SLEEP ASSESSMENT AND ASSOCIATED FACTORS IN HOSPITAL NURSING WORKERS

EVALUACIÓN DEL SUEÑO Y FACTORES ASOCIADOS EN TRABAJADORES DE ENFERMERÍA HOSPITALARIA

ABSTRACT

Objective:

analyze the relationship between sleep quality, excessive daytime sleepiness, and health symptoms among the nursing team working in a hospital.

Method:

cross-sectional research, carried out with the nursing team of a public hospital in Brazil, between September 2017 and April 2018. A sociodemographic questionnaire, health symptoms, Sleepiness Scale, and the Pittsburgh Sleep Quality Index were used. Data are presented as absolute and relative frequencies, means, standard deviations, bivariate analysis, and binary logistic regression.

Results:

a total of 308 workers participated in the study, and poor sleep quality and absence of daytime sleepiness predominated among them. There was an association between sleepiness, children (p=0.006), and work accidents (p=0.044). Factors associated with poor sleep quality and drowsiness, appetite disorders, feeling of poor digestion, flatulence, weight gain, irritability, headache, feeling of low self-esteem, and mood lability.

Conclusion:

appetite disorder was the main factor for poor sleep quality for the nursing team working in a hospital in Brazil. This suggests that it is important to consider sleep quality when examining a worker´s health.

DESCRIPTORS:
Nursing team; Shift Work Schedule; Worker's health; Hospitals, Public; Sleep

RESUMEN

Objetivo:

analizar la relación entre la calidad del sueño, la somnolencia diurna excesiva y los síntomas de salud entre el personal de enfermería que trabajaba en un hospital.

Método:

investigación transversal, realizada con el equipo de enfermería de un hospital público en Brasil, entre septiembre de 2017 y abril de 2018. Se utilizó un cuestionario sociodemográfico, síntomas de salud, Escala de Somnolencia e Índice de Calidad del Sueño de Pittsburgh (PSQI-BR). Los datos fueron presentados como frecuencias absolutas y relativas, medias, desviaciones estándar, análisis bivariado y regression logística binaria.

Resultados:

Participaron del estudio 308 trabajadores, con predominio de pobre calidad del sueño y ausencia de somnolencia diurna entre ellos. Hubo asociación entre somnolencia, hijos (p=0,006) y accidentes de trabajo (p=0,044). Los factores asociados con la mala calidad del sueño y la somnolencia fueron trastornos del apetito, sensación de mala digestión, flatulencia, aumento de peso, irritabilidad, dolor de cabeza, sensación de baja autoestima y labilidad del estado de ánimo.

Conclusión:

el trastorno del apetito fue el principal factor de mala calidad del sueño para el equipo de enfermería de un hospital en Brasil. Esto sugiere la importancia de tener en cuenta la calidad del sueño al examinar la salud del trabajador.

DESCRIPTORES:
Grupo de enfermería; Horario de trabajo por turnos; Personal de salud; Hospitales públicos; Sueño

RESUMO

Objetivo:

analisar a relação entre qualidade do sono, sonolência diurna excessiva e sintomas de saúde entre a equipe de enfermagem que atuava em um hospital.

Método:

pesquisa transversal, realizada com a equipe de enfermagem de um hospital público do Brasil, entre setembro de 2017 e abril de 2018. Foram utilizados questionário sociodemográfico, sintomas de saúde, Escala de Sonolência e Índice de Qualidade do Sono de Pittsburgh (PSQI-BR). Os dados são apresentados como frequências absolutas e relativas, médias, desvios padrão, análise bivariada e regressão logística binária.

Resultados:

participaram do estudo 308 trabalhadores, predominando entre eles a má qualidade do sono e a ausência de sonolência diurna. Houve associação entre sonolência, crianças (p=0,006) e acidentes de trabalho (p=0,044). Os fatores associados à má qualidade do sono e sonolência foram distúrbios do apetite, sensação de má digestão, flatulência, ganho de peso, irritabilidade, dor de cabeça, sensação de baixa autoestima e labilidade do humor.

Conclusão:

o transtorno do apetite foi o principal fator de má qualidade do sono para a equipe de enfermagem que atuava em um hospital no Brasil. Isso sugere que é importante considerar a qualidade do sono ao examinar a saúde do trabalhador.

DESCRITORES
Equipe de Enfermagem; Jornada de trabalho em turnos; Pessoal de Saúde; Hospitais Públicos; Sono

INTRODUCTION

The work performed in hospitals involves a large number of nursing professionals, who work in different shifts, perform a multiplicity of unhealthy activities, are exposed to body fluids inherent to the task1, and live with ergonomic inadequacies, suggesting musculoskeletal discomfort2 and damage to workers' health.

