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Impact of rotational shiftwork related sleep deprivation on quality

of life and job satisfaction among healthcare professionals in Southern
India from the SNORE study findings
A. Y. Nirupama1 · Vinoth Gnana Chellaiyan2 · Amatullah Sana Qadeer1 · Winnie Paulson1 ·
Sarva Priya Pandey3 · G. Ravivarman2

Received: 4 September 2024 / Accepted: 12 December 2024

© The Author(s) 2024  OPEN

Abstract
Background Sleep is essential for cognitive function and overall well-being, yet healthcare providers often experience
sleep deprivation due to long hours and night shifts. This study evaluates how sleep deprivation affects Quality of Life
(QoL) and job satisfaction among these workers.
Methods We conducted a cross-sectional study at a tertiary healthcare facility in Chengalpattu District, Tamil Nadu,
India, including 293 healthcare providers working rotational night shifts. Participants were selected through stratified
random sampling. QoL was assessed using the Short Form-12 QoL Questionnaire (SF-12). Sleepiness was assessed using
Epworth Sleepiness Scale (EPSS). Statistical analyses included Pearson chi-square tests for associations, independent
samples t-tests for comparing QoL scores between sleep-deprived and non-sleep-deprived participants, and binary
logistic regression to evaluate the impact of sociodemographic factors and shift work patterns on SF-12 scores.
Results Significant associations were observed between sociodemographic factors, shift work patterns, and SF-12 QoL
scores. Married participants had nearly four times higher odds (OR = 3.97, 95%CI 1.87–8.43) of scoring < 40. Diploma hold-
ers had nearly three times higher odds (OR = 2.94, 95%CI 1.48–5.83) compared to graduates. Paramedical professionals
had over three times higher odds (OR = 3.48, 95%CI 1.55–7.82) compared to doctors. Sleep deprivation was associated
with lower PCS (aOR = 2.45, 95%CI 1.40–4.27) and MCS scores (aOR = 3.80, 95%CI 1.56–9.23). Increased night work hours
correlated with higher odds of poor work satisfaction (OR = 1.39, 95%CI 1.18–1.63).
Conclusion Sleep deprivation significantly impacts physical and mental QoL scores among healthcare providers working
rotational night shifts. Current shift work patterns also affect QoL, highlighting the need for targeted interventions to
improve sleep and manage shift work.

Supplementary Information The online version contains supplementary material available at https://​doi.​org/​10.​1186/​s12982-​024-​
00375-8.

* Amatullah Sana Qadeer, [email protected]; A. Y. Nirupama, [email protected]; Vinoth Gnana Chellaiyan, drchellaiyan@
gmail.com; Winnie Paulson, [email protected]; Sarva Priya Pandey, [email protected]; G. Ravivarman, raviv743@
gmail.com | 1Institute of Public Health Sciences, Indian Institute of Public Health-Hyderabad, Hyderabad, India. 2Chettinad Hospital
and Research Institute Kelambakkam, Kelambakkam, Tamil Nadu, India. 3PRASHO Foundation, Hyderabad, India.

