Sleep Deprivation among Health-Care Workers: A Cross-sectional Study at the University of Gondar Comprehensive Specialized Hospital

doi:10.21203/rs.3.rs-1516915/v1

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Sleep Deprivation among Health-Care Workers: A Cross-sectional Study at the University of Gondar Comprehensive Specialized Hospital

https://doi.org/10.21203/rs.3.rs-1516915/v1

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Background: Sleep disturbance is a common problem among health care workers and it has been associated with poor clinical services including medical errors.

Objective: This study aimed to determine the prevalence of sleep deprivation and identify factors impacting among health care workers at the University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

Methods: Health care workers were approached to subjectively assessed their sleep quality. Study participants completed the Pittsburgh Sleep Quality Index (PSQI), and they reported demographic, working departments, and behavioral information. Poor sleep quality was defined as a PSQI score >5. Multiple binary logistic regression was used to estimate the strength of the association between risk factors and sleep deprivations. P value ≤ 0.05 was used to declare statistically significant.

Results: A total of 418 surveys were completed. The mean age of the study participants was 30.7 years (SD ± 6.3). The overall prevalence of poor sleepers was 58.9% [95% CI (54.2, 63.6%)]. Being female [AOR=1.9, 95%CI (1.2, 2.9)], working in night shifts [AOR=5.7, 95%CI (2.3, 14.3), physically inactive [AOR=2.08(1.2-3.6)], chewing khat [AOR = 3.1, 95% CI (1.2, 7.6)], and the presence of depressive symptoms [AOR = 2.6, 95% CI (1.3, 6.8)] were significantly associated with sleep deprivation.

Conclusion: Based on the PSQI scoring, the prevalence of sleep deprivation among health care workers was high. Night shiftwork schedule, lack of regular physical activity, chewing khat, and the presence of depressive symptoms were associated with sleep deprivation. This research suggests sleep interventions for health care workers.

Health care professionals

Pittsburg Sleep Quality Index

Poor sleep quality

Prevalence

Ethiopia

Sleep is fundamental to overall health, and quality sleep is best described as a good feeling of sleep experience upon awakening(1). According to the American Academy of Sleep Medicine, an adult person should sleep about 7 or more hours per day(2). Poor sleep quality can lead to physical and mental abnormalities, which increases the incidence of chronic medical conditions, poor productivity at work, and increased workplace injuries and harm(3-6).

Worldwide, the prevalence of sleep problems in the general population ranges from 1.6% to 56.0%(7–9). The overall magnitude of poor sleep quality in the general population in Ethiopia has been estimated to be 53 % (15).

Sleep deprivation is also common among health care workers and significantly affects their quality of life, productivity, and clinical service(10). The prevalence of poor sleep quality among healthcare workers is 56.3% in Turkey (11), 86.8% in Malaysia (12), 42.3% in Saudi Arabia (13), 85.9% in Riyadh (10), and 54.2% in Nigeria(14).

Sleep quality can be affected by different factors. Several lines of evidence outlined that female sex (16,17), aging (16,18), night shift work (14,20–22), coffee consumption (11), khat chewing (23,24), alcohol consumption (18), depression (25), poor physical activity (26–28), and self-rated health (29) were factors associated with perceived poor sleep quality.

Taking the nature of the profession and the working areas into consideration, we assumed that health care workers at hospitals are prone to sleep problems. However, hospital-based studies showing the magnitude of sleep deprivation among health care workers in Ethiopia are limited. The purpose of this study, therefore, was to determine the degree of sleep deprivation among health care workers at the University of Gondar Comprehensive Specialized Hospital (UoGCSH).

Study Design

A hospital based cross-sectional study was conducted at UoGCSH, Gondar, northwest Ethiopia, from February 1 to June 20, 2020. University of Gondar Comprehensive Specialized Hospital is the largest teaching hospital in Amhara National Regional State, providing tertiary level care for more than five million people annually.

Study Participants

During the study period, there were a total of 938 full-time healthcare workers in different disciplines. In our study, we surveyed sleep quality among nurses, doctors, pharmacists, laboratory technologists, midwifes, and others (anesthetists, psychiatric nurses, and physiotherapists) who were active in their duties. Qualifying participants for our study were at least 18 years of age and served for at least six months at this hospital.

