To the best of our knowledge, this is the first study to evaluate self-reported sleep disturbances among health care workers at UoGCSH using PSQI. Our study demonstrates that nearly 60% (58.9%) [95% CI (54.2, 63.6%)] of the surveyed health care workers reported some degree of sleep deprivation. This finding is comparable with the results of studies conducted in Turkey (55.3%) (11), Malaysia (57.8%) (12) and Nigeria (54.2%) (14). However, the prevalence of poor sleepers in our study is lower than studies done in Saudi Arabia (85.9%) (10), China (75%) (37), Malaysia (86.8%) (12), and Ethiopia (70.6%) (38). The possible reason for this variation could be the differences in the study population and the workload that can be responsible for the discrepancy in the prevalence of poor sleep quality among studies. Unlike our study, these studies only include nurses or medical doctors.
However, the current study is higher than the finding in Saudi Arabia (42.3%) (13) and another study done in Ethiopia (25.6%) (39). The reason for this difference could be because of variations in the instrument used and sample size differences. For instance, a previous study conducted in Ethiopia used the shift work sleep disorder questionnaire to determine sleep quality, whereas PSQI was used in this study.
One important finding from this study is that being female health care worker was associated with poor sleep quality. Similar findings were reported from studies done in Pakistan(17), Spain (16) and Saudi Arabia (40). This could be due to increased household and family responsibilities in females, which are typically associated with late-night sleeping and may have an impact on their sleep quality.
The current study revealed that shift workers have an increased likelihood of poor sleep quality than non-shift workers. This finding is in line with studies in China (21), Spain (20), and Ethiopia (38). People working the night shifts usually have an increased risk of sleep deprivations than those working without shifts. The plausible reason behind this could be because of the impact of the night shift on sleep architecture and disruption of circadian rhythm, as it is associated with unpredictable working conditions that restrict the opportunity for good sleep (14, 39).
As expected, khat chewers have demonstrated three times higher odds of poor sleep quality than non-chewers. This finding agrees with studies conducted in Yemen and Ethiopia (23, 24, 41). This could be due to khat's effect on sleep architecture. Because it includes cathinone, an active component with an amphetamine-like action, the first effect of Khat is to excite the brain (24, 42). However, despair, irritability, anorexia, and difficulty sleeping are common side effects of the transient euphoria. The stimulatory effect of khat is assumed to be due to cathinone-induced increases in dopamine concentration in the synaptic cleft, which activates post-synaptic neurons in a sustained way, causing sleep disturbances (18, 24, 43).
Our study also revealed that participants who did not engage in regular physical activity were more likely to be poor sleepers, which is consistent with the findings of research done in China (26). This is due to the fact that regular physical activity causes favorable changes in circadian rhythms and raises adenosine levels in the body, both of which help to regulate sleep (44). Regular physical activity is also said to promote the production and release of melatonin, which is known to improve the quality of sleep (45). In support of these physiological correlations, the World Health Organization (46) and the American Sleep Disorder Association (47) recommend engaging in regular physical exercise to mitigate sleep problems.
Finally, there was a positive relationship between sleep quality and the presence of moderate-to-severe depressive symptoms. This finding is consistent with studies done in Turkey, Saudi Arabia, China and Ethiopia (25, 48–50). This link could be due to melatonin secretion being reduced and the circadian rhythm of melatonin being delayed in people who experience depressive symptoms (51, 52).
The present study has its own limitations. First, since the study is cross-sectional, it is difficult to show the cause-effect relationship between predictor variables and sleep deprivations. Second, because the tool is based on a subjective questionnaire, recall bias and subjective perception about sleep disturbances may not show the actual magnitude of the problem. Third, we didn’t address the impact of sleep deprivation on clinical services (e.g. self-harm, patient harm). Therefore, future comprehensive research work is warranted to fill these limitations.