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1 Introduction

1.1 Background

Sleep stands as an indispensable pillar of human existence, often overlooked for its seemingly passive nature [1]. Sleep
plays an important role in maintaining neuronal circuitry, signalling and helps maintain overall health and wellbeing. This
activity, essential for memory consolidation and cognitive enhancement, underscores its pivotal role in optimizing human
performance across diverse tasks. Sleep deprivation (SD) disturbs the circadian physiology and exerts a negative impact on
brain and behavioural functions [2].
Sleep loss has negative impacts on Quality of Life (QoL), mood, cognitive function and heath [3]. It is linked to poor mood,
increased use of health care resources, and decreased quality of life as well as possible links to cardiovascular risk factors and
disease [4]. Studies have shown an increase in cortisol levels, decreased immunity, and increased markers of sympathetic
activity in sleep-deprived healthy subjects and those with chronic insomnia [5]. The literature also shows that subjective
complaints consistent with chronic insomnia and shortened sleep time, both independently and in combination, can be
associated with the development of diabetes, hypertension, and cardiovascular disease [5].
Moreover, the economic ramifications of SD loom large on a global scale. The Sleep Health Foundation of Australia has
quantified this burden, estimating a staggering $409 million attributed to health costs arising from sleep-related conditions
[6]. Notably, a significant portion of depression, workplace injuries, and road accidents can be traced back to inadequate
rest [7].
Research consistently links sleep patterns—duration, quality, and timing—to QoL. Adequate, high-quality sleep enhances
physical health, mental well-being, and life satisfaction, while poor or irregular sleep patterns are associated with diminished
QoL. Previous studies indicate that while both insufficient and excessive sleep negatively impact health, the quality of sleep
is a critical determinant of QoL [3].
Regrettably, the ethos of sacrificing sleep for productivity permeates societal norms from an early age [8]. Whether fueled
by academic pressures or professional ambitions, the relentless pursuit of tasks often eclipses the need for adequate rest.
This paradigm is especially pronounced in healthcare settings, where long hours, night shifts, and heightened stress levels
converge to undermine the well-being of professionals entrusted with safeguarding lives [9, 10].
Despite existing regulations aimed at ensuring workplace safety, the unique vulnerabilities of healthcare professionals
to sleep-related challenges necessitate a tailored approach. By harnessing robust research and evidence-based strategies,
it is possible to foster work environments that prioritize the sleep health of individuals, thereby fortifying the foundations of
a resilient and effective healthcare ecosystem.

1.2 Rationale

Recognizing the critical link between occupational health, public health, and health systems development, the World Health
Organization (WHO) implemented the Global Plan of Action on Workers’ Health 2008–2017. This plan, endorsed by the
World Health Assembly (WHA) in 2007, aimed to develop and implement policy instruments on workers’ health; protect
and promote health at the workplace; improve the performance and access to occupational health services; provide and
communicate evidence for action and practice; and integrate workers’ health into other policies [11]. Given these objectives,
it is essential to reassess current working conditions in the healthcare industry and evaluate their impact on the health and
quality of life of healthcare professionals, ensuring that existing work patterns are sustainable or require modification.
Glitches in daytime performance due to SD are suffered universally and are more than often linked to significant changes
in daily activities. There is a necessity to evaluate the burden of SD among health care providers for the identification of its
deleterious effects. By measuring the effects on Quality of Life (QoL) necessary steps can be taken to provide better quality
of life and to decrease cognitive impairment, especially among health care professionals working night shifts. Hence, this
study aims to determine the effect of SD on the QoL of health care providers working on night shifts in rotation and work
satisfaction among healthcare providers working on night shifts in rotation

