Investigating the Sleep-Burnout Connection and Its Impact on Health-Related Quality of Life Among Medical Registrars at a University in South Africa

Medical registrars constitute a critical workforce within South African healthcare, yet their routine exposure to long working hours, high patient loads, and academic pressures places them at risk for sleep disturbance, burnout, and reduced health-related quality of life. Despite growing evidence linking these factors internationally, limited data exist for South African registrars, particularly regarding the interrelationships between sleep, burnout, and Health-Related Quality of Life. This thesis investigated the relationships between sleep disturbance, burnout, and health-related quality of life among medical registrars at Stellenbosch University and assessed the potential mediating pathways linking these outcomes. A cross-sectional study was conducted. Data were collected using an electronic self-administered questionnaire comprising validated instruments such as Simple Lifestyle Indicator Questionnaire, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Copenhagen Burnout Inventory, Depression Anxiety and Stress Scale-21, Connor–Davidson Resilience Scale-2, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Additional measures included biographical characteristics, clinical training demands, working hours, and screen-time behaviours. Descriptive statistics characterised the sample profile. Pearson’s chi-square tests were used to examine associations between categorical variables, with likelihood ratio chi-square tests applied when expected cell counts were violated. Cramer’s V was used to determine the strength of contingency associations. Of the registrars who accessed the survey (n = 59), 39 completed all required sections. Sleep disturbance was highly prevalent, with 76.9% classified as poor sleepers (mean PSQI = 8.9 ± 3.9) and 64.1% sleeping less than seven hours per night. Daytime sleepiness was common (mean ESS = 8.2 ± 4.8). Burnout levels were high across domains, particularly personal burnout (mean 59.1 ± 24.3) and work-related burnout (mean 60.6 ± 24.6). Overall, Health-Related Quality of Life scores were moderate, with physical and psychological domains showing the greatest impairment. Psychological symptoms showed mild depression, moderate anxiety, and normal-to-mild stress. Lifestyle assessment indicated overall moderate lifestyle health, while screen-time findings suggested frequent evening device use. Resilience levels were moderate (mean CD-RISC-2 = 6.4 ± 3.1). Correlation and mediation analyses showed strong associations between burnout, reduced sleep, and Health Related Quality of Life. Health-Related Quality of Life significantly mediated the associations between burnout and both sleep quality and daytime sleepiness. Variability in working hours, night duties, and academic pressures contributed to the broader pattern of strain, though subgroup comparisons were limited by sample size. In this study, medical registrars experienced substantial sleep disturbance, high burnout, and compromised Health-Related Quality of Life, alongside moderate lifestyle health and resilience. The mediation between burnout and sleep via Health-Related Quality of Life highlights the interconnected nature of registrars’ wellbeing. These findings underscore the need for institutional interventions that address workload, rostering, recovery opportunities, mental-health support, and sleep health to safeguard registrar wellbeing and optimise clinical performance.

Grantor dc:publisher

Stellenbosch : Stellenbosch University

Year dc:date.issued

2026

Author dc:creator

• Mkatazo, Nomvuyiseko Aluta

Advisors dc:contributor.advisor

• Rampf, Nadine
• Mentoor, Ilze

Language dc:language.iso

en

Repository record dc:identifier.uri

https://scholar.sun.ac.za/handle/10019.1/136222

OAI identifier oai:identifier

oai:scholar.sun.ac.za:10019.1/136222