Shift work is a factor that can change sleep patterns. Shift work is a factor that can affect sleep quality. Some consequences are sleep deprivation, poor sleep quality, and daytime sleepiness3. Nurses working on the night shift were significantly associated with gastrointestinal changes, loss of appetite, heartburn, nausea, and weight gain when compared to those on the day shift4. These signs and symptoms may arise from sleep disturbances.

Poor sleep quality can decrease the professional performance of nurses5, reduce alertness and cognitive performance, increase the chances of headache6, cause changes in hunger7, and be related to symptoms of depression8, anxiety9 and worse general health10. The relationship between depression and anxiety occurs through the corticolimbic circuit, related to difficulties in reactivity and affective regulation, which seems to be affected by poor sleep quality9.

Drowsiness is a consequence of poor sleep quality. Symptoms of insomnia or drowsiness may include difficulty concentrating, lack of energy and headaches, suggest an imbalance between professional and personal life, and work-related errors and accidents11. Poor sleep quality also interferes with body mass index through hormonal and biochemical changes, such as variations in leptin, ghrelin, and cortisol levels or increased insulin resistance7. These data is in line with American research which identified that nurses with higher body mass index have poor sleep quality (p=0.0032)12.

There are studies on signs and symptoms that result from poor sleep quality in different countries. In Jordan, poor sleep quality of nurses working in hospitals was positively associated with increased stress and depression13. In Spain, the lack of sleep impaired the ability of emergency nurses to process and understand the emotions14.

Thus, studies on sleep quality for the health of the nursing team are relevant15^. They were identified in the national literature16 and international17, especially when they go beyond the objective of identifying the prevalence of poor sleep quality among the nursing team. It is necessary to identify the relationship of this variable with other factors that can have negative consequences on the health of the worker.

Considering this, this study aimed to analyze the relationship between sleep quality, excessive daytime sleepiness, and health symptoms among the nursing team working in a hospital.

METHOD

A cross-sectional study was carried out in a public teaching hospital, which has 403 inpatient beds. The population of nursing professionals at the time of data collection was 960 people (333 nurses, 500 nursing technicians, and 127 nursing assistants). The eligibility criteria were to provide direct assistance to users, excluding those on leave of any kind during the period of data collection. The sample was of the probabilistic type, stratified by professional category (95% confidence level, 5% sampling error). The minimum sample size was 277 nursing workers and, from that, a minimum representative sample was defined as 97 nurses (35% of the total population), 144 nursing technicians (52%), and 36 nursing assistants (13%).

Data collection took place from September 2017 to April 2018 in the adult and children's Emergency Room; medical and surgical inpatient units; adult and child intensive care units; and surgical center unit (surgical center and post-anesthetic recovery). Nursing work in these places is organized in shifts (morning - 7 am to 1 pm; afternoon - 1 pm to 7 pm, and evening - 7 pm to 7 am).

The team that assisted in data collection was trained in face-to-face meetings with the research coordinator and received the collector's manual with project data and questionnaires. The team participants were two professional volunteers working at the institution, three undergraduate students, one graduate student, and a scientific initiation scholarship.

We invited 350 professionals individually and in the workplace. The ethical precepts that govern research with human beings were presented to the professionals. After their consent, the questionnaires were handed out and a return date was agreed upon. There were 10 refusals and 32 questionnaires were not returned after the 5th attempt to collect the instruments. A questionnaire was used for socio-occupational characterization (professional category, work shift, working time in the unit, age, gender, children, partner, physical activity, leisure activity), and a questionnaire on self-reported health symptoms in the last week (appetite disturbance, feeling of poor digestion, heartburn, weight gain, irritability, insomnia, headaches, difficulty concentrating, feeling depressed or unhappy, feeling low in self-esteem, and mood lability (involuntary emotional swings).

To assess excessive daytime sleepiness, we used the Epworth Sleepiness Scale (ESS), versão traduzida e adaptada para o português do Brasil. The 8 ESE-BR items had a total reliability coefficient of 0.83. In this study, the value of Cronbach's alpha was 0.82. The analysis of the Epworth Sleepiness Scale was based on the sum of the response values, which can vary from 0 to 24 points. If the value is ≤10, the absence of excessive daytime sleepiness is considered, a score of 11 to 15 suggests excessive sleepiness and if the value is ≥16, severe sleepiness is considered18. The variable was dichotomized into the absence of excessive daytime sleepiness (≤10) and the presence of excessive daytime sleepiness (>10), according to a previous study19.