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2 Methodology

A cross-sectional study was conducted at a tertiary healthcare facility in Chengalpattu District, Tamil Nadu, India,
from November 2018 to September 2020. The study included healthcare providers (doctors and paramedical staff )
working rotational night shifts. Inclusion criteria were individuals over 18 years old who worked at least 7 h of con-
tinuous night work between 11 pm and 6 am, while exclusion criteria included those over 60 years old and those
with factors affecting sleep or cognitive function. The sample size was set at 281 but included 293 participants to
account for non-response. Stratified random sampling was employed, with participants selected proportionally from
different professional groups using Statistical Package for the Social Sciences (SPSS, Version 23) software.
The Short Form-12 QoL Questionnaire (SF-12, Version 1) was used to assess participants’ quality of life. The SF-12
evaluates physical and mental health across eight domains, with scores ranging from 0 to 100, where higher scores
indicate better quality of life [12, 13]. Details of the protocol are available in a previously published paper [14].
The Epworth Sleepiness Scale (ESS) was employed to assess daytime sleepiness. Participants rated their likelihood
of dozing off during eight different activities on a 4-point scale (0–3), resulting in a total score ranging from 0 to 24.
Higher scores indicate a higher average sleep propensity in daily life. Incomplete responses were excluded due to
the impossibility of interpolating missing item scores. While acknowledging the subjective nature of this measure,
we interpreted sleep deprivation based on the Thoracic and Sleep Group’s recommendations scores of 0–7 suggest
normal daytime alertness, while higher scores indicate an increasing likelihood of abnormal daytime sleepiness
due to inadequate sleep (60). To quantify sleep patterns, we calculated the Computed Average Duration of Sleep
(CADS) for each participant over a 30-day period. This metric was derived from participants’ work schedules and
self-reported sleep hours.
Statistical analyses were performed using SPSS, Version 23. Pearson chi-square tests were utilized to examine asso-
ciations between SF-12 QoL scores and sociodemographic factors, shift work patterns, and self-reported hours of sleep
during night shifts. Independent samples t-tests compared QoL scores between sleep-deprived and non-sleep-deprived
healthcare providers. Binary logistic regression was employed to evaluate the association of sociodemographic factors
and shift work patterns with SF-12 QoL scores of < 40. This regression also assessed the relationship between various
measures of sleep deprivation and both the Physical Component Summary (PCS) and Mental Component Summary
(MCS) of SF-12 QoL scores.
This study is a component of the broader SNORE (Sleep deprivation among Night shift health staff On Rotation Evalu-
ation) study, which aims to examine the impacts of sleep deprivation on healthcare professionals working rotational
night shift by employing a comparative cross-sectional design, conducted at a tertiary-level healthcare facility in the
Chengalpattu District of Tamil Nadu, India. The data collection and analysis spanned an 18-month period [14].

3 Result

A total of 293 participants were interviewed for this study, with ages ranging from 20 to 42 years and a mean age of
27.9 ± 4.3 years. The majority (58.0%) were between 25 and 30 years old. The sample was predominantly female, with
only 31.1% (n = 91) male participants. Among the 202 female participants, 57.4% were in the 25 to 30 age group, and
20.3% were over 30 years old. Approximately half of the participants (50.9%) were never married, while the remaining
49.1% had been married at least once, including 141 (97.9%) currently married, 1 (0.6%) divorced, and 2 (1.4%) widowed
participants. Over three-quarters (76.5%) of the participants had graduated or obtained higher degrees, with 17.4% of
them holding postgraduate qualifications. Among the graduates, 46.2% of those with postgraduate degrees were female,
while 66.7% of those with only diploma qualifications were female (Table 1).

3.1 QoL assessment

SF-12 QoL scores ranged from 28.64 to 55.89, with a mean score of 44.66 ± 6.06. Among the 293 participants, 42 (14.3%)
had scores below 40. The PCS scores ranged from 26.47 to 58.24, with a mean of 44.76 ± 7.54, and the MCS scores ranged
from 20.87 to 61.28, with a mean of 44.56 ± 7.61. Notably, 106 (36.2%) and 50 (17.1%) participants had scores below 40
on the PCS and MCS, respectively (Fig. 1).

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Table 1  Association of Sociodemographic factors and shift work pattern with SF-12 QoL scores by Pearson Chi-square analysis (N = 293)

QoL Total PCS MCS

2 2
< 40 ≥ 40 χ < 40 ≥ 40 χ < 40 ≥ 40 χ2
n (%) n (%) (p value) n (%) n (%) (p value) n (%) n (%) (p value)