Sample Size

The sample size was determined using a single population proportion formula by assuming the prevalence of poor sleep quality (p=50%) as there was no previous similar study done in Ethiopia, with 95% confidence interval, and 5% margin of error. After adding a non-response rate of 5%, the final sample size calculated was 423. We used a simple random sampling technique to select the study participants.

Data collection methods

A self-administered questionnaire adapted by the authors from different literatures was used to collect the demographic, life style, health status and work-related information. Participants were said to be current substance users when they used cigarettes, khat, alcohol, or coffee at least once in the past month prior to the survey (34–36). Physical activity level was determined by the habit of regular exercise. Shiftwork was defined as more than one night shift per week during the last month.

The study participants perceived sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) tool. The PSQI is a validated questionnaire that measures sleep quality over 1 month(31). The instrument contains seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each domain is rated on a 4-point scale (0–3), which generates a total score ranging between 0 and 21. A global score of greater than 5 indicates a “poor” sleep quality(poor sleepers) and a score of less than or equal to 5 is good sleep quality(good sleepers)(32).

The presence of depressive symptoms was measured by the Beck’s Depression Inventory version II (BDI-II). Study participants with BDI-II scores of between 0 and 13 would be considered normal. Participants with BDI-II scores between 14 and 19, 20 and 28, and between 29 and 63 would be considered to have mild, moderate, and severe depression, respectively (33).

Ethical clearance was obtained from the ethical review committee of the School of Medicine, University of Gondar. A permission letter was obtained from the University of Gondar Comprehensive Specialized Hospital and written informed consent was obtained from each study participant, whose information was kept confidential.

Statistical Analysis

Descriptive statistics were used to quantify the participants’ demographics, behavioral, work related information. The primary outcome was poor sleep quality as measured by the PSQI score. Multivariable logistic regression was used to test for independent associations between the primary outcome and factors affecting it. Variables with a p-value of ≤ 0.05 were considered statistically significant. The data was entered into Epi-data version 3.02 and then exported to SPSS version 25 for analysis. Both the crude odds ratio (COR) and the adjusted odds ratio (AOR) with a 95% confidence interval (CI) were computed.

Sociodemographic characteristics

A total of 418 health care workers participated in this study, giving a response rate of 98.8%. The mean age of the participants was 30.7 years, with a standard deviation (SD) of ± 6.3 years. Two hundred thirteen (51%) of them were females, and one-third (33.3%) of the participants were married. More than half the study participants were nurses (226, 54.1%), followed by midwives (60, 14.4%)(Table 1).

Table 1

Sociodemographic characteristics of HCPs working at UoGCSH, Gondar, northwest Ethiopia, 2020 (n = 418).
Variables	Category	Frequency	Percentage
Age (in years)	20–30 31–40 41–50 > 50	265 119 26 8	63.4% 28.5% 6.2% 1.9%
Sex	Male Female	205 213	49% 51%
Marital status	Single Married Divorced	261 139 18	62.4% 33.3% 4.3%
Family size	1 3 ≥ 4	277 101 40	66.3% 24.2% 9.6%
Profession	Nurses Medical doctor Pharmacist Laboratory technologist Midwifery Others*	226 27 35 46 64 20	54.0% 6.5% 8.4% 11.0% 15.3% 4.8%
*Anesthetists, psychiatric nurses and physiotherapist

Table 2 shows the health status and work-related characteristics of the study participants. Three hundred eighty-five (92.1%) participants were working the night shift. Four hundred six (97.8%) of them were working less than 56 hours per week. Regarding substance use, 45 (10.8%), 260 (62.2%), and 35 (8.4%) participants were current khat chewers, alcohol drinkers, and cigarette smokers, respectively. Thirty-five (8.4%) of the partakers had a history of chronic illness (Table 2).

