|Year : 2019 | Volume
| Issue : 3 | Page : 211-216
Sleep disturbance and its effect on work performance of staffs following shifting duties: A cross-sectional study in a medical college and hospital of Tripura
Kaushik Nag, Anjan Datta, Nabarun Karmakar, Tamal Chakraborty, Partha Bhattacharjee
Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala, Tripura, India
|Date of Submission||19-Jul-2018|
|Date of Acceptance||16-Jan-2019|
|Date of Web Publication||15-May-2019|
Department of Community Medicine, Tripura Medical College and Dr. BRAM Teaching Hospital, Agartala - 799 014, Tripura
Source of Support: None, Conflict of Interest: None
Introduction: Sleep disturbance among night-shift workers results in serious adverse effects on their health affecting almost all the systems of the body. Recently, the World Health Organization has also identified night-shift work as being carcinogenic to human. Objective: The main objective is to study the prevalence of sleep disturbance and its effect on work performance of health-care staff working in shifts in a Medical College Hospital of Tripura. Materials and Methods: An institution-based cross-sectional study was conducted in February 2018, among 135 staffs working in shifts, including resident doctors, intern doctors, nursing staffs, security guards, technicians, ward boys, and ward girls of the Tripura Medical College and DR. BRAM Teaching Hospital. Systematic random sampling was used to collect the required samples with a predesigned and pretested interview schedule designed based on the Pittsburgh Sleep Quality Index. Data entry and analysis were done in the Statistical Package for the Social Sciences software version 16.0 (SPSS Inc. SPSS for Windows, Chicago, Illinois, USA). Data were represented in percentages in tables and charts, and the Chi-square test was applied to find out the statistical association. Results: Of the total 135 participants, the majority (28.9%) were interns and nursing staffs and paramedical students (26.7%). The prevalence of sleep disturbance was 54% among the participants, and it was significantly higher among those residing in hostel and quarter as compared to their own home (P = 0.003). Sleep disturbance was also found to be significantly decreasing their performance at work (P < 0.001). Conclusion: This study showed the high prevalence of sleep disturbance among shift workers, which significantly hampered their work performance in this institute. To find the measures to prevent sleep disturbance among staffs having a shifting duty, further research work can be done based on the findings of the study.
Keywords: Night, performance, shift, sleep, staff
|How to cite this article:|
Nag K, Datta A, Karmakar N, Chakraborty T, Bhattacharjee P. Sleep disturbance and its effect on work performance of staffs following shifting duties: A cross-sectional study in a medical college and hospital of Tripura. Med J DY Patil Vidyapeeth 2019;12:211-6
|How to cite this URL:|
Nag K, Datta A, Karmakar N, Chakraborty T, Bhattacharjee P. Sleep disturbance and its effect on work performance of staffs following shifting duties: A cross-sectional study in a medical college and hospital of Tripura. Med J DY Patil Vidyapeeth [serial online] 2019 [cited 2020 Oct 25];12:211-6. Available from: https://www.mjdrdypv.org/text.asp?2019/12/3/211/258194
| Introduction|| |
Sleep is an active, repetitive, and reversible state of perceptual disengagement from the environment. It is a physiological process essential to life. It serves several different functions such as growth and repair, learning, and memory consolidation, and all these occur throughout the brain and the body.
Sleep deprivation is the condition of not having enough sleep; it can be either chronic or acute. An average adult needs 7–9 h of sleep each night, teenagers 9.5 h, and infants 16 h/day. Even a small reduction in the amount of sleep, especially when accompanied with a varying sleep schedule, may cause symptoms such as fatigue,clumsiness, daytime sleepiness, weight loss/gain, adverse effect on the brain and cognitive function and confusion, memory lapses, false memory, malaise, and headache.
Sleep deprivation also affects various systems of the body such as the central nervous system (disruption in signal transmission, brain exhaustion, decreased concentration and inability to learn new things, negatively affecting mental abilities and emotional state, and if deprivation continues for long, then hallucination, mania, and impulse behavior are seen among individuals. Again, microsleep at driving can cause fatal accidents), immune system, respiratory system (obstructive sleep apnea), and digestive system (affects hormones such as leptin and ghrelin which control the feelings of hunger and fullness as well as increased insulin). Sleep deprivation causes increased sleep debt and increased excessive daytime sleepiness. Various studies have been made regarding the effects of sleep deprivation throughout the world.
