Association between problematic smartphone use, sleep quality, and chronotype among Sudanese medical students during armed conflict: a cross-sectional study

Abstract

Introduction Mobile phones play a pivotal role in the lives of young adults and medical students, but their problematic use may negatively affect daily functioning. The ongoing armed conflict in Sudan has substantially disrupted daily routines, academic activities, psychological wellbeing, and sleep behaviors among university students. This study aimed to assess the association between problematic smartphone use and sleep quality, sleep patterns, chronotype, and life satisfaction among undergraduate medical students during the conflict period in Sudan. Methods An analytical cross-sectional study was conducted among 387 undergraduate medical students in Sudan between September 2025 and November 2025, during an ongoing armed conflict. Data were collected using self-administered online questionnaire incorporating validated instruments: the Problematic Use of Mobile Phone (PUMP) Scale, Smartphone Addiction Scale–Short Version (SAS-SV), Pittsburgh Sleep Quality Index (PSQI), Morningness–Eveningness Questionnaire (MEQ), and Satisfaction With Life Scale (SWLS), alongside demographic variables. Descriptive statistics summarized participant characteristics and scale scores. Associations were examined using Spearman correlation analyses. Multivariable logistic regression was performed with poor sleep quality (PSQI >5) as the dependent variable. Independent variables entered simultaneously into the model included PUMP score, SAS-SV score, MEQ score, SWLS score, age, gender, and employment status. Analyses were conducted using R software, with p < 0.05 considered statistically significant. Results A total of 387 students participated (mean age 22.1 ± 2.3 years; 69% female). Poor sleep quality (PSQI >5) was observed in 71% of participants. Smartphone addiction showed a modest but statistically significant association with poorer sleep quality (ρ =0.22, p < 0.001). In multivariable analysis, higher smartphone addiction scores were associated with increased odds of poor sleep quality (OR = 1.04; 95% CI: 1.00–1.07) and greater morningness preference was associated with lower odds of poor sleep quality (OR = 0.94; 95% CI: 0.91–0.96; p < 0.001). Employment status (OR = 2.34; 95% CI: 1.27–4.56) was independently associated with poor sleep quality (all p < 0.05). Conclusion Poor sleep quality was highly prevalent among Sudanese medical students and was independently associated with smartphone addiction, evening chronotype, and employment status. These findings highlight important associations between smartphone use behaviors, chronotype, and sleep quality in conflict-affected academic settings and support the need for further longitudinal research, particularly within conflict-affected academic settings.