The Pittsburgh Sleep Quality Index (PSQI) was used, translated, and validated into Brazilian Portuguese20, which assesses sleep quality over 1 month. It has 19 questions, the higher the score, the worse the sleep quality. A global score of 5 indicates that the person has great difficulties in at least two components or moderate problems in three or more components. We chose to categorize the variable as “good” (less than or equal to 5) and “bad” (greater than 5) sleep quality, as already used in the scientific literature21. The internal consistency of the Brazilian version was 0.73, and in this study was 0.72.

Data were double-entered into Excel for Windows/7 (Microsoft Office 2007) and statistically analyzed using PSS (Predictive Analytics Software, SPSS INc., Chicago, USA), version 18.0 for Windows. Data normality was assessed using the Kolmogorov-Smirnov test (n>50).

Categorical variables were analyzed using absolute (n) and relative (%) frequency, and quantitative variables, as they follow the normal distribution, are presented with measures of position (mean) and dispersion (standard deviation). Internal consistency analysis was performed using Cronbach's alpha coefficient and association tests Chi-Square or Fisher's exact test. In all analyses, a significance level of 5% (p<0.05) was used.

To verify the associated factors between the variables, binary logistic regression was used (by the Enter method) to identify the adjusted association between the variable poor sleep quality (dependent variable) and the other variables. The association measure used was Odds Ratio (OR) and their respective confidence intervals (95%CI). Logistic regression models were run with the variables, which were removed from the models as p was greater than 25%. Multicollinearity was verified using the variance inflation factor (VIF), and a VIF < 5 for each variable was acceptable.

The fit quality was verified using the Hosmer-Lemeshow test. For the binary regression, the variables that obtained p<0.25 in the bivariate analysis were included in the adjusted model 1; and in adjusted model 2, p<0.15 with statistical significance (p<0.05).

We respected the ethical issues involving research with human beings such as anonymity and the voluntary nature of participation. Research carried out with human beings was approved by the Research Ethics Committee and complies with Resolution 466/12.

RESULTS

The percentage of responses was 88% (n=308 participants), with a predominance of females (86.4%, n=266), mean age of 40.84 years old (SD±9.12), a minimum of 23 and a maximum of 69 years old; and a mean working time of 8.07 years (SD± 8.10). Professionals with technical level totaled 67.53% (n=208) and higher level 32.47% (n=100). Worked on the day shift were 54.9% (n=169) and 45.1% (n=139) were on the night shift.

There was a predominance of professionals with a partner (77.9%, n=240), children (72.7%, n=224) who did not practice physical activity (51%, n=157), and who had free time for leisure activities or more times a week (91.9%, n=283).

There was a prevalence of poor sleep quality among the participants (57.1%, n=176), followed by the presence of disorder (27.6%, n=85) and good sleep quality (15.3%, n=47). When dichotomized, we observed that 84.7% (n=261) had poor sleep quality, and when associating with sociodemographic variables, no significant association was identified (p>0.05).

Regarding drowsiness, a predominance of the absence of drowsiness was identified (58.8%, n=181). An association was identified between workers with drowsiness who had children (p=0.006), between workers without drowsiness and children, and between workers with drowsiness and involvement in a work accident (p=0.044).

Poor sleep quality and drowsiness were associated with appetite disorders, feeling of poor digestion, flatulence or abdominal distension, weight gain, irritability, headache, feeling of low self-esteem, and mood lability (p<0.05). Insomnia and feelings of depression or unhappiness were associated with poor sleep quality (p<0.05) (Table 1).

Table 1 -
Association between sleep quality, sleepiness, and health symptoms of nursing workers at a public hospital in Brazil. Santa Maria, RS, Brazil, 2017-2018. (n=308)

