1.97 vs. 23.11 ± 2.02, P-value < 0.001, 95% CI, 0.47–1.35) and took more time to reach college (21.57 ± 11.28 vs. 18.59 ± 7.57, P-value, 0.035, 95% CI, –5.73–0.002), Table 3 shows a comparison between male and female students. In this study, skipping classrooms was associated with age (Wald, 4.36, P-value, 0.037, and 95% CI, 0.52–0.98) and daytime sleepiness (Wald, 3.86, P-value, 0.049, and 95% CI, 0.19-0.91). However, no association was found between skipping classrooms DOI 10.18502/sjms.v18i2.13601 Page 169 Sudan Journal of Medical Sciences Turki Aqahtani et al and cumulative grade average (Wald, 0.010, P-value, 0.920, and 95% CI, 0.45–2.41, transportation (Wald, 0.092, P-value, 0.762, and 95% CI, 0.95–1.03), and chronotype (Wald, 2.38, P-value, 0.122, and 95% CI, 0.16–0.99) (Table 4). Table 1: Basic characteristics of medical students, University of Tabuk, Saudi Arabia. Character Mean ± SD Age (19–28 yr) 24.49 ± 1.92 Cumulative grade average (1.2–5.0) 4.03 ± 0.76 Time to reach the college (min) 20.15 ± 9.78 Skipping classrooms 2.99 ± 3.46 Epworth Sleepiness Scale 8.65 ± 4.22 Morningness–Eveningness score 47.47 ± 9.11 Table 2: Sleep pattern, reasons for skipping classroom, and the importance of attendance among medical students at the University of Tabuk, Saudi Arabia. Character No (%) Sex Women Men 226 (67.6%) 108 (32.3%) Lectures positively influence performance 260 (80%) Optional classrooms 258 (77.9%) Attending if video was provided 149 (45%) Reason of absence Early lectures Late lectures Lecturers’ presentation skills The lecturer is not strict in taking attendance The lecturer reads directly from the slideshows Lack of interest 165 (49.8%) 225 (67.8%) 217 (65.6%) 79 (23.8%) 241 (72.8%) 191 (57.9%) Daytime sleepiness Excessive daytime sleepiness 129 (40.1%) 30 (9.3%) Chronotype Morning Intermediate Evening 31 (9.5%) 217 (66.4%) 79 (24.2%) Skipping classroom 216 (74.7%) Table 3: Comparison between males and females at the University of Tabuk, Saudi Arabia regarding skipping classroom. Character Males Females P-value 95% CI Age (19–28 yr) 23.11 ± 2.02 22.19 ± 1.97 <0.001 0.47–1.35 Cumulative grade average (1.2–5.0) 3.92 ± 0.73 4.14 ± 0.79 0.052 –0.0.43–0.002 Time to the college (min) 18.59 ± 7.57 21.57 ± 11.28 0.035 –5.73–0.002 Skipping classrooms 2.92 ± 3.33 3.01 ± 3.54 0.806 —9.43–0.73 Epworth Sleepiness Scale 8.21 ± 4.07 8.85 ± 4.28 0.203 –1.62–0.34 Morningness– Eveningness score 47.11 ± 9.81 47.64 ± 8.78 0.625 –2.65–1.59 ∗T-test DOI 10.18502/sjms.v18i2.13601 Page 170 Sudan Journal of Medical Sciences Turki Aqahtani et al Table 4: Relationship between skipping classes and daytime sleepiness, chronotype, transportation, cumulative grade average, age, and gender among the medical students of the University of Tabuk. Character Wald Difference P-value 95% CI Age (yr) 4.36 1 0.037 0.52–0.98 Sex 0.003 1 0.956 0.40–2.63 Cumulative grade average 0.010 1 0.920 0.45–2.41 Time to the College (min) 0.092 1 0.762 0.95–1.03 Daytime sleepiness 3.86 1 0.049 0.19–0.91 Morningness– Eveningness score 2.38 1 0.122 0.16–0.99 Constant 0.85 0.356 ∗Binary logistic regression analysis 4. Discussion In the present study, 80% of the students believed that the lectures positively influenced their performance, 77.9% were on the side of optional classrooms, and only 45% will attend classrooms if videos are provided. A study conducted among medical students in five public and private sector colleges [16] reported that lectures are helpful in line with the present findings. In the present study, 74.7% of the students skipped at least one lecture in the past month. The main reasons behind skipping classrooms were the lecturer’s presentation skills, the time of lectures, and the lack of interest. Policies for rescheduling the lectures and improving the lecturers’ presentation skills are needed. Notably, a lack of interest in lectures is a warning because it might be that the students joined Medicine against their choice. Lack of interest and absence after graduation will substantially affect patient’s care. The lecturers’ presentation skill was the most common reason for absence in a study conducted among medical