Sleep deficiency increased the length of time awake before work, and misalignment of circadian phase produces decreased alertness and performance, increased reaction time, and increased risk of performance lapses, thereby resulting in the greater safety hazards among night workers and other sleep-deprived individuals. Sleep disturbance nearly doubles the risk of a fatal work accident. Long-term night-shift workers have higher rates of breast, colorectal, and prostate cancer and cardiac, gastrointestinal, and reproductive disorders. The World Health Organization has added night-shift work to its list of probable carcinogens. It was found from various studies done in different countries that academic performance of medical students and health status were affected by sleep deprivation. The shift workers, especially the night-shift workers in the hospitals and staffs on emergency duties had health-related problems, and their work performance was also hampered.
The prevalence of shift work disorder is a serious matter of concern these days. No such data regarding the same are available in Tripura. Therefore, the present study was conducted to find the magnitude of sleep disturbance and its effect on work performance of staffs in Tripura Medical College and DR. BRAM Teaching Hospital.
| Materials and Methods|| |
A hospital-based cross-sectional study was conducted among health-care staffs following shifting duties (which included resident doctors and postgraduate trainees, intern doctors, nursing staffs, security guards/watchmen, technicians/paramedical staffs, Group D staffs, i.e., ward boys and ward girls) in Tripura Medical College and DR. BRAM Teaching Hospital, for 1 month (February 2018). The sampling frame consisted in total of 377 staffs following shifting duties in their routine work schedule, comprising of 67 Group D assistants, 109 interns, 47 resident doctors and postgraduate trainees, 101 nurses and paramedical staffs, and 53 security personnel.
Considering 50% as the prevalence of sleep deprivation among medical staffs, the sample size was calculated as 100 by using the following formula:
Where “p” is the prevalence of sleep disturbance from previous studies, q = 100 – p and l = allowable error. Considering p = 50%, q = 50%, l (absolute precision) = 10%, the minimum total sample size came as 100. Finally, 135 staffs were included in this study considering additional nonresponse.
Probability proportionate to sample size technique was used to determine the number of participants required from each group of health-care staff, and then, the systematic random sampling was done within each group after enlisting their names and assigning serial number to them. Every alternate staff within each group was selected as the sampling interval was calculated as two.
- Medical staffs working in shifting duties, those who were available at the time of survey, and those who were willing to participate in the study were included in the study.
- Those who were sick during survey or on leave were excluded from the study.
Study tool and data collection
A predesigned, pre-tested semi-structured interview schedule was designed based on the Pittsburgh Sleep Quality Index (PQSI) to collect the required information from the participants. The interview schedule consisted of questions related to sociodemographic information, sleep disturbance, and work performance. Sleep disturbance and work performance were assessed based on their own perception of sleep disturbance and work performance and subjective responses of the staffs to the interview schedule. Internal consistency of the tool was measured by Cronbach's alpha (0.72, which is acceptable).
The study tool was administered by faculties and medical social workers under the Department of Community Medicine. The study participants were interviewed individually at their usual place of work within Tripura Medical College and DR. BRAM Memorial Teaching Hospital during college hours, i.e., from 8 a.m. to 4 p.m. If any staff could not be interviewed on two consecutive visits, the next study subject sampled was interviewed until the required sample size is achieved.
Data were entered and analyzed with the help of Statistical Package for the Social Sciences software version 16.0. (SPSS Inc. SPSS for Windows, Chicago, Illinois, USA). Data were represented using appropriate tables and charts in the form of frequencies and percentages. Chi-square test was applied to find out statistical association as required.
A well-explained consent was obtained in the written form from all the participants before commencing the study.
