To assess daytime sleepiness, we used the Epworth Sleepiness Scale (ESS) [12]. This questionnaire consists of 8 self-rated items, each scored from 0 to 3, that measure a subject’s habitual “likelihood of dozing or falling asleep” in common situations of daily living. The final score is the sum of individual items (scores 0–24). Values > 10 are considered excessive daytime sleepiness and values > 15 are considered severe sleepiness. ESS was translated and validated to Brazilian Portuguese [13].

To assess sleep quality, we used Pittsburgh Sleep Quality Index (PSQI) [14]. This questionnaire has 19 items to evaluate subjective sleep quality. We used only the global score of PSQI (range 0 to 21). Higher scores indicate worse sleep quality. Values > 5 are considered poor quality of sleep [14]. PSQI had been previously translated and validated to Brazilian Portuguese [13].

To assess sleep deprivation, we calculated the difference between mean hours of sleep during weekends and mean hours of sleep during weekdays, that was called Sleep Deprivation Index (SDI). SDI was derived from the questions: a) How many hours, on average, did you sleep on weekdays during the last 2 weeks? b) On weekends, if nobody wakes you up, how many hours, on average, do you sleep?

To assess quality of life (QoL) we used three questionnaires:

WHOQOL-BREF, that has 26 items with four domains: environment, psychological, social relationships, and physical health [15]. Answers are given on a 5-point Likert scale and points within each domain are transformed to a score from 0 to 100. Higher scores represent better QoL (WHOQOL GROUP 1995). This questionnaire was translated and validated to Brazilian Portuguese [16].

QoL self-assessment, that consisted of two questions to evaluate students’ perception regarding their overall QoL and QoL related to medical school (MSQoL) on a scale from 0 to 10. The items were [1] rate your overall quality of life [2]; rate your quality of life in medical school [8, 10].

VERAS-Q that is a questionnaire created to evaluate quality of life from students in the health professions. This questionnaire has 45 statements on a 5-points Likert scale divided in four domains (time management, psychological, physical health and learning environment) and a global score [17, 18].

To assess the perception of the educational environment in medical school we used DREEM (Dundee Ready Education Environment Measure), a 50-item questionnaire which evaluates educational environment perceptions. This questionnaire has 5 domains: perceptions of learning, perceptions of teachers, academic self-perceptions, perceptions of atmosphere, and social self-perceptions [19, 20]. Answers are given on a 5-point Likert scale. This questionnaire was translated and validated to Brazilian Portuguese [21].

To assess emotional symptoms, we used Beck Depression Inventory (BDI) and State Trait Anxiety Inventory (STAI). BDI is a 21-item questionnaire to measure depression symptoms [22]. Scores of each item vary from 0 to 3 according to increasing symptom intensity. This questionnaire was translated and validated to Brazilian Portuguese [23]. STAI has a scale with 20 items each evaluating the intensity of state-anxiety and of trait-anxiety symptoms [24]. This questionnaire was also previously translated and validated to Brazilian Portuguese [23].

The results of the reliability analyses performed using the Cronbach’s α coefficient demonstrated that the data had and α value between 0.65 and 0.94 for all domains of the questionnaires (data not shown).

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