Age in years
< 25 2 (4.8) 57 (22.7) 8.72 12 47 8.03 2 57 19.12
(0.013) (11.3) (25.1) (0.018) (4.0) (23.5) (< 0.001)
25–30 32 (76.2) 138 (55.0) 68 102 27 143
(64.2) (54.5) (54.0) (58.8)
> 30 8 (19.0) 56 (22.3) 26 38 21 43
(24.5) (20.3) (42.0) (17.7)
Gender
Male 0 (0.0) 91 (36.3) 20.43# 18 73 15.37 13 78 0.72
(< 0.001) (17.0) (39.0) (< 0.001) (26.0) (32.1) (0.396)
Female 42 (100.0) 160 (63.7) 88 114 37 165
(83.0) (61.0) (74.0) (67.9)
Marital status
Never mar- 10 (23.8) 139 (55.4) 14.35 33 116 25.85 1 148 57.57
ried (< 0.001) (31.1) (62.0) (< 0.001) (2.0) (60.9) (< 0.001)
Married 32 (76.2) 112 (44.6) 73 71 49 95
(68.9) (38.0) (98.0) (39.1)
Educational qualification
Diploma 18 (42.9) 51 (20.3) 10.15 24 45 0.08 14 55 0.66
(0.001) (22.6) (24.1) (0.783) (28.0) (22.6) (0.415)
Graduation 24 (57.1) 200 (79.7) 82 142 36 188
or above (77.4) (75.9) (72.0) (77.4)
Occupation
Doctor 8 (19.0) 113 (45.0) 10.01 37 84 2.80 28 93 5.38
(0.002) (34.9) (44.9) (0.094) (56.0) (38.3) (0.020)
Paramedic 34 (81.0) 138 (55.0) 69 103 22 150
(65.1) (55.1) (44.0) (61.7)
Hours of work per night
≤ 12 34(81.0) 163(64.9) 4.19 76 121 1.50 35 162 0.21
(0.041) (71.7) (64.7) (0.220) (70.0) (66.7) (0.647)
> 12 8(19.0) 88(35.1) 30 66 15 81
(28.3) (35.3) (30.0) (33.3)
No. of working nights per month
<7 2(4.8) 67(26.7) 29.44 23 46 8.27 1 68 22.44
(< 0.001) (21.7) (24.6) (0.016) (2.0) (28.0) (< 0.001)
7 36(85.7) 102(40.6) 61 77 23 115
(57.5) (41.2) (46.0) (47.3)
>7 4(9.5) 82(32.7) 22 64 26 60
(20.8) (34.2) (52.0) (24.7)
No. of non-working nights between 2 consecutive night shifts
< 14 7(16.7) 124(49.4) 15.60 37 94 6.46 27 104 2.11
(< 0.001) (34.9) (50.3) (0.011) (54.0) (42.8) (0.147)
≥ 14 35(83.3) 127(50.6) 69 93 23 139
(65.1) (49.7) (46.0) (57.2)
No. of years of working night shifts
<2 1(2.4) 84(33.5) 29.64 24 61 8.48 4 81 31.25
(< 0.001) (22.6) (32.6) (0.014) (8.0) (33.3) (< 0.001)
2–5 26(61.9) 142(56.6) 60 108 28 140
(56.6) (57.8) (56.0) (57.6)
>5 15(35.7) 25(10.0) 22 18 18 22
(20.8) (9.6) (36.0) (9.1)

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Table 1  (continued)

QoL Total PCS MCS

2 2
< 40 ≥ 40 χ < 40 ≥ 40 χ < 40 ≥ 40 χ2
n (%) n (%) (p value) n (%) n (%) (p value) n (%) n (%) (p value)
SRHS-night
<7 31 (12.9) 210 (87.1) 2.39 92 (38.2) 14 (26.9) 2.35 (0.126) 50 (20.7) 191 (79.3) 11.58# (0.001)
≥7 11 (21.2) 41 (78.8) (0.122) 14 (26.9) 14 (26.9) 0 (0.0) 52 (100.0)
QoL: Quality of life; PCS: Physical component score; MCS: Mental component score; SRHS: sleep during night shift period
#
Yates corrected; Level of significance at p-value < 0.05 are marked in bold