Ethical clearance was obtained from the Institutional Ethics Committee of Tripura Medical College and DR. BRAM Teaching Hospital before conducting the study.
| Results|| |
As shown in [Table 1], of 135 study participants, maximum (65.9%) belonged to 20–30 years of age group. Among them, 51.1% participants were females and 48.9% responders were males. Majority of the studied participants were Hindus (92.6%), and the rest were Muslims (4.4%) and Christians (3.0%). Most of the participants were resided in their own house (86%) whereas the rest either stayed in hostel (29%) or in quarter (20%). In this study, 55.6% of the participants were of General caste, 20.7% were SC, 12.6% were OBC, and 11.1% belonged to ST caste. Of the participants studied, 28.9% were interns, 26.7% were nursing staff and paramedical students, 17.8% were Group D staffs, 14.1% were watchman, and 12.6% were junior residents and postgraduate students.
|Table 1: Frequency distribution of study participants according to sociodemographic variables (n=135)|
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[Table 2] revealed only 43.7% of the participants had sleep at night between 7 and 9 h on average daily. Surprisingly, 87.6% reported awakening whole night in a previous 1-month period, and predominant activity (83.7%) during whole-night awakening was performing night-shift duty. Majority after being awake throughout a whole night felt lethargic (20%), had a headache (19%), and felt drowsy (18%) on the next morning. Almost 75% of the respondents had interrupted sleep at night and 51.9% reported daytime sleepiness, and the majority (50%) slept 1–2 h on average daily during daytime.
|Table 2: Frequency distribution table showing responses of participants on sleep disturbance and work performance (n=135)|
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[Figure 1] showed the prevalence of sleep disturbance among the participants as 54%. [Figure 2] revealed the prevalence of various problems faced by the participants during nighttime sleep. The majority (18.6%) reported difficulty in going to get sleep after 30 min of going to bed and waking up in the middle of the night, followed by had to get up for going to bathroom (14.53%), bad dreams (6.98%), and coughing and snoring (4.07%). [Table 3] revealed the majority (55%) of the participants were having comorbidities in this study.
|Figure 1: Proportion of sleep disturbance among study participants (n = 135)|
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|Figure 2: Proportion of respondents reporting various problems faced during sleep at night within past 1 month (n = 119, multiple responses considered)|
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|Table 3: Frequency distribution table of comorbidities of the study participants (n=135)|
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[Table 4] showed the residence of respondents was significantly associated (P = 0.003) with sleep disturbance among them and their disturbed sleep significantly (P < 0.001) decreased their work performance [Table 5].
|Table 4: Association of various sociodemographic variables with sleep disturbance among the participants (n=135)|
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|Table 5: Association between work performance and sleep disturbance among the participants (n=135)|
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| Discussion|| |
In the present study, of 135 study participants, the majority (65.9%) belonged to 20–30 years of age group. Similarly, Boughattas et al. at Tunisia showed majority from 20 to 30 years' age group (54.4%) and Attia–Attia in their study in Egypt showed that 55% belong to the age group between 26 and 30 years. Both these studies, had used PQSI score to assess the quality of sleep but Boughattas et al., in addition, had used Horne–Ostberg questionnaire, Epworth sleepiness scale, SF-12 questionnaire and an objective test of vigilance. The present study also showed an almost equal proportion of males (48.9%) and females (51.1%). Whereas similar study by Ferri et al. at Italy had female predominance (71%), and study by A. Wisetborisut et al. in Thailand showed that 76% were male. In the present study, 51.8% revealed average sleep duration at night of 6 h or less whereas the study by Boughattas et al. at Tunisia showed that 60% of night-shift workers sleep 6 h or less.
In this study, we found that 54% of respondents suffered from disturbed sleep and 46% of them did not suffer from any disturbed sleep, and a similar study done by Attia–Attia in Egypt found that almost 70% of night workers complain of sleep disorders and most of the study participants complained of insufficient and unsatisfactory sleep.
The present study also showed that 48.9% of respondents felt daytime sleepiness whereas the study by Boughattas et al. at Tunisia revealed 65.2% of night-shift workers suffer from daytime sleepiness.
In this study, 55% of the participants suffered from other comorbidities whereas Siddalingaiah et al. in their study at Tumkur, India found most of their study population (94.1%) had comorbid conditions such as consisting of snoring (8.3%), jerking of legs during sleep (24.4%), history of allergy (29.4%), asthma/lung disease (5.8%), sinus infections (22.8%), and chronic diseases (3.4%).
This present study showed that sleep disturbance was significantly higher among participants residing in hostel and quarters as compared to their own home (P = 0.003) in contrast to the study by Verma et al., where they had found a significant association of sleep disturbance of the study participants with residence outside the campus. Difference between in-campus resting facilities might be the reason for this difference.