students in the USA [17]. Further studies observed that lecture timings and the lecturers’ presentation skill as the main factors for absence in agreement with our findings [15]. The current study found daytime sleepiness in 40.1% of the students, in agreement with El Hangouche et al. [18], who conducted a survey among medical students in Morocco and found daytime sleepiness in 36.6%. Previous studies from Saudi Arabia have reported a prevalence of 37.8% [19]. In the present data, no differences between males and females regarding daytime sleepiness support the findings of a previous meta-analysis [20]. No association was evident between daytime sleepiness and cumu- lative grade average, similar to a prior study in Jordon[21]. Authors from Jordon reported no difference in daytime sleepiness among females and males similar to the current DOI 10.18502/sjms.v18i2.13601 Page 171 Sudan Journal of Medical Sciences Turki Aqahtani et al findings in which the daytime sleepiness was not different across gender. Our results contradict Abdulghani and colleagues’ [22], who published a study in Malaysia and found more daytime sleepiness among women. Similarly, our results also contradict the findings of a recent study that reported a high excessive daytime sleepiness (54.4%), especially among women [23]. Excessive daytime sleepiness might be due to poor sleep quality or duration. Investigating the causes of daytime sleepiness, including meal timing, caffeinated drinks, and display viewing, is needed [24]. The present study showed a positive correlation between daytime sleepiness and skipping classrooms. Similarly, Bati et al. reported that sleepiness is among the most cited reasons for skipping lectures in Turkey [1]. In this study, 9.5%, 66.4%, and 24.2% were morning, intermediate, and evening chronotypes (with no difference between women and men), similar to previous studies [25, 26]. There is no association between skipping lectures and chronotype; similar results were reported by an earlier study [10]. A plausible explanation might be the dominance of the intermediate chronotype. Evening chronotype, social jetlag, and short sleep duration are significant determinants of daytime sleepiness [27]. The association between skipping lectures and age found in this study might be due to peer influence and familiarity with the program. Interventions targeting specific age groups might improve attendance rates. Desalegn et al. [28] found no association between skipping classrooms and cumulative grade average (GPA) in agreement with our findings. Our findings also support previous observations [29, 30]. On the other hand, Alamoudi et al. [15] found better academic performance among non-skippers. The GPA is a cumulative grade over the years and might not reflect the student’s performance during the survey. Limitations The study was limited by the cross-sectional methodology and being a single-center study. Thus, generalization cannot be ensured. 5. Conclusion Most students had skipped at least one lecture in the past month; the causes were lec- ture timing and lecturers’ presentation skills. Daytime sleepiness was prevalent among medical students in Tabuk University, Saudi Arabia, and was associated with skipping DOI 10.18502/sjms.v18i2.13601 Page 172 Sudan Journal of Medical Sciences Turki Aqahtani et al classrooms. Most students were intermediate chronotype that was not associated with classroom absence. Further larger multi-center studies are needed. Acknowledgments The authors would like to extend their sincere gratitude to the Deanship of Higher Education and Scientific research, University of Tabuk, Saudi Arabia, for the financial support of this research under grant number (S-1443-0003). Ethical Considerations All participants signed written informed consent and their privacy was secured according to the Declaration of Helsinki. Furthermore, ethical clearance was obtained from the ethical committee of the University of Tabuk (ref, UT-164-27-2021. Dated 13/12/2021). Competing Interests None to declare. Availability of Data and Material The data and material of this study are available from the corresponding