Table 1 shows the association between sociodemographic factors and shift work patterns with SF-12 QoL scores.
In the < 40 score group, there were only females (100%). Married individuals had a higher proportion of scores below
40 (76.2%) compared to those never married (23.8%). Graduates (57.1%) and paramedics (81.0%) had higher propor-
tions of scores < 40 compared to diploma holders (42.9%) and doctors (19.0%), respectively. Participants working
more than 12 h per night had 19.0% scoring below 40, compared to 81.0% of those working 12 h or less. Those with
7 working nights per month had 85.7% of participants scoring below 40, compared to 4.8% of those with fewer than
7 working nights. Participants with fewer than 14 non-working nights between shifts had 16.7% scoring below 40,
while 83.3% of those with 14 or more non-working nights fell into this group. Participants with 2–5 and more than
5 years of night shift experience had 61.9% and 35.7%, scoring below 40, compared to 2.4% of those with less than
2 years of experience.
Association of the sociodemographic factors and shift work pattern with SF-12 QoL physical and mental components
summaries was seen using Pearson chi-square. Age, gender, marital status, no. of working nights per month, no. of non-
working nights between 2 consecutive night shifts and no. of years of working night shift are found to have a statistically
significant association with PCS. Age, marital status, occupation, no. of working nights per month and no. of years of
working night shifts are found to have a statistically significant association with MCS (Supplementary Table 1).
Binary logistic regression analysis assessed the association of sociodemographic factors and shift work patterns with
SF-12 QoL scores of < 40. Married participants had an odds ratio (OR) of 3.97[95% Confidence Interval (CI) 1.87–8.43] for
scoring < 40 compared to those never married. Diploma holders had an OR of 2.94 [95%CI 1.48–5.83] compared to gradu-
ates, and paramedical professionals had an OR of 3.48[95%CI 1.55–7.82] compared to doctors. Additionally, the odds of
scoring < 40 increased with the number of years of night work, OR = 1.48[95%CI 1.30–1.69] (Table 2).
Further binary logistic regression revealed significant odds for PCS scores < 40 associated with gender, marital status,
number of non-working nights between shifts, and years of shift work. For MCS scores < 40, significant associations
were noted with age, marital status, occupation, number of working nights, number of non-working nights, and years
of night shift work (Table 2).

3.2 Association of status of sleep deprivation with QoL

The association between sleep deprivation and SF-12 QoL scores was assessed using Pearson chi-square tests. A statisti-
cally significant association was found between the Mental Component Summary (MCS) score and self-reported hours
of sleep during the night shift period (Table 1). Independent samples t-tests revealed that sleep-deprived participants
had significantly lower mean QoL scores compared to those who were not sleep-deprived (Supplementary Table 3).
Binary logistic regression was conducted to evaluate the association between sleep deprivation—measured by self-
reported hours of sleep during the night shift period, computed average per day hours of sleep (CADS), and Epworth
Sleepiness Scale (EPSS) scores—and SF-12 QoL scores, including PCS and MCS. The analysis showed that sleep depriva-
tion, as measured by EPSS scores, was significantly associated with a higher likelihood of a PCS score < 40 (aOR = 2.45
[1.40–4.27]). Conversely, sleep deprivation assessed by CADS was significantly associated with a higher likelihood of an
MCS score < 40 (aOR = 3.80 [1.56–9.23]) (Table 3).

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Fig. 1  Description of SF-12

QoL scores among study
participants (N = 293) SF-12 QOL scores
<40
42(14%)

≥40
251(86%)

SF-12 Mental components score SF-12 Physical components score

<40
50 <40
(17%) 106
≥40 ≥40 (36%)
243 187
(83%) (64%)

SF-12: Short Form-12; QoL: Quality of Life

3.3 Status of work satisfaction among participants

Among the 293 study participants, 95 (32.4%) reported poor work satisfaction, while approximately half indicated aver-
age work satisfaction. Pearson chi-square analysis did not reveal a statistically significant association between work
satisfaction and either sleep status or overall quality of life (p > 0.05).
Binary logistic regression showed a significant association between the number of hours worked during the night and
work satisfaction, with increasing night work hours associated with higher odds of poor work satisfaction, OR = 1.39[95%CI
1.18–1.63].