Sleep disturbance was found to be significantly hampering (P < 0.001) the work performance of the staffs involved in shifting duties in this study. Similarly, deprivation of sleep was found to be distressing in the study by Muruganathan et al., with evidence showing raised stress hormones which might have suppressed memory consolidation of participants, and due to fatigue and somnolence, shift workers were not able to perform their duties efficiently, which in turn affected the productivity outcome of their work as reported by Jehan et al. in their study. Furthermore, the study by Gómez–García et al. among nurses working in shifts in the Spanish health system revealed the worse perception of organizational and work environmental factors, especially among night-shift workers.
Although shift work disorder is a known entity, very few studies have included staffs other than doctors and nurses working in hospitals unlike ours. Therefore, exact prevalence for calculation of sample size was not available, and a relatively small study population might be a limitation of this study. Again, there was no objective assessment done to verify the work performance of the staffs following shifting duties; therefore, reporting bias could be another limitation in this study.
| Conclusion|| |
This study showed the high prevalence of sleep disturbance among shift workers, which was found to be significantly hampering their work performance. It is very much essential to find out measures to prevent the sleep disturbance among staffs having a shifting duty, which is a scope for future research. Promoting home-like environment for doctors and other staffs residing within the campus (in hostels and quarters both) and distributing the night-shift work into halves and allowing each half a minimum sleeping time might help in this context.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guyton A, Hall J. Central Nervous System. Textbook of Physiology. Vol. 11. New Delhi: Elsevier Inc. RELX India Private Limited; 2015. p. 739-41.
Sarita M, Sukhwant B. Study of sleep pattern and sleep problems of under graduate students from different professional courses. Indian J Basic Appl Med Res 2016;5:16-28.
Czeisler C, Scammell T, Saper C. Disorders of Sleep and Wakefulness Harrisons's Principle of Internal Medicine. Vol. 19. New Delhi: Tata: McGraw Hill Education Private Limited; 2015. p. 187.
Boughattas W, Maalel O, Chikh R, Maoua M, Houda K, Braham A, et al
. Hospital night shift and its effects on the quality of sleep, the quality of life, and vigilance troubles among nurses. Int J Clin Med 2014;5:572-83.
Attia F, Attia M. Effect of shift rotation on sleep quality and associated health problems among nurses at Asser hospital KSA. Int J Nurs Sci 2016;6:58-65.
Ferri P, Guadi M, Marcheselli L, Balduzzi S, Magnani D, Di Lorenzo R, et al.
The impact of shift work on the psychological and physical health of nurses in a general hospital: A comparison between rotating night shifts and day shifts. Risk Manag Healthc Policy 2016;9:203-11.
Wisetborisut A, Angkurawaranon C, Jiraporncharoen W, Uaphanthasath R, Wiwatanadate P. Shift work and burnout among health care workers. Occup Med (Lond) 2014;64:279-86.
Siddalingaiah H, Chandrakala D, Singh A. Sleep pattern, sleep problems and co morbidities among resident doctors at a tertiary care institution in India: A cross sectional study. Int J Community Med Public Health Community Med Public Health 2017;4:4477-84.
Verma A, Kishore J, Gusain S. A comparative study of shift work effects and injuries among nurses working in rotating night and day shifts in a tertiary care hospital of North India. Iran J Nurs Midwifery Res 2018;23:51-6.
Muruganathan A, ThirunavukKarasu S, Kumar R, Tamilselvan T, Saravanan P, Jothi S, et al.
Sleep deprivation and its impact on doctors doing continuous duties. IOSR J Dent Med Sci 2017;16:22-5.
Jehan S, Zizi F, Pandi-Perumal SR, Myers AK, Auguste E, Jean-Louis G, et al.
Shift work and sleep: Medical implications and management. Sleep Med Disord 2017;1 pii: 00008.
Gómez-García T, Ruzafa-Martínez M, Fuentelsaz-Gallego C, Madrid JA, Rol MA, Martínez-Madrid MJ, et al.
Nurses' sleep quality, work environment and quality of care in the Spanish national health system: Observational study among different shifts. BMJ Open 2016;6:e012073.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]