Influence of sleep-wake cycle on body mass index in female shift-working nurses with sleep quality as mediating variable

Sleep Quality and its Associated Factors among Nurses in a Tertiary Care Public Hospital in Puducherry District: A Cross-sectional Study

Background

Adequate sleep is essential for human beings to maintain optimal health. Medical professionals, including nurses, work in stressful environments that could affect their sleep quality. The objective of this study was to determine the prevalence and the factors associated with poor sleep quality among nurses in a tertiary care public hospital.

Materials and Methods

This cross-sectional analytical study was conducted on 1217 nurses aged between 21 and 60 years from May 2019 to April 2020 in a tertiary care public hospital in Puducherry. Sleep quality was assessed using the Pittsburgh sleep quality index scoring system, and the workplace stress scale was used to assess workplace stress. The Chi-squared test and adjusted Prevalence Ratio (aPR) were used to determine the factors associated with poor sleep quality.

Results

The response rate was 99% (1217/1229), and three-fourths of the participants were women (943, 77.50%). The mean (SD) PSQI score was 4.49 (2.98), and more than one-third of participants, 42.80% (95% CI: 40.10-45.70), had poor sleep quality. The prevalence of poor sleep quality was significantly higher among women (z = 2.33, p = 0.019) aPR (95% CI): 1.08 (1.01-1.16), those having severe to dangerous levels of workplace stress (z = 8.22, p > 0.001) aPR (95% CI): 1.54 (1.39-1.71) and chronic pain (z = 2.11, p = 0.016) aPR (95% CI): 1.09 (1.02-1.17).

Conclusions

The prevalence of poor sleep quality among the study population was high. This highlights the urgent need for implementing health promotion programs among nurses.

Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016

STUDY OBJECTIVES

We aimed to identify the relationship between duration of categorized catch-up sleep on free days (CUS) and measured body mass index (BMI) in adults using the data from the seventh Korean National Health and Nutrition Examination Survey (KNHANES VII), 2016.

METHODS

CUS duration was classified as ≤ 0, > 0-1, > 1-2, and > 2 hours. Being overweight or obese was defined as having a BMI ≥ 25.0 kg/m2 or ≥ 30.0 kg/m2, respectively.

RESULTS

Of 6,382 participants aged 19-80 years in the KNHANES VII survey of 2016, 201 and 583 participants were excluded because of shift-working and insufficient data, respectively. Of 5,598 participants, CUS was observed in 2,274 (44.9%) participants, of which 3,324 (55.1%), 1,043 (19.4%), 724 (14.7%), and 507 (10.8%) had CUS of ≤ 0, > 0-1, > 1-2, and > 2 hours, respectively; the prevalence of obesity was 5.6%, 5.6%, 4.8%, and 6.1%, respectively. The association between BMI and CUS duration showed a significant negative association in the CUS ≤ 0 hours group (beta [95% confidence interval], -0.394 [-0.646, -0.143], P = .002); however, other CUS groups did not show any significant association with BMI (CUS > 0-1 hours: -0.196 [-1.258, 0.865], P = .716; CUS > 1-2 hours, -0.542 [-1.625, 0.541], P = .325; CUS > 2 hours, -0.113 [-0.459, 0.233], P = .519).

CONCLUSIONS

Our findings provide an understanding of the relationship between CUS and BMI and can serve as an instructive basis for the management of BMI.

CITATION

Lee HJ, Cho S, Lee SH, Kim SJ, Kim KM, Chu MK. Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016. J Clin Sleep Med. 2024;20(1):39-47.

The relationship between the emergency nurses' sleep quality and the sleep quality of their spouses: A cross-sectional descriptive-analytical study

Background and Aims

Due to the heavy working shifts, emergency nurses may have to sleep at unusual times of the day, affecting their spouse's sleep. This study proposed to detect the relationship between the woman emergency nurse's sleep quality and the sleep quality of their spouses.

Methods

This cross-sectional descriptive-analytical study has lasted for 4 months since June 21, 2020. The study population was all women nurses working at a hospital emergency department. The data was collected by a demographic questionnaire and Pittsburgh sleep quality index (PSQI) for nurses and their spouses. The data were analyzed by descriptive and inferential statistics.

Results

The prevalence of sleep quality disorder among female emergency department nurses and their husbands was 82.7% and 80.6%, respectively. The mean sleep quality score of female nurses and their husbands was 8.46 ± 4.43 and 6.50 ± 2.52, respectively. A strong and positive correlation was found between the PSQI score of female nurses and their husbands (p < 0.001). The regression model showed that increasing the body mass index (BMI) of female emergency nurses can decrease their sleep quality. However, increasing the BMI of female emergency nurses' spouses and their work experience in the emergency department can improve their sleep quality.

Conclusion

The sleep quality of female emergency department nurses was directly correlated with their husbands' sleep quality. Therefore, the sleep quality of nurses working in the emergency departments and their spouses should be examined periodically.