4 Discussion

Our study reveals significant associations between sleep deprivation and various aspects of QoL among healthcare
workers. The findings demonstrate that sleep-deprived individuals exhibit markedly lower mean QoL scores, under-
scoring the profound impact of inadequate sleep on overall well-being.
The results indicate that increased scores on the EPSS are associated with higher odds of poor physical QoL
(aOR = 2.45, 95% CI 1.40–4.27). This suggests that excessive daytime sleepiness, a common consequence of sleep dep-
rivation, may significantly impair physical functioning and health. Similarly, decreased hours of sleep were found to
be linked to higher odds of poor mental QoL (aOR = 3.80, 95% CI 1.56–9.23), highlighting the crucial role of adequate
sleep in maintaining mental health and cognitive function.
These findings are in line with several previous studies that have reported significant associations between sleep
deprivation from shift work and QoL. For instance, research conducted on nurses in Iraq [15], healthcare workers in
Brazil [16], and nurses in Brazil [17] all demonstrated negative correlations between sleep deprivation and QoL using
the World Health Organization Quality-of-Life Scale (WHOQOL-BREF tool) (r = − 0.56; p < 0.001) [18]. Additional stud-
ies, such as those on nurses in Tunisia [19] using the SF-12 QoL tool and Tokyo nurses [20] using the SF-8 QoL tool,

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Table 2  Association of SF-12 QoL total and component summaries with socio-demographic factors and shift work pattern through Logistic
regression (N = 293)
QoL Total PCS MCS
OR [95% CI] p value OR [95% CI] p value OR [95% CI] p value

Age in years 0.999 0.979 1.03 0.285 1.20 < 0.001

[0.93–1.08] [0.98–1.09] [1.12–1.30]
Marital status
Never married 1 < 0.001 1 < 0.001 1 < 0.001
[Reference] [Reference] [Reference]
Married 3.97 3.61 76.34
[1.87–8.43] [2.18–6.00] [10.37–562.12]
Educational qualification
Diploma 2.94 0.002 0.92 0.783 1.33 0.416
[1.48–5.83] [0.53–1.63] [0.67–2.64]
Graduation or above 1 1 1
[Reference] [Reference] [Reference]
Occupation
Doctor 1 0.003 1 0.095 1 0.022
[Reference] [Reference] [Reference]
Paramedic 3.48 1.52 0.49
[1.55–7.82] [0.93–2.49] [0.26–0.90]
No. of working nights per month 0.99 0.851 0.96 0.476 1.34 < 0.001
[0.85–1.15] [0.86–1.07] [1.14–1.57]
No. of non-working nights between 2 con- 1.15 0.002 1.06 0.022 0.93 0.026
secutive night shifts [1.06–1.26] [1.01–1.12] [0.87–0.99]
Number of years of working night shifts 1.48 < 0.001 1.22 < 0.001 1.24 < 0.001
[1.30–1.69] [1.10–1.35] [1.11–1.39]

QoL: Quality of life; PCS: Physical component score; MCS: Mental component score; Level of significance at p-value < 0.05 are marked in bold