Health symptoms	GQS*	BQS‡	p†	ND	WS**	p†
	n(%)	n(%)		n(%)	n(%)
Appetite disorders
One or more times	6(12.8)	124(47.5)	<0.001	62(34.3)	68(53.5)	0.001
None	41(87.2)	137(52.5)		119(65.7)	59(46.5)
Feeling of Bad Digestion
One or more times	14(29.8)	144(55.2)	0.001	71(39.2)	87(68.5)	<0.001
None	33(70.2)	117(44.8)		110(60.8)	40(31.5)
Heartburn
One or more times	14(29.8)	111(42.5)	0.102	66(36.5)	59(46.5)	0.079
None	33(70.2)	150(57.5)		115 (63.5)	68(53.5)
Flatulence or bloating
One or more times	17(36.2)	163(62.5)	0.001	97(53.6)	83(65.4)	0.039
None	30(63.8)	98(37.5)		84(46.4)	44(34.6)
Weight gain
One or more times	22(46.8)	177(67.8)	0.006	107(59.1)	92(72.4)	0.016
None	25(53.2)	84(32.2)		74(40.9)	35(27.6)
Irritability
One or more times	29(61.7)	199(76.2)	0.036	119(65.7)	109(85.8)	<0.001
None	18(38.3)	62(23.8)		62(34.3)	18(14.2)
Insomnia
One or more times	10(21.3)	147(56.3)	<0.001	98 (54.1)	59(46.5)	0.184
None	37(78.7)	114(43.7)		83 (45.9)	68(53.5)
Headaches
One or more times	21(44.7)	178(68.2)	0.002	106(58.6)	93(73.2)	0.008
None	26(55.3)	83(31.8)		75(41.4)	34(26.8)
Difficulty concentrating
One or more times	20(42.6)	175(67)	0.001	99 (54.7)	96(75.6)	<0.001
None	27(57.4)	86(33)		82 (45.3)	31(24.4)
Feelings of depression or unhappiness
One or more times	10(21.3)	131(50.2)	<0.001	76(42)	65(51.2)	0.111
None	37(78.7)	130(49.8)		105(58)	62(48.8)
Feeling of low self-esteem
One or more times	10(21.3)	142(54.4)	<0.001	78(43.1)	74(58.3)	0.009
None	37(78.7)	119(45.6)		103(56.9)	53 (41.7)
Mood lability
One or more times	16(34)	164(62.8)	<0.001	90(49.7)	90(70.9)	<0.001
None	31(66)	97(37.2)		91(50.3)	37(29.1)

• p† chi-square test; * Good Quality of Sleep; ‡ Bad Quality of Sleep; §No drowsiness ** With Drowsiness

Crude binary logistic regression analyzes showed a significant relationship between poor sleep quality and excessive daytime sleepiness, appetite disorders, feeling of poor digestion, heartburn, flatulence, weight gain, irritability, insomnia, headache, difficulty concentrating, depression, decreased self-esteem, and mood lability. Table 2 shows the crude odds ratio and adjusted by the logistic regression model of the variable sleep quality, excessive daytime sleepiness, and health symptoms.

Table 2 -
Crude and adjusted associations between sleep quality, sleepiness, and self-reported health symptoms of nursing workers at a public hospital in Brazil. Santa Maria, RS, Brazil, 2017-2018. (n=308)

	Gross association OR (IC)	p	†RBLAjus 1*	p	‡RBLAjust 2**	p
Drowsiness
With	2.03	0.043
	(1.02-4.02)
Without	1.00
Appetite disorders
One or more times	6.18	<0.001	2.77	0.056	3.09	0.021
	(2.54-15.07)		(0.97-7.85)		(1.18-8.11)
None	1.00		1.00		1.00
Feeling of Bad Digestion
One or more times	2.90	0.002
	(1.48-5.67)
None	1.00
Heartburn
One or more times	1.74	0.104	0.55	0.197
	(0.89.41)		(0.222-1.36)
None	1.00		1.00
Flatulence
One or more times	2.93	0.001	1.97	0.085	1.88	0.078
	(1.53-5.60)		(0.91-4.27)		(0.93-3.80)
None	1.00		1.00		1.00
Weight gain
One or more times	2.39	0.007
	(1.27-4.49)
None	1.00
Irritability
One or more times	1.99	0.039
	(1.04-3.83)
None	1.00
Insomnia
One or more times	4.77	<0.001	3.28	0.005	2.98	0.006
	(2.27-10.00)		(1.43-7.52)		(1.36-6.55)
None	1.00		1.00		1.00
Headache
One or more times	2.65	0.002	2.07	0.064	1.90	0.067
	(1.41-4.99)		(0.95-4.48)		(0.95-9.80)
None	1.00		1.00		1.00
Difficulty concentrating
One or more times	2.74	0.002
	(1.46-5.17)
None	1.00
Feeling of depression
One or more times	3.73	<0.001
	(1.78-7.81)
None	1.00
Feeling of low self-esteem
One or more times	4.41	<0.001	1.84	0.208	2,45	0.028
	(2.10-9.25)		(0.71-4.81)		(1.10-5.47)
None	1.00		1.00		1
Mood lability
One or more times	3.28	<0.001
	(1.70-6.30)
None	1.00

• †RBLAjus 1 (p<0.25): Adjusted logistic binary regression 1: sleep quality+appetite and feeling of poor digestion+heartburn+flatulence+insomnia+headache+decreased self-esteem. *Hosmer and Lemeshow test =0.788 ‡RBLAjust 2 (p<0.15): Adjusted logistic binary regression 2. Model: sleep quality+appetite+flatulence+insomnia+headache+decreased self-esteem. **Hosmer and Lemeshow test=0.254.

