Poor Sleep Quality in Nurses Working or Having Worked Night Shifts: A Cross-Sectional Study

Abstract

Night shifts are part of clinical care. It is unclear whether poor sleep quality of nurses working both consecutive night shifts and day shifts after quitting night shifts is common. In this cross-sectional study, Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality as study outcome. Univariable and multivariable linear and logistic regressions were performed to compare PSQI score and prevalence of poor sleep quality between 512 nurses currently working consecutive night shifts and 174 nurses having worked night shifts in the past. The prevalence of poor sleep quality was 62.11% in nurses working consecutive night shifts and 55.75% in nurses having worked night shifts before. In multivariable regressions with adjustment for potential confounders, compared with nurses working consecutive night shifts, nurses having worked past night shifts reported decreased PSQI score [mean difference: −0.82 (95% CI: −1.27 to −0.38, p < 0.001)] and lower poor sleep quality [odds ratio (OR): 0.49 (95% CI: 0.29 to 0.80, p = 0.005)]. In nurses working consecutive night shifts, a rising curve that plateaued at the end was observed between years of consecutive night shifts and PSQI score, p = 0.004. To explore the change in PSQI score after quitting night shift, we constructed a hypothetical prospective cohort from the cross-sectional data. Here, 98 pairs of nurses with consecutive and past night shifts were matched for the number of night shift years, religion, marital status, living condition, hypertension, and hyperlipidemia. In each pair, a hypothetical change in PSQI score was calculated between the two types of nurses and hypothetical years after quitting night shifts was obtained from the matched nurse with past night shifts. A U-shaped curve between change in PSQI and years after quitting night shifts was observed, p = 0.007. The rising curve and U-shaped curve together formed an S-shaped curve, which mapped the change in sleep quality. These results based on the hypothetical cohort constructed from cross-sectional data suggested the presence of persistent poor sleep quality in night shift nurses. Also, we support early and continuous sleep hygiene education and reflection for an optimal strategy for when to cease working night shifts with regard to sleep-related problems.

Which Shiftwork Pattern Is the Strongest Predictor for Poor Sleep Quality in Nurses?

“…The current study found that nurses at a university hospital had a high prevalence of poor sleep quality (75.9%). The rate was somewhat higher than reported in a previous report from China (62.1%) [ 24 ] The current study may have a higher poor sleep quality rate because there were several shiftwork patterns, particularly rotational shiftwork (452 persons: 72.7%), as previously reported [ 22 ]. Rotational shiftwork is reported to affect the circadian rhythm, with an odds ratio of 1.456–2.348 times for poor sleep quality [ 23 , 25 , 26 , 27 , 28 , 29 ].…”

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran

“…Another study reported that of 207 participants 34.30% were found with poor sleep quality (total PSQI score > 10) [ 23 ]. Also, in another study, more than 50% of nurses reported poor sleep quality [ 24 ]. In our study, midwives' sleep disturbance was similar to the findings of previous studies, which was reported to be 30–50%.…”

“…In line with our findings, a study showed that working years >15 years (P = 0.04) was associated with poor sleep quality [ 23 ]. Huang et al believe that as work experience increases due to increased night shifts, sleep quality decreases slightly, which may be due to adaptation to night shifts and work-family conflict [ 24 ].…”

Association between circadian rhythm and sleep quality among nursing interns: A latent profile and moderation analysis

“…Nursing interns are a special subgroup of the nursing team and have received tremendous attention from multidisciplinary researchers ( Mei et al, 2022c ). Nursing interns experience transition-related stressors as well as non-habitual sleep–wake schedule ( Zhang et al, 2019 ), which leads to night-shift intolerance and poor sleep quality among them ( Huang et al, 2021 ). Previous studies reported that approximately 22.8–38.2% of nursing interns experience sleeping problems ( Lai et al, 2020 ; Gao et al, 2021 ).…”

“…Previous studies reported that approximately 22.8–38.2% of nursing interns experience sleeping problems ( Lai et al, 2020 ; Gao et al, 2021 ). Additionally, circadian rhythm disruption affects the levels of ghrelin, leptin, insulin, cortisol, and melatonin among night-shift workers, causing poor sleep quality ( Ulhôa et al, 2015 ; Huang et al, 2021 ). Poor sleep adversely affects their physical and mental health (e.g., cardiovascular risk, mood disorders, etc.)…”