corroborate these findings, suggesting a consistent pattern across different healthcare settings and geographical
locations.
Furthermore, our study revealed statistically significant associations between both PCS and MCS scores and sleep
deprivation. These results are consistent with findings from studies conducted in the general population in Lebanon
[21] using SF-12 and among nurses in Tokyo [20] using SF-8. This consistency across diverse populations underscores
the pervasive nature of sleep deprivation’s impact on both physical and mental well-being.
Regarding work satisfaction, our study found that 32.4% of participants reported poor work satisfaction, with increased
hours of night work associated with higher odds of dissatisfaction (aOR = 1.39, 95% CI 1.18–1.63). This prevalence is nota-
bly higher than the 17.09% reported by Lee et al., suggesting that our study population may be experiencing particularly
challenging work conditions. The association between night work hours and decreased satisfaction aligns with studies
which found that rotating shift workers reported lower job satisfaction compared to day workers [22, 23].
These findings collectively emphasize the complex interplay between sleep deprivation, quality of life, and work
satisfaction among healthcare workers. The higher prevalence of poor work satisfaction in our study population com-
pared to previous research warrants further investigation into potential contributing factors specific to our setting.
The consistency of our results with previous studies across different healthcare settings and geographical locations
strengthens the generalizability of these findings. However, it is important to note the potential limitations of our study,
such as its cross-sectional nature, which precludes the establishment of causal relationships.
Our study provides compelling evidence for the detrimental effects of sleep deprivation on both quality of life and
work satisfaction among healthcare workers. These findings underscore the urgent need for interventions aimed at
improving sleep patterns and mitigating the negative impacts of shift work in healthcare settings. Future research should
focus on longitudinal studies to establish causality and on developing and evaluating targeted interventions to enhance
sleep quality and work satisfaction among healthcare professionals.
It is also suggested that women healthcare workers experience a pronounced impact from shift work on their quality of
life particularly those who are married. This disparity can be attributed to the deeply ingrained cultural expectations and

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Table 3  Logistic regression analysis of association of sleep deprivation with an SF-12 QoL, PCS, and MCS score < 40 (N = 293)
PCS MCS
Crude odds ratio Adjusted odds ratio* Crude odds ratio Adjusted odds ratio#
OR [95% CI] p-value aOR [95% CI] p-value OR[95% CI] p-value Adj. OR[95% CI] p-value

CADS
<7 1.24 [0.77–2.02] 0.379 1.25 [0.74–2.11] 0.412 4.23 [1.97–9.08] < 0.001 3.80 [1.56–9.23] 0.003
≥7 1 [Reference] 1 [Reference] 1 [Reference] 1 [Reference]
EPSS
0–7 1 [Reference] 0.001 1 [Reference] 0.002 1 [Reference] 0.375 1 [Reference] 0.383
8–24 2.33 [1.40–3.88] 2.45 [1.40–4.27] 1.34 [0.71–2.53] 1.47 [0.62–3.50]
SRHS-night
<7 1.68 [0.86–3.26] 0.128 1.37 [0.67–2.82] 0.389 Logistic regression is not reported as association between
≥7 1 [Reference] 1 [Reference] SRHS-night and MCS was found through Pearson-chi
square test

PCS: Physical component score; MCS: Mental component score; CADS: Computed average per day hours of sleep; EPSS: Epworth sleepiness
scale; SRHS: sleep during night shift period; Level of significance at p-value < 0.05 are marked in bold
*Adjusted for gender, marital status, no. of non-working nights between 2 consecutive night shifts and number of years of working night
shifts
#Adjusted for age, marital status, occupation, no. of working nights per month, no. of non-working nights between 2 consecutive night
shifts and number of years of working night shifts

societal norms in India, where women typically bear the primary responsibility for household management and familial
care. Married women often face the additional challenge of balancing their professional duties with the demands of
maintaining a home and caring for family members. This dual burden of managing both work and domestic responsibili-
ties may exacerbate the stress and fatigue associated with irregular work schedules, potentially leading to greater sleep
disruption and reduced overall well-being [24]. These gender-specific findings underline this area for future research.
Further exploration is needed to fully understand the intersectionality of gender roles, cultural expectations, and shift
work in healthcare professionals.
This study has several notable strengths. First, we employed a two-visit approach, providing feedback and assessment
results to participants during the second visit. This strategy not only increased awareness about their quality of life and
sleep status but also allowed for personalized health education based on their initial assessment. This approach poten-
tially enhanced participant engagement and provided immediate benefit to the study subjects. Second, our assessment
of quality of life utilized the SF-12, a standardized international questionnaire validated for the Indian context. This choice
of instrument strengthens the reliability and validity of our QoL measurements, allowing for meaningful comparisons
with other studies both within India and internationally.