Adjusted analyzes showed that nursing professionals with appetite disorders one or more times a week were three times more likely to have poor sleep quality (OR=3.09; CI=1.18-8.11); those with flatulence were once more likely to have poor sleep quality (OR=1.88; CI=0.93-3.80); with insomnia, twice (OR=2.98; CI=1.35-6.54); with headache, once (OR=1.90; CI=0.95-3.80); and those with a feeling of decreased self-esteem were twice as likely to have poor sleep quality (OR=2.45; CI=1.10-5.47).

DISCUSSION

The results showed that appetite disturbance was the main factor for poor sleep quality for the nursing team working in a hospital in Brazil, followed by insomnia, feeling of decreased self-esteem, and headaches.

There was a predominance of poor sleep quality and an absence of excessive daytime sleepiness, which converges with data from national studies19^,22. A higher percentage of professionals with a partner and children was identified, data similar to the previous research19.

Although no significant relationship was identified between better sleep quality and the practice of physical activity (p>0.05), we must consider that physical activity is an aspect that can improve sleep quality and vice versa23. A study suggests that an active and healthy lifestyle reduces the risk of insomnia in people with chronic musculoskeletal pain24, while sedentary behaviors contribute to greater chances of developing sleep problems25. On the other hand, lower exercise frequency was associated with poor sleep quality17.

Among the factors that affect sleep quality, insomnia is mentioned, which in this study increased the chance of having poor sleep quality by two times. It suggests an implication for the health of the worker and health care. The conflict in the structure of rhythms, caused by the work performed in alternative shifts, has direct implications for the wake/sleep cycle and the organic systems, as the individual is forced to change their sleep and eating schedules16.

There was a significant relationship between poor subjective sleep quality, excessive daytime sleepiness, and variables related to weight gain, feeling of poor digestion, flatulence, and appetite disorders. Appetite disorders increased the chances of having poor sleep quality by three times. In this regard, research identified that individuals who gained weight equal to or greater than 5 kg reported poor sleep quality (p=0.002) and excessive daytime sleepiness more often (p=0.041)26 which converges with our findings. In Norway, data confirmed the existence of a significant relationship between poor sleep quality and the variables of uncontrolled eating and emotional eating15.

Sleep alterations can affect the health of the nursing worker and have repercussions on signs and symptoms such as headache, which in this study was related to poor sleep quality and drowsiness. These data converge with the result of Chinese research that identified that health workers with sleep problems were more likely to report headaches (OR=2.64, 95% CI=2.27 to 3.03), which suggests that this is one of the risk factors for poor sleep quality6.

Other symptoms were significantly related to poor sleep quality, such as feelings of low self-esteem, irritability, insomnia, difficulty concentrating, and mood lability. There is evidence that people who suffer from stress have difficulty falling asleep and often wake up during sleep. Even more, the increase in the level of anxiety and stress negatively affects the quality of sleep and leads to psychological problems. Sleep and stress are factors that can negatively affect each other, and prolonged exposure to high levels of stress can lead to insomnia27, which can impair concentration and imply a risk to safety in health care.

Healthy sleep repairs adaptive processing, functional brain activity, and the integrity of medial prefrontal cortex-amygdala connections and improves the ability to regulate individuals' emotions and well-being, being essential for our mood and mental health; sleep disorders restrict daily well-being and social functioning and influence the evolution of affective disorders such as depression28. Studies developed in China have identified a greater association of sleep disorders with depression than with anxiety10, and that symptoms of depression increase the chance of having poor sleep quality by three times8.

The feeling of decreased self-esteem increases the chance of having poor sleep quality by twice. In India, a study showed that health professionals with low self-esteem were twice as likely to experience high stress, with Odds Ratio (OR)=2.84 (1.36-5.92)29. Spanish research carried out with nurses identified that low scores for sleep problems correlated with high scores for stress management, suggesting that individuals with good sleep quality had better stress management, which points to the relevance of sleep quality for the health of the nursing staff15.

We must consider that sleep alterations can impair health care. In this study, there was an association between the occurrence of an accident at work and drowsiness, which converges with a study carried out in England, where adverse safety outcomes were strongly associated with high sleepiness scores30.

Therefore, interventions are urgently needed to improve the quality of actions that promote workers' sleep hygiene. It is important to consider sleep quality when examining worker health.

The limitations of this study are related to the cross-sectional design, which limits the possibility of concluding the causal relationships between sleep quality and excessive daytime sleepiness and self-reported symptoms by nursing professionals. Therefore, we should not generalize the findings. In particular, this study was based on the subjective assessment of sleep without the consequent objective analysis.

CONCLUSION

There was an association between sleep quality, excessive daytime sleepiness, and health symptoms, and appetite disorder was the main factor for poor sleep quality for the nursing team working in a hospital in Brazil.