Influence of shift work on rest-activity rhythms, sleep quality, and fatigue of female nurses

Female nurses working rotating shifts must change their daily routines often, which affects their biological circadian rhythms and could cause sleep disorders and fatigue. The objective of this study was to compare the sleep-wake rhythms, sleep quality, and fatigue of female nurses working rotating shifts and fixed day shifts and to analyze the factors that influence their fatigue. Participants comprised a shift worker group of 101 nurses and a day worker group of 76 nurses. Following the collection of basic information of the nurses and their scores in the various constructs of the Pittsburg Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS) questionnaire, each nurse wore an actigraph for seven consecutive days to collect for analysis the sleep-wake rhythm parameter dichotomy index (I < O) and durations of continuous sleep and wake. Multivariable linear regression was then used to determine whether the influence of various variables on fatigue differed between the two groups. Results revealed that the sleep-wake rhythm parameter I < O of the day worker group was significantly higher than that of the shift worker group (t = 5.08, p < .001). The shift worker group exhibited significantly higher PSQI global scores (t = -2.00, p = .047), longer total sleep time (t = 2.07, p = .040), poorer habitual sleep efficiency (t = -3.06, p = .003), and greater use of sleeping medication (t = -2.90, p = .004) than did the day worker group. Multivariable linear regression was performed to analyze the important predictors of the CIS score in the two groups with body mass index, age, work experience, marital status, educational background, department of employment, shift type at the time of recruitment, sleep-wake rhythm parameter I < O, and quality of sleep as independent variables. Results indicated that in the shift worker group, the overall explanatory power (R²) of the multivariable linear regression model was 22.9% (F = 3.01, p = .003), and only the PSQI global score (β = 0.33, p = .003) influenced the CIS score. In the day worker group, the various variables did not influence the CIS score in the multivariable linear regression model. Although the female nurses working rotating shifts spent more time in bed, their sleep-wake rhythms and sleep quality were poorer than those of the day worker group. Furthermore, the sleep quality of female nurses in the shift worker group had a significant impact on their fatigue. In other words, for female nurses who must work rotating shifts, sleep quality determines whether fatigue can be reduced. The shift-working nurses themselves should implement sleep management, such as avoiding disruptions to their sleep-wake rhythm and improving sleep quality, which should be effective strategies to reduce fatigue.

Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: a systematic literature review and meta-analysis

The objective of this study was to understand the influence of rotating shifts and fixed night shifts on the sleep quality of nurses using a systematic literature review and meta-analysis and to determine whether the sleep quality of nurses working rotating shifts or fixed night shifts differs from that of nurses working fixed day shifts. We conducted a meta-analysis on literature that had used the Pittsburgh Sleep Quality Index (PSQI) to gauge sleep quality and had been published between 2000 and 2020 in the Cochrane Library, CINAHL, MEDLINE, and PubMed databases. This study was conducted in accordance with PRISMA, and the quality of the literature was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. CMA 3.0 was employed for data analysis, and meta-regression analysis was conducted to examine the differences between the PSQI scores of nurses working fixed day shifts and those working rotating shifts or fixed night shifts. Following assessment, a total of 29 papers (34 items of data) were analyzed. The papers included a total of 3,935 nurses who worked fixed day shifts, 3,777 nurses who worked rotating shifts, and 1,559 nurses who worked fixed night shifts. Our subgroup analysis indicated that the sleep quality of nurses working rotating shifts was poorer than the sleep quality of nurses working fixed day shifts; the standardized mean difference (SMD) was 0.38 (95% CI: 0.24-0.52, p< .001), and the meta-regression analysis found that the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts was significantly smaller than the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts (β = -0.368, p= .011). The sleep quality of nurses working fixed night shifts was also poorer than the sleep quality of nurses working fixed day shifts; the SMD was 0.58 (95% CI: 0.38-0.78, p< .001), and the meta-regression analysis revealed that the difference in sleep quality between nurses over 40 years old working fixed night shifts and those working fixed day shifts was not significantly different from the difference in sleep quality between nurses 40 years old or younger working fixed night shifts and those working fixed day shifts (β = -0.118, p= .608). This meta-analysis found that both nurses working rotating shifts and those working fixed night shifts had poorer sleep quality than those working fixed day shifts and that age influenced the difference in sleep quality only between nurses working rotating shifts and those working fixed day shifts; the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts was greater than the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts.

Exploring the Association between Sleep Quality and Heart Rate Variability among Female Nurses

The quality of nurses' work has a direct effect on patient health, and poor sleep has been positively associated with nurses' medical errors. The aim of this study was to investigate the relationship between quality of sleep and heart rate variability (HRV) among female nurses. A descriptive cross-sectional correlational study design was used in January 2014 to study female nurses (n = 393) employed in a medical center in Taiwan. Data were obtained from several questionnaires. HRV was analyzed with five-minute recordings of heart rate signals obtained using a Heart Rater SA-3000P. Approximately 96% of the participants self-reported a poor quality of sleep. Compared to non-shift nurses, significant decreases were found in total power (TP) and low-frequency HRV among shift-work nurses. However, negative correlations were found between sleep quality and HRV, including total power, low frequency, and the low frequency/high frequency ratio (r = -0.425, p < 0.05; r = -0.269, -0.266, p < 0.05). In a stepwise multiple regression analysis, 23.1% of variance in quality of sleep can be explained by TP and heart rate. The sleep quality of female nurses was poor and this affected their autonomic nervous system, which can contribute unfavorable consequences for their health.