Table 2

Health and work-related characteristics of health care workers at UoGCSH, in Gondar, northwest Ethiopia, 2020 (n = 418).
Variables Categories		Frequency	Percentage
Shift working	Yes No	385 33	92.1% 7.9%
Work experience(years)	1–9 10–19 20–29 ≥ 30	310 81 22 5	74.2% 19.4% 5.3% 1.2%
Working hours per week	≤ 56 > 56	409 9	97.8% 2.2%
Current khat chewing	Yes No	45 375	10.8% 89.2%
Current alcohol drinking	Yes No	260 158	62.2% 37.8%
Current cigarette smoking	No Yes	383 35	91.6% 8.4%
Drinking coffee	Yes No	306 112	73.2% 26.8%
History of chronic illness	Yes No	35 383	8.4% 91.6%
Regular exercise	Yes No	76 342	18.2% 81.8%
Self-rated health	Excellent Very good Good Fair	119 152 120 27	28.5% 36.4% 28.7% 6.5%
Depression status	Normal Mild Moderate Sever	323 47 27 21	77.3% 11.2% 6.5% 5%

Prevalence of sleep deprivation

The overall prevalence of poor sleepers (PSQI > 5) in this study was 58.9% [95% CI (54.2, 63.6%)]. The average night sleep duration and sleep latency of the study participants were 6.5 hours (SD ± 1.27) and 18.6 minutes (SD ± 16.6), respectively. Three hundred and five (73%) of the participants had less than 7 hours of sleep per day (Table 3).

Table 3

Sleep quality and its component scores among health care professionals working at UoGCSH, Gondar, Northwest Ethiopia, 2020(n = 418).
Variables Category		Frequency	Percentage
Subjective sleep quality (score)	Very good (0) Fairly good (1) Fairly bad (2) Very bad (3)	158 129 61 70	37.8% 30.9% 14.6% 16.7%
Sleep latency(score)	Never (0) < 1 time per week (1) 1–2 times a week (2) ≥ 3 times a week (3)	95 234 74 15	22.7% 56% 17.7% 3.6%
Sleep duration	> 7 hours 6–7 hours 5–6 hours < 5 hours	113 206 71 28	27% 49.3% 17% 6.7%
Sleep efficacy	> 85% 75–84% 65–74% < 65%	209 127 49 33	50% 30.4% 11.7% 7.9%
Sleep disturbance(score)	Never (0) < 1 time a week (1) 1–2 times a week (2) ≥ 3 times a week (3)	6 290 118 4	1.4% 69.4% 28.2% 1%
Use of sleep medication (score)	Never (0) < 1 time a week (1) 1–2 times a week (2) ≥ 3 times a week (3)	345 48 10 15	82.5% 11.5% 2.4% 3.6%
Day time dysfunction (score)	Never (0) < 1 time a week (1) 1–2 times a week (2) ≥ 3 times a week (3	121 185 95 17	28.9% 44.3% 22.7% 4.1%

Factors associated with sleep deprivation healthcare workers

In the bivariable logistic regression analysis, variables with a p value < 0.25 were included in the multivariable logistic regression model. Accordingly, being female, night shift work, chewing khat, having depressive symptoms, and lack of regular exercise were significantly associated with poor sleep quality(p ≤ 0.05). In this study, females were 1.9 times [AOR = 1.9, 95%CI: 1.2, 2.9] more likely to experience sleep disturbances compared to male counterparts. The odds of poor sleep quality was 5.7 times [AOR = 5.7, 95%CI: 2.3, 14.3] higher among night shift workers compared to non-shift workers. Current khat chewers were 3.1 times [AOR = 3.1, 95% CI: 1.2, 7.6] more likely to experience poor sleep quality than those who don’t chew khat. Participants with moderate to severe depression were 2.6 times [AOR = 2.6, 95% CI: 1.3, 6.8] more likely to incur poor sleep quality than those with no depression (Table 4).