Identifying the factors that can contribute to a better quality of sleep favors the construction of knowledge in nursing and health, and points to the need for better awareness and understanding of sleep behaviors by nursing professionals who work in the health area in hospital institutions. Studies should be developed to explore other variables, as well as conducting intervention research aimed at improving workers' health.

ACKNOWLEGEMENT

This work is supported by the National Council for Scientific and Technological Development - Brazil. (CNPq Call 25/2021 - Senior Post-Doctorate - PDS 2021 - Process: 102085/2022-6)

REFERENCES

• 1. Silva K, Cattani AN, Hirt MC, Peserico A, Silva RM, Beck CLC. Sonolência diurna excessiva e os efeitos do trabalho na saúde de trabalhadores de enfermagem. Enf Global [Internet]. 2020 [cited 2022 Jul 25];19(1):276-88. Available from: http://doi.org/10.6018/eglobal.19.1.377381
  » http://doi.org/10.6018/eglobal.19.1.377381
• 2. Tottoli CR, Toledo AM, Silva NC, Araújo WN, Souza RN, Carregado RL. Health professionals working in a hospital environment have a high prevalence of fatigue and back pain: a cross-sectional study. Fisioter Pesqui [Internet]. 2019 [cited 2022 Jul 25];26(1):91-100. Available from: https://doi.org/10.1590/1809-2950/18032926012019
  » https://doi.org/10.1590/1809-2950/18032926012019
• 3. Francis MN, Wishart IM, Williamson T, Iverach R. Use of pharmacologic sleep aids and stimulants among emergency medicine staff physicians in a Canadian tertiary care setting: a web-based survey.Ann Emerg Med [Internet]. 2019 [cited 2022 Jul 25];73(4):325-9. Available from: https://doi.org/10.1016/j.annemergmed.2018.07.006
  » https://doi.org/10.1016/j.annemergmed.2018.07.006
• 4. Ljevak I, Vasilj I, Neuberg M, Tomić J, Meštrović T. The effect of shift work on the overall health status of hospital-employed nursing staff in Bosnia and Herzegovina: A Cross-Sectional Study. Psychiatr Danub [Internet]. 2021 [cited 2022 Jul 25];33(Suppl 4):771-7. Available from: https://pubmed.ncbi.nlm.nih.gov/34718317/
  » https://pubmed.ncbi.nlm.nih.gov/34718317/
• 5. Park E, Lee HY, Park CS. Association between sleep quality and nurse productivity among Korean clinical nurses. J Nurs Manag [Internet]. 2018 [cited 2022 Jul 25];26(8):1051-8. Available from: https://doi.org/10.1111/jonm.12634
  » https://doi.org/10.1111/jonm.12634
• 6. Liu H, Liu J, Chen M, Tan X, Zheng T, Kang Z, Gao L, Jiao M, Ning N, Liang L, Wu Q, Hao Y. Sleep problems of healthcare workers in tertiary hospital and influencing factors identified through a multilevel analysis: a cross-sectional study in China. BMJ Open [Internet]. 2019 [cited 2022 Jul 25];9(12):e032239. Available from: https://doi.org/10.1136/bmjopen-2019-032239
  » https://doi.org/10.1136/bmjopen-2019-032239
• 7. Clement-Carbonell V, Portilla-Tamarit I, Rubio-Aparicio M, Madrid-Valero JJ. Sleep quality, mental and physical health: a differential relationship. Int J Environ Res Public Health [Internet]. 2021 [cited 2022 Jul 25];18(2):460. Available from: https://doi.org/10.3390/ijerph18020460
  » https://doi.org/10.3390/ijerph18020460
• 8. Tu ZH, He JW, Zhou N. Sleep quality and mood symptoms in conscripted frontline nurse in Wuhan, China during COVID-19 outbreak: A cross-sectional study. Medicine (Baltimore) [Internet]. 2020 [cited 2022 Jul 25];99(26):e20769. Available from: https://doi.org/10.1097/MD.0000000000020769
  » https://doi.org/10.1097/MD.0000000000020769
• 9. Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev [Internet]. 2018 [cited 2022 Jul 25];63:25-40. Available from: https://doi.org/10.1016/j.cpr.2018.05.006
  » https://doi.org/10.1016/j.cpr.2018.05.006
• 10. Chueh K-H, Chen K-R, Lin Y-H. Psychological distress and sleep disturbance among female nurses: anxiety or depression? J Transcult Nurs [Internet]. 2021 [cited 2022 Jul 25];32(1):14-20. Available from: https://doi.org/10.1177/1043659619881491