4.1 Limitations

However, some limitations should be considered when interpreting our results. The reliance on self-reported hours of
sleep as a measure of sleep deprivation status introduces the possibility of bias due to social desirability or selective recall.
This subjective assessment method may not fully capture the complexities of sleep patterns and quality. Additionally, our
study sample had a predominance of female participants, which may limit the generalizability of our findings to male
healthcare workers. Lastly, as this was a single-institution study, the results may not be fully representative of healthcare
workers in other settings or regions, potentially affecting the broader applicability of our conclusions. Future multi-center
studies with more balanced gender representation and objective sleep measures could address these limitations and
further validate our findings.

4.2 Recommendations

Our findings underscore the need for strategic interventions to mitigate the effects of sleep deprivation among healthcare
providers. We recommend reducing the number of consecutive night shifts and extending recovery periods between

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Discover Public Health (2024) 21:249 | https://doi.org/10.1186/s12982-024-00375-8
Research

shifts to allow adequate time for recuperation from residual fatigue along with modifications to existing work policies
could significantly contribute to maintaining a healthier workforce. For instance, implementing mandatory days off fol-
lowing night shift rotations and introducing nap breaks during night shifts have been shown to be effective strategies
in reducing fatigue and enhancing performance.
Establishing sleep hygiene counseling programs for all shift workers should be prioritized by human resources depart-
ments. These programs can provide valuable support and education on managing sleep patterns in the context of
irregular work schedules. We also advocate for the development of an active, supportive feedback system between
administration and staff. This could take the form of a digital portal where healthcare providers can seek support or pro-
pose solutions, facilitating a more responsive and collaborative approach to addressing work-related lifestyle challenges.
We also recommend that hospital administrations focus on designing improved work shift schedules. Additionally, we
suggest the establishment of mandatory sleep counseling centers for employees engaged in shift work. These centers
could provide personalized strategies for managing sleep patterns and mitigating the impacts of irregular schedules
on overall well-being.

5 Conclusion

A significant burden of sleep deprivation was observed among healthcare providers working rotational night shifts,
with notable associations to lower QoL scores. The findings highlight that sleep deprivation is not only prevalent but
also significantly impacts both physical and mental components of QoL. Additionally, the current shift work patterns
were found to have a statistically significant relationship with QoL outcomes, emphasizing the need for interventions
targeting sleep and shift work management in this population.

Author contributions Conceptualization: [NAY, VGC, RG]; Methodology: [NAY, VGC]; Formal analysis and investigation: [NAY, VGC]; Writing—
original draft preparation: [NAY, ASQ, SPP]; Writing—review and editing: [ASQ, WP]; Resources: [NAY]; Supervision: [RG]. All authors have read
and approved the final version of the manuscript.

Funding No funding was received for conducting this study.

Data availability The data that support the findings of this study are not openly available due to reasons of sensitivity and are available upon
reasonable request.

Code availability Statistical data analysis is done using the Statistical Package for Social Sciences (IBM Corp. Released 2012. IBM SPSS Statistics
for Windows, Version 21.0. Armonk, NY: IBM Corp).

Declarations
Ethics approval and consent to participate The study has been reviewed and approved by the Institutional Human Ethics Committee, Chet-
tinad Academy of Research and Education in accordance to the Declaration of Helsinki. Informed consent was obtained from all individual
participants included in the study.

Consent for publication Not applicable.

Competing interests The authors declare no competing interests.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adapta-
tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article
are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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