Table 4

Bivariable and Multivariable logistic regression analysis of factors associated with poor sleep quality among HCPs working at UoGCSH, Gondar, Northwest Ethiopia, 2020(N = 418)
Variables	Categories	Poor sleep quality (PSQI > 5)		OR (95% CI)
Variables	Categories	Yes	No	COR	AOR
Sex	Male Female	102(24.4%) 144(39.4%)	103(24.6%) 69(16.5%)	1.0 2.1(1.4–3.1)	1.0 1.9(1.2–2.9)*
Shift working	Yes No	239(57.2%) 7(1.7%)	146(34.9%) 26(6.2%)	6.1(2.5–14.3) 1.0	5.7(2.3–14.3)* 1.0
Current khat chewing	Yes No	38(9.1%) 208(49.8%)	7(1.7%) 165(39.5%)	4.3(1.8–9.8) 1.0	3.1(1.2–7.6)* 1.0
Drinking coffee	Yes No	191(45.7%) 55(13.2%)	115(27.5%) 57(13.6%)	1.7(1.1–2.6) 1.0	1.2(0.7–2.04) 1.0
Self-rated health	Excellent Very good Good Fair	60(14.4%) 81(19.4%) 80(19.1%) 25(6%)	59(14.1%) 71(17%) 40(9.6%) 2(0.5%)	1.0 1.1(0.6–1.8) 1.9(1.1–3.3) 1.2(0.7–2.2)	1.0 0.9(0.5–1.7) 1.3(0.7–2.4) 1.2(0.4–3.1)
Regular exercise	Yes No	29(6.9%) 217(51.9%)	47(11.2%) 125(29.9%)	1.0 2.8(1.6–4.6)	1.0 2.08(1.2–3.6)*
Depression	Normal Mild Moderate to severe	175(41.9%) 35(8.4%) 36(8.6%)	148(35.4%) 12(2.9%) 12(2.9%)	1.0 2.4(1.23–4.92) 2.1(0.9–4.6)	1.0 2.1(0.9–4.5) 2.6(1.3–6.8)*
*= P ≤ 0.05, OR = odds ratio, COR = crude Odds Ratio, AOR = adjusted odds ratio

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).

Limitations

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.

The current study found that sleep deprivation was highly prevalent among healthcare workers and had significant associations with female workers, night shift work, khat chewing, lack of regular exercise, and depression. To reduce the overall impact of sleep deprivation, measures should be taken to improve the quality of sleep in this study population.

Ethics approval and consent to participate

Consent for publication

Not applicable

Availability of data and materials

The dataset is available from the corresponding author upon reasonable request

Competing interests

The authors declare that they have no competing interests

Funding

Not applicable

Authors' contributions

W.T. conceived the study, coordinated the process of data collection, was involved in data cleaning and statistical analysis, and prepared the first draft of the manuscript. Y.Y., B.D., Y.A., and A.G. supervise the data collection process, and participated in statistical analysis and interpretation of the results, manuscript reviewing, and editing. All authors reviewed and approved the final manuscript.

Acknowledgements

The authors would like to express their genuine and heart emanated gratitude to study

participants and data collectors.