  » https://doi.org/10.1177/1043659619881491
• 11. Greubel J, Arlinghaus A, Nachreiner F, Lombardi DA. Higher risks when working unusual times? A cross-validation of the effects on safety, health, and work-life balance. Int Arch Occup Environ Health [Internet]. 2016 [cited 2022 Jul 27];89:1205-14. Available from: https://doi.org/10.1007/s00420-016-1157-z
  » https://doi.org/10.1007/s00420-016-1157-z
• 12. Beebe D, Chang JJ, Kress K, Mattfeldt-Beman M. Diet quality and sleep quality among day and night shift nurses. J Nurs Manag [Internet]. 2017 [cited 2022 Jul 27];25(7):549-57. Available from: https://doi.org/10.1111/jonm.12492
  » https://doi.org/10.1111/jonm.12492
• 13. Almhdawi KA, Alrabbaie H, Obeidat DS, Kanaan SF, Alahmar MR, Mansour ZM, et al. Sleep quality and its predictors among hospital-based nurses: a cross-sectional study. Sleep Breath [Internet]. 2021 [cited 2022 Jul 27];25(4):2269-75. Available from: https://doi.org/10.1007/s11325-021-02333-z
  » https://doi.org/10.1007/s11325-021-02333-z
• 14. Miguez-Torres N, Martínez-Rodríguez A, Martínez-Olcina M, Miralles-Amorós L, Reche-García C. Relationship between Emotional Intelligence, Sleep Quality and Body Mass Index in Emergency Nurses. Healthcare (Basel) [Internet]. 2021 [cited 2022 Jul 27];9(5):607. Available from: https://doi.org/10.3390/healthcare9050607
  » https://doi.org/10.3390/healthcare9050607
• 15. Gázquez Linares JJ, Pérez-Fuentes MdC, Molero Jurado MdM, Oropesa Ruiz NF, Simón Márquez MdM, Saracostti M. Sleep quality and the mediating role of stress management on eating by nursing personnel. Nutrients [Internet]. 2019 [cited 2022 Jul 27];11(8):1731. Available from: https://doi.org/10.3390/nu11081731
  » https://doi.org/10.3390/nu11081731
• 16. Viana M, Silva KKM, De-Martino MMF, Bezerra CMB, Oliveira APC, Souza AML. Qualidade de vida e sono de enfermeiros nos turnos hospitalares. Rev Cub Enferm [Internet]. 2019 [cited 2022 Jul 27];35(2). Available from: http://www.revenfermeria.sld.cu/index.php/enf/article/view/2137
  » http://www.revenfermeria.sld.cu/index.php/enf/article/view/2137
• 17. Dong H, Zhang Q, Zhu C, Quian LV. Sleep quality of nurses in the emergency department of public hospitals in China and its influencing factors: a cross-sectional study. Health Qual Life Outcomes [Internet]. 2020 [cited 2022 Jul 27];18(1):116. Available from: https://doi.org/10.1186/s12955-020-01374-4
  » https://doi.org/10.1186/s12955-020-01374-4
• 18. Bertolazi AN, Fagondes SC, Hoff LS, Pedro VD, Menna-Barreto SS, Johns MW. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol [Internet]. 2009 [cited 2022 Jul 30];35(9):877-83. Available from: http://doi.org/10.1590/S1806-37132009000900009
  » http://doi.org/10.1590/S1806-37132009000900009
• 19. Silva RM, Beck CL, Prestes FC, Cigana FA, Trindade ML, Santos IG. Excessive daytime sleepiness and health damage in nursing clinic surgical workers. Texto Contexto Enferm [Internet]. 2019 [cited 2022 Jul 30];28:e20170455. Available from: https://doi.org/10.1590/1980-265X-TCE-2017-0455
  » https://doi.org/10.1590/1980-265X-TCE-2017-0455
• 20. Bertolazi AN, Fagondes SC, Hoff LS, Dartora EG, Miozzo IC, Barba ME, et al. Validation of the Brazilian Portuguese version of the Pittsburgh Sleep Quality Index. Sleep Med [Internet]. 2011 [cited 2022 Nov 07];12(1):70-5. Available from: http://doi.org/10.1016/j.sleep.2010.04.020
  » http://doi.org/10.1016/j.sleep.2010.04.020
• 21. Cattani NA, Beck CLC, Miranda FMD, Dalmolin GL, Camponogara S. Eveningwork, sleep quality and illness of nursing workers. Acta Paul Enferm [Internet]. 2021 [cited 2022 Jul 30];34:eAPE00843. Available from: https://doi.org/10.37689/acta-ape/2021AO00843
  » https://doi.org/10.37689/acta-ape/2021AO00843