author upon request. Funding None. References [1] Bati, A. H., Mandiracioglu, A., Orgun, F., & Govsa, F. (2013). Why do students miss lectures? A study of lecture attendance amongst students of health science. Nurse Education Today, 33(6), 596–601. https://doi.org/10.1016/j.nedt.2012.07.010 [2] Skoglund, E., Fernandez, J., Sherer, J. T., Coyle, E. A., Garey, K. W., Fleming, M. L., & Sofjan, A. K. (2020). Using the theory of planned behavior to evaluate factors DOI 10.18502/sjms.v18i2.13601 Page 173 Sudan Journal of Medical Sciences Turki Aqahtani et al that influence pharmd students’ intention to attend lectures. American Journal of Pharmaceutical Education, 84(5), 7550. https://doi.org/10.5688/ajpe7550 [3] Irwin, N., Burnett, K. M., & McCarron, P. A. (2018). Association between attendance and overall academic performance on a module within a professional pharmacy degree. Currents in Pharmacy Teaching & Learning, 10(3), 396– 401. https://doi.org/10.1016/j.cptl.2017.11.008 [4] Hidayat, L., Vansal, S., Kim, E., Sullivan, M., & Salbu, R. (2012). Pharmacy student absenteeism and academic performance. American Journal of Pharmaceutical Education, 76(1), 8. [5] Liu, B. (2020). The United States Medical Licensing Examination Step 1 is changing-US medical curricula should too. JMIR Medical Education, 6(2), e20182. https://doi.org/10.2196/20182 [6] Martin, J. S., Gaudreault, M. M., Perron, M., & Laberge, L. (2016). Chronotype, light exposure, sleep, and daytime functioning in high school students attending morning or afternoon school shifts: An actigraphic study. Journal of Biological Rhythms, 31(2), 205–217. https://doi.org/10.1177/0748730415625510 [7] Porcheret, K., Wald, L., Fritschi, L., Gerkema, M., Gordijn, M., Merrrow, M., Rajaratnam, S. M. W., Rock, D., Sletten, T. L., Warman, G., Wulff, K., Roenneberg, T., & Foster, R. G. (2018). Chronotype and environmental light exposure in a student population. Chronobiology International, 35(10), 1365– 1374. https://doi.org/10.1080/07420528.2018.1482556 [8] Mirghani, H. O. (2017). The effect of chronotype (morningness/eveningness) on medical students’ academic achievement in Sudan. Journal of Taibah University Medical Sciences, 12(6), 512–516. https://doi.org/10.1016/j.jtumed.2017.03.007 [9] Owens, J. A. (2001). Sleep loss and fatigue in medical training. Current Opinion in Pulmonary Medicine, 7, 411–418. https://doi.org/10.1097/00063198-200111000-00009 [10] Rique, G. L., Fernandes Filho, G. M., Ferreira, A. D., & de Sousa-Muñoz, R. L. (2014). Relationship between chronotype and quality of sleep in medical students at the Federal University of Paraiba, Brazil. Sleep Science, 7(2), 96– 102. https://doi.org/10.1016/j.slsci.2014.09.004 [11] Bakotic, M., Radosevic-Vidacek, B., & Koscec Bjelajac, A. (2017). Morningness- eveningness and daytime functioning in university students: The mediat- ing role of sleep characteristics. Journal of Sleep Research, 26(2), 210– 218. https://doi.org/10.1111/jsr.12467 [12] American Academy of Sleep Medicine. (2014). International classification of sleep disorders (3rd ed.). American Academy of Sleep Medicine. DOI 10.18502/sjms.v18i2.13601 Page 174 Sudan Journal of Medical Sciences Turki Aqahtani et al [13] Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14, 540545. https://doi.org/10.1093/sleep/14.6.540 [14] Bahmamm, A. S., Alaseem, A. M., Alzakri, A. A., Alminessier, A. S., & Sharif, M. M. (2012). The relationship between sleep and wake habits and academic performance in medical students; A cross-sectional study. BMC Medical Education, 12, 61. https://doi.org/10.1186/1472-6920-12-61 [15] Alamoudi, W. A., Alhelo, A. F., Almazrooa, S. A., Felemban, O. M., Binmadi, N. O., Alhindi, N. A., Ali, S. A., Akeel, S. K., Alhamed, S. A., Mansour, G. M., & Mawardi, H. H.. (2021). Why do students skip classroom lectures: A single dental school report. BMC Medical Education, 21(1), 388. 