Gellman MD, Turner JR. Sleep Deprivation and Deficiency [Internet]. 2020. Available from: https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency
Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF TER. Recommended Amount of Sleep for a Healthy Adult : A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med. 2015;11(6):591–2.
Michael A. Grandner, Nicholas J. Jackson, Victoria M. Pak PRG. Sleep disturbance is associated with cardiovascular and metabolic disorders. J Sleep Res. 2012;21(4):427–33.
Foster R. A good introduction to sleep and sleep disorders. Lancet Neurol [Internet]. 2012;11(10):848.
Harvey AG, Stinson K, Whitaker KL, Moskovitz D, Virk H. The Subjective Meaning of Sleep Quality : A Comparison of Individuals with and without Insomnia. Sleep. 2008;31(3):383–93.
Nakata A, Ikeda T, Takahashi M, Haratani T. Sleep-related Risk of Occupational Injuries in Japanese Small and Medium-scale Enterprises. Ind Health. 2005;43:89–97.
Koyanagi A, Stickley A. The Association between Sleep Problems and Psychotic Symptoms in the General Population : A Global Perspective. Sleep. 2015;38(12):1875–85.
Poursain B. An international survey of sleeping problems in the general population. 2008;24(1):307–17.
Stranges S, Tigbe W, Thorogood M, Kandala N, Africa S, Sciences H, et al. Sleep Problems : An Emerging Global Epidemic ? Findings From the INDEPTH WHO-SAGE Study Among More Than 40 , 000 Older Adults From 8 Countries Across Africa and Asia. Sleep. 2012;35(8):1173–81.
Alamri FA, Amer SA, Almubarak A, Alanazi H, Health P. Sleep Quality among Healthcare Providers ; In Riyadh , 2019 . family Medicine , Ministry Of health ( MOH ), Saudi Arabia ( SA ). Int J Med Sci Clin Invent. 2019;6(5):4438–48.
Hekimlerde A, Kalitesi U. Sleep Quality and Related Factors in Medical Residents. 2017;11(4):271–7.
Ganasegeran K, Abdulrahman SA, Al-dubai SAR, Perumal M, Renganathan P. Identifying factors associated with sleep disturbances among health workers using WhatsApp in Malaysia. 2017; Vol 1, No 9.
O OO, O AT, Hesham A. Quality of sleep and well‑being of health workers in Najran , Saudi Arabia. Indian J Psychiatry 2017;59347-51.
E. Kolo, A. Ahmed, A Hamisu, A. Ajiya BA. Sleep Health of Healthcare Workers in Kano, Nigeria. Niger j clini Pr. 2017;20:479–83.
Manzar MD, Bekele BB NM. Prevalence of poor sleep quality in the Ethiopian population : A systematic review and meta-analysis Prevalence of poor sleep quality in the Ethiopian population : a systematic review and meta-analysis. Sleep and Breathings. 2020;24(2):709–16.
Madrid-valero JJ, Martínez-selva JM, Ribeiro B, Sánchez-romera JF, Ordo JR. Age and gender effects on the prevalence of poor sleep quality in the adult population. 2017;31(1):18–22.
Aa S, Surani A, Zahid S, Ali S, Farhan R, Surani S. To Assess Sleep Quality among Pakistani Junior Physicians ( House Officers ): A Cross‑sectional Study. 2015; 5(5):329-33.
Berhanu H, Mossie A, Tadesse S, Geleta D. Prevalence and Associated Factors of Sleep Quality among Adults in Jimma Town , Southwest Ethiopia : A Community-Based Cross-Sectional Study. 2018; 22;2018:8342328.
Nazatul SM, Saimy I, Moy FM NA. Prevalence of sleep disturbance among nurses in a Malaysian government hospital and its association with work characteristics. UMMEC. 2008;11(2).
Gómez-garcía T, Ruzafa-martínez M, Fuentelsaz-gallego C, Madrid JA, Rol MA, Martínez-madrid MJ. Nurses ’ sleep quality , work environment and quality of care in the Spanish National Health System : observational study among different shifts. BMJ. 2016;6:1–11.
C. Dai Q huang, P. hu, X. hong, J. Tu, Q.Xie h. li , W. ren S. Ni F chen. The effect of night shift on sleep quality and depressive symptoms among Chinese nurses. Neuropsychiatr Dis Treat. 2019;15:435–40.
Alsaif HI. Prevalence of and risk factors for poor sleep quality among residents in training in KSA. J Taibah Univ Med Sci. 2019;14(1):52–9.
Ali AD, Al-adhroey AH, Al-shammakh AA. A Pilot Community-Based Study on Association of Khat (Catha edulis) Chewing Practice with Psychosis in Yemen. Am J Heal Res. 2015;3(2).;91-96
Jemere T, Mossie A, Berhanu H, Yeshaw Y. Poor sleep quality and its predictors among type 2 diabetes mellitus patients attending Jimma University Medical Center. BMC Res Notes [Internet]. 2019;12, 488.
Thichumpa W, Howteerakul N, Suwannapong N, Tantrakul V. Sleep quality and associated factors among the elderly living in rural Chiang Rai , northern Thailand. Epidemiol Health. 2018;40:1–9.
Huan Liu , Jingjing Liu, Mingxi Chen, Xiao Tan, Tong Zheng, Zheng Kang, Lijun Gao, Mingli Jiao, Ning Ning, Libo Liang, Qunhong Wu YH. Sleep problems of healthcare workers in tertiary hospital and influencing factors identified through a multilevel analysis: a cross-sectional study in China. BMJ Open. 2019;9(12):e032239.