• 22. Soares CG, Almeida MCV, Santos KNSC, Modernel DX, Cesar-Vaz MR. Excessive daytime sleepiness among nursing professionals. Rev Enferm UFPE on line [Internet]. 2018 [cited 2022 Jul 30];12(6):1603-9. Available from: https://doi.org/10.5205/1981-8963-v12i6a231336p1603-1609-2018
  » https://doi.org/10.5205/1981-8963-v12i6a231336p1603-1609-2018
• 23. Rúni B, Emil S, Markus DJ, Hans B, Anne HG, Lars LA. Are insomnia type sleep problems associated with a less physically active lifestyle? a cross-sectional study among 7,700 adults from the general working population. Front Public Health [Internet]. 2019 [cited 2022 Aug 2];14(7):117. Available from: https://doi.org/10.3389/fpubh.2019.00117
  » https://doi.org/10.3389/fpubh.2019.00117
• 24. Skarpsno ES, Nilsen TIL, Sand T, Hagen K, Mork PJ. Do physical activity and body mass index modify the association between chronic musculoskeletal pain and insomnia? Longitudinal data from the HUNT study, Norway. J Sleep Res [Internet]. 2018 [cited 2022 Aug 2];27(1):32-9. Available from: https://doi.org/10.1111/jsr.12580
  » https://doi.org/10.1111/jsr.12580
• 25. Vancampfort D, Stubbs B, Firth J, Hagemann N, Myin-Germeys I, Rintala A, Probst M, Veronese N, Koyanagi A. Sedentary behaviour and sleep problems among 42,489 community-dwelling adults in six low- and middle-income countries. J Sleep Res [Internet]. 2018 [cited 2022 Aug 8];27(6):e12714. Available from: https://doi.org/10.1111/jsr.12714
  » https://doi.org/10.1111/jsr.12714
• 26. Nadine H, Raphaël H, Jose HR, Pedro MV. oes sleep affect weight gain? Assessing subjective sleep and polysomnography measures in a population-based cohort study (CoLaus/HypnoLaus). Sleep [Internet]. 2019 [cited 2022 Aug 10];42(6):zsz077. Available from: https://doi.org/10.1093/sleep/zsz077
  » https://doi.org/10.1093/sleep/zsz077
• 27. Bilgiç Ş, Çelikkalp Ü, Mısırlı C. Stress level and sleep quality of nurses during the COVID-19 pandemic. Work [Internet]. 2021 [cited 2022 Aug 10];70(4):1021-9. Available from: https://pubmed.ncbi.nlm.nih.gov/34842216/
  » https://pubmed.ncbi.nlm.nih.gov/34842216/
• 28. Vandekerckhove M, Wang YL. Emotion, emotion regulation and sleep: An intimate relationship. AIMS Neurosci [Internet]. 2017 [cited 2022 Aug 10];5(1):1-17. Available from: https://doi.org/10.3934/Neuroscience.2018.1.1
  » https://doi.org/10.3934/Neuroscience.2018.1.1
• 29. Johnson AR, Jayappa R, James M, Kulnu A, Kovayil R, Joseph B. Do low self-esteem and high stress lead to burnout among health-care workers? evidence from a tertiary hospital in Bangalore, India. Saf Health Work [Internet]. 2020 [cited 2022 Sep 02];11(3):347-52. Available from: https://doi.org/10.1016/j.shaw.2020.05.009
  » https://doi.org/10.1016/j.shaw.2020.05.009
• 30. Westwell A, Cocco P, Van Tongeren M, Murphy E. Sleepiness and safety at work among night shift NHS nurses. Occup Med (Lond) [Internet]. 2021 [cited 2022 Aug 8];71(9):439-45. Available from: https://doi.org/10.1093/occmed/kqab137
  » https://doi.org/10.1093/occmed/kqab137

NOTES

• ORIGIN OF THE ARTICLE

  Article extracted from a postdoctoral project in progress at the Anna Nery School of Nursing, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

• FUNDING INFORMATION

  National Council for Scientific and Technological Development (CNPq) - Universal Notice 2016, process No. 402986/2016-4. Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - Financing Code 001.

• APPROVAL OF ETHICS COMMITTEE IN RESEARCH

  Approved by the Ethics Committee in Research of the Universidade Federal de Santa Maria, opinion n. 2,237,779/2017, Presentation Certificate for Ethical Assessment 71819717.9.0000.5346

Edited by

EDITORS

Associated Editors: Clemente Neves de Sousa, Monica Motta Lino. Editor-in-chief: Elisiane Lorenzini

Publication Dates

• Publication in this collection
  13 Jan 2023
• Date of issue
  2022

History

• Received
  26 Oct 2022
• Accepted
  14 Nov 2022