Relationship between sleep, anxiety, nomophobia and academic performance in Peruvian medical students: A structural analysis

Introduction: Medical training involves high cognitive and emotional demands; however, the interaction between sleep, anxiety, nomophobia, and academic performance remains insufficiently studied. The objective was to analize the structural relationship between sleep quality, anxiety, nomophobia, and academic performance in Peruvian medical students. Materials and methods: An analytical secondary data study was conducted in 3,139 Peruvian medical students. Sleep quality (PSQI), anxiety (HSCL-A), nomophobia (NMP-Q), and academic performance were analyzed, along with sex, academic year, and mobile phone use time. A structural equation model estimated using WLSMV was applied, assessing direct and indirect effects. Model fit was evaluated using CFI, TLI, RMSEA, and SRMR. Results: The structural equation model showed adequate fit (CFI = 0.984; TLI = 0.985; RMSEA = 0.073; SRMR = 0.051). Poorer sleep quality was associated with higher anxiety, which in turn increased nomophobia; a direct effect of sleep on nomophobia was also observed. Effects on academic performance were small but significant for sleep and nomophobia, while anxiety acted as a partial mediator in the sleep–nomophobia relationship. Covariates showed consistent associations with sex, academic year, and mobile phone use. Conclusions: The findings indicate that sleep, anxiety, and nomophobia form an interrelated system, in which anxiety links impaired sleep with greater mobile dependence. This highlights the need for interventions focused on sleep hygiene, emotional regulation, and balanced technology use within medical education.