Tan X, Saarinen A, Hospital C, Mikkola TM, Rahikainen A. Effects of exercise and diet interventions on obesity-related sleep disorders in men : study protocol for a randomized controlled trial. Trials. 2013;14:235.
Yang P, Ho K, Chen H, Chien M. Exercise training improves sleep quality in middle-aged and older adults with sleep problems : a systematic review. J Physiother. 2012;58(3):157–63.
Ghalichi L, Pournik O. Sleep Quality among Health Care Workers. 2013; 16(2):100-3.
Spiegel K, Leproult R, Cauter E Van. Early report Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435–40.
Salahuddin M, Maru TT, Kumalo A, Pandi-perumal SR, Bahammam AS, Manzar D. Validation of the Pittsburgh sleep quality index in community dwelling Ethiopian adults. Health Qual Life Outcomes. 2017;15(58):1–7.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index : A New Instrument Psychiatric Practice and Research. El sevier Sci Publ Irel. 1989;28:193-2 I3.
Gebrie MH. An Analysis of Beck Depression Inventory 2 nd Edition ( BDI-II ). Glob J Endocrinol METBOLISM. 2018;2(3):1–5.
Eticha T, Kidane F. The Prevalence of and Factors Associated with Current Smoking among College of Health Sciences Students , Mekelle University in Northern Ethiopia. PLoS One. 2015;9(10):1–6.
Yeshaw Y, Zerihun MF. Khat chewing prevalence and correlates among university staff in Ethiopia : a cross‑sectional study. BMC Res Notes. 2019;12(1):673.
Getachew T, Defar A, Teklie H, Gonfa G, Bekele A, Bekele A. Magnitude and predictors of excessive alcohol use in Ethiopia : Findings from the 2015 national non- communicable diseases STEPS survey. EthiopJ Heal Dev. 2018;31:312–9.
Chien P, Su H, Hsieh P, Siao R, Ling P, Jou H. Sleep Quality among Female Hospital Staff Nurses. Seep Disord. 2013;2013:6.
Dereje D, Mossie A, Abebe S. Sleep quality and its associated factors among nurses in jimma zone public hospitals , Southwest Ethiopia , 2018. Sleep Hypn. 2020;21:292–301.
Haile KK, Asnakew S, Waja T, Kerbih HB. Shift work sleep disorders and associated factors among nurses at federal government hospitals in Ethiopia : a cross-sectional study. 2019; 9(9):e029802
A. Darraj , M. Mahfouz , A Alsabaani , M. Sani AA. Assessment of sleep quality and its predictors among patients with diabetes in Jazan , Saudi Arabia. Diabetes, Metab Syndr Obes Targets Ther. 2018;11:523–31.
Manzar D, Mohammed S, Alamri MS. alcohol , khat , and tobacco smoking in. 2018;13(3).
Patel N. Mechanism of action of cathinone : The active ingredient of Khat ( Catha Edulis. 2000; 77(6):329-32.
Abebe M, Kindie S, Adane K. Family Medicine & Medical Science Research Adverse Health Effects of Khat : A Review.2015; 4(1):1–5.
Karimi S, Soroush A, Abdi A. Surveying the effects of an exercise program on the sleep quality of elderly males. 2016;997–1002.
Hower IM, Harper SA, Buford TW. Circadian Rhythms , Exercise , and Cardiovascular Health. J Circadian Rhythms. 2018;16(1):1–8.
World Health Organization. Global recommendations on physical activity for health. 2010.
Reid KJ, Baron KG, Lu B, Naylor E. in older adults with insomnia. 2011;11(9):934–40.
Dağ B, Kutlu FY. The relationship between sleep quality and depressive symptoms in adolescents. 2017;721–7.
Guo L, Deng J, He Y, Deng X, Huang J, Huang G, et al. Prevalence and correlates of sleep disturbance and depressive symptoms among Chinese adolescents : a cross-sectional survey study. BMJ Open. 2014;4(7):1–9.
Lemma, S., Gelaye, B., Berhane, Y. et al. Sleep quality and its psychological correlates among university students in Ethiopia: a cross-sectional study. BMC Psychiatry.2012; 12(237).
Claustrat B, Chazot G, Bran J, Jordan D, Sassolas G. A Chronobiological Study of Melatonin and Cortisol Secretion in Depressed Subjects : Plasma Melatonin , A Biochemical Marker in Major Depression. 1984;19(8).
Haynes PL, Ancoli-israel S, Mcquaid J, Diego S, Doctoral J, Diego S, et al. ILLUMINATING THE IMPACT OF HABITUAL BEHAVIORS. 2005;22(2):279–97.

No competing interests reported.

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Sleep Deprivation among Health-Care Workers: A Cross-sectional Study at the University of Gondar Comprehensive Specialized Hospital

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Abstract

Introduction

Methods And Materials

Study Design

Study Participants

Sample Size

Data collection methods

Statistical Analysis

Results

Sociodemographic characteristics

Prevalence of sleep deprivation

Factors associated with sleep deprivation healthcare workers

Discussion

Limitations

Conclusion

Declarations

Ethics approval and consent to participate

Consent for publication

Availability of data and materials

Competing interests

Funding

Authors' contributions

Acknowledgements

References

Additional Declarations

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