10.1186/s12909-021-02824-3. Erratum in: BMC Medical Education, 21(1), 427. [16] Mustafa, T., Farooq, Z., Asad, Z., Amjad, R., Badar, I., Chaudhry, A. M., Khan, M. A., & Rafique, F. (2014). Lectures in medical education: What students think? Journal of Ayub Medical College, Abbottabad, 26(1), 21–25. Erratum in: Journal of Ayub Medical College, Abbottabad, 26(2). [17] Emahiser, J., Nguyen, J., Vanier, C., & Sadik, A. (2021). Study of live lecture attendance, student perceptions and expectations. Medical Science Educator, 31(2), 697–707. [18] El Hangouche, A. J., Jniene, A., Aboudrar, S., Errguig, L., Rkain, H., Cherti, M., & Dakka, T. (2018). Relationship between poor quality sleep, excessive daytime sleepiness and low academic performance in medical students. Advances in Medical Education and Practice, 9(9), 631–638. https://doi.org/10.2147/AMEP.S162350 [19] Al-Zahrani, J. M., Aldossari, K. K., Abdulmajeed, I., Al-Ghamdi, S. H., Al-Shamrani, A. M., & Al-Qahtani, N. S. (2016). Daytime sleepiness and academic performance among Arab medical students. Journal of Thoracic Disease, 8(2), AB006. [20] Jahrami, H., Alshomili, H., Almannai, N., Althani, N., Aloffi, A., Algahtani, H., Brown, C. A. (2019). Predictors of excessive daytime sleepiness in medical students: A meta- regression. Clocks & Sleep, 1(2), 209–219. [21] Alqudah, M., Balousha, S. A. M., Balusha, A. A. K., Al-U’dat, D. G., Saadeh, R., Alrabadi, N., & Alzoubi, K. (2022). Daytime sleepiness among medical colleges’ students in Jordan: Impact on academic performance. Sleep Disorders, 2022, 7925926. https://doi.org/10.1155/2022/7925926 [22] Abdulghani, H. M., Alrowais, N. A., Bin-Saad, N. S., Al-Subaie, N. M., Haji, A. M., & Alhaqwi, A. I (2012). Sleep disorder among medical students: relationship to their academic performance. Medical Teacher, 34(1), S37–S41. DOI 10.18502/sjms.v18i2.13601 Page 175 Sudan Journal of Medical Sciences Turki Aqahtani et al [23] Dutra da Silva, R. C., Garcez, A., Pattussi, M. P., & Olinto, M. T. A. (2022). Prevalence and factors associated with excessive and severe daytime sleepiness among healthcare university students in the Brazilian Midwest. Journal of Sleep Research, 31(3), e13524. https://doi.org/10.1111/jsr.13524 [24] Shimura, A., Hideo, S., Takaesu, Y., Nomura, R., Komada, Y., & Inoue, T. (2018). Comprehensive assessment of the impact of life habits on sleep disturbance, chronotype, and daytime sleepiness among high-school students. Sleep Medicine, 44, 12–18. https://doi.org/10.1016/j.sleep.2017.10.011 [25] Tan, M. N., Mevsim, V., Pozlu Cifci, M., Sayan, H., Ercan, A. E., Ergin, O. F., Oksuz, U., & Ensari, S. (2020). Who is happier among preclinical medical students: The impact of chronotype preference. Chronobiology International, 37(8), 1163– 1172. https://doi.org/10.1080/07420528.2020.1761373 [26] Li, T., Xie, Y., Tao, S., Yang, Y., Xu, H., Zou, L., Tao, F., & Wu, X. (2020). Chronotype, sleep, and depressive symptoms among Chinese college students: A cross-sectional study. Frontiers in Neurology, 11, 592825. https://doi.org/10.3389/fneur.2020.592825 [27] Kolomeichuk, S. N., Randler, C., Morozov, A. V., Gubin, D. G., & Drake, C. L. (2021). Social Jetlag and Excessive Daytime Sleepiness from a sample of Russian children and adolescents. Nature and Science of Sleep, 13, 729– 737. https://doi.org/10.2147/NSS.S290895 [28] Desalegn, A. A., Berhan, A., & Berhan, Y. (2014). Absenteeism among medical and health science undergraduate students at Hawassa University, Ethiopia. BMC Medical Education, 14, 81. [29] Azab, E., Saksena, Y., Alghanem, T., Midle, J. B., Molgaard, K., Albright, S., & Karimbux, N. (2016). Relationship among dental Students’ class lecture attendance, use of online resources, and performance. Journal of Dental Education, 80(4), 452– 458. https://doi.org/10.1002/j.0022-0337.2016.80.4.tb06103.x [30] Alghamdi, A. Y. K., Albarkati, B., Alrehili, O., & Salih, M (2016). Prevalence causes and impacts of absenteeism among medical students at UQU. Education 6(1):9–12. DOI 10.18502/sjms.v18i2.13601 Page 176 Introduction Materials and Methods Sample size calculation Classroom skipping assessment Daytime sleepiness measurement Morningness–Eveningness measurement Reasons for skipping lectures Data analysis Results Discussion Limitations Conclusion Acknowledgments Ethical Considerations Competing Interests Availability of Data and Material Funding References