RGUHS Nat. J. Pub. Heal. Sci Vol No: 9 Issue No: 1 eISSN: 2584-0460 pISSN:
Dr Ranganath T S1, Dr. Iswarya2 , Mr.Vishwanatha3 , Dr. Riya2 ,Dr.Annandaneshwari2 , Dr.Mithun2 , Dr.Shwetha2 .
1: Professor and Head Of the Department 2: Post- graduate student, 3. Statistician:, Department of Community Medicine,Bangalore Medical College and Research Institute,Bangalore, Karnataka -560002
Address for correspondence:
Dr Iswarya Partheeban
Post-graduate, Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore. Email:ispaa2010@gmail.com
Date of Receiving: 15/11/2020 Date of Acceptance: 20/12/2020
Abstract
Background: Sleep deprivation can be defined as “obtaining inadequate sleep to support adequate daytime alertness”. Healthcare workers being the frontline warriors of COVID-19 may have quality of sleep compromised in those who are frequently involved in extended working hours and shift work which is found to be more common among nurses.
Objectives: To assess sleep deprivation among the staff nurses working for COVID night shift in rotation in tertiary care hospitals in Bengaluru and to determine the factors causing sleep deprivation among them.
Methodology: The present crosssectional study was undertaken in tertiary care hospitals of Bengaluru by involving175 participants. A pre-validated questionnaire Epworth Sleepiness Scale along with details on socio-demographic profile was self-administered for the study using Google forms.
Results: Out of the 175 participants surveyed, majority of the study participants were male nursing staff (99, 57%). Poor sleep quality (ESS score>5) was observed among 61% of night shift working nurses, of which majority were belonging to the Higher normal daytime sleepiness (30%) group. The mean ESS scores obtained is 9.26±3.9.
Conclusions: This study cited the frequency of sleep deprivation according to ESS scores and factors like thirst, hunger, stress, odd duty timings in the night as the factors which affect their sleep.
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Introduction
Sleep is a vital process of human life. According to the National health portal (NHP) India; “Like good eating, drinking and breathing habits; good sleeping habit and adequate duration of sleep are key factors of a healthy lifestyle”1.The Ministry of Health and Family Welfare, Govt. of India harmonizes with the Centers for Disease Control and Prevention (CDC) United States of America, on its consideration of sleep deprivation disorders as a public health epidemic1,2. Sleep loss is often accompanied by disorders in cognitive and psychomotor function comprising mood, memory, thinking capacity, focus/ concentration, learning ability, vigilance and reaction time.3,4 The toxic aftermath of sleep deprivation on cognitive ability seems to materialize from interaction between the task environment and specific derangements in components of cognitive functioning.5 Sleep deprivation and altered circadian rhythm lead to fatigability,6 decline in attention and deteriorating mental health status which in turn affects their quality of life. The compromise on sleep is an even worse issue among the healthcare professionals. Starting from college days all through to their professional days, sleep is more than often questioned by stress, anxiety, emotional disturbances and late working hours or night shifts. Both sleep deprivation and disruption of circadian phase are undergone during rotating night shift work and are both independently and cumulatively related to recurrent lapses of attention and increased reaction time, resulting in increased error rates on task performance.7 The role of healthcare workers in preservation of patient safety and prevention of harm during the provision of care in both short-term and long-term care settings is extremely vital.8 This study was conducted to assess sleep deprivation among staff nurses working in COVID duty in night shifts in tertiary care hospitals of Bengaluru and the factors causing them.
Materials and methods
The present hospital based cross-sectional study was undertaken in the tertiary care hospitals of Bangalore from October 2020 to November 2020 after getting clearance from institutional ethics committee (IEC). The study was carried out among 175 staff nurses after calculating the sample size based on a study conducted by Kaliyaperumal et al9 who were working in COVID duty in night shift by simple random sampling method by lottery method. After obtaining informed consent, data regarding socio-demographic details, sleep pattern, diet history, exercise history, substance use, factors affecting sleep deprivation were collected using a pre-tested, semi-structured questionnaire and the Epsworth sleepiness scale was used to assess sleep deprivation and day time sleepiness. The data was collected using a semi-structured pre-validated questionnaire by Google forms which were circulated through Whatsapp. The data was entered in MS Office Excel and analyzed using SPSS software ver. 20.0. P-value of <0.05 was considered statistically significant.
Results
In this study, out of 175 subjects, 76 (43.8%) were females and 99 (56.3%) were males.71% i.e. 124 subjects were aged between 31 to 40 years and 77.8% (n=136) were married. 56.8% (n=99) were graduates, 54% (n=94) were following a mixed diet whereas 20%(n=35) were following a vegetarian diet and majority of the study participants 54.5%(n=95) did physical exercise occasionally. The study participants were interviewed regarding the hours of sleep in daytime and night time for which 77% of the study participants(n=134) slept for less than 2 hours in the daytime and 46% (n=80) slept for 6-8 hours in the night time (as mentioned in figure 1 and figure 2 respectively).4%(n=7) of the study participants had history of smoking, 16% (n=27) had history of alcohol use, 1%(n=3) had history of both alcohol and smoking and the 79%(n=138) had no history of substance use.90.3% (n=158) had undergone training for donning and doffing of PPE of which 73.3% (n=128) reported that working in PPE affected their sleep. The mean ESS scores was calculated as9.26 ± 3.9 (from figure 3).The maximum frequency of the study participants (n=68) 39% had obtained ESS scores of 0-5which implies lower normal daytime sleepiness and ESS scores of 6-10 which implies higher normal daytime sleepiness were obtained by 30%(n=52) of the study population.
Discussion
The present study was conducted to assess the sleep deprivation and the factors causing it among staff nurses working in COVID duty in night shift in tertiary care hospitals of Bengaluru and the factors causing them. This study has taken into account the demographic details, personal history which consists of diet history, exercise history, numbers of hours of sleep in daytime and night time and the Epsworth sleepiness scale of which majority of the participants were found to have mild normal daytime sleepiness.
To assess if wearing PPE affected their sleep, the participants were asked if they had undergone training for donning and doffing of PPE and if they had undergone training for sleep hygiene. The factors which were likely to cause sleep deprivation in the study population is as shown in figure 4.
The limitation of the study is that in spite of there being many scales for assessing sleep quality like Montreal cognitive assessment scale, Stanford sleepiness scale, Pittsburgh sleep quality index only ESS was used because the study involved collecting the data online from the study population by Google forms and the usage of these scales involves assessment of cognitive also in person.Since the study population consisted of staff nurses in COVID duty and the assessment of cognition required meeting them in person which is beyond the scope of the study.
Conclusions
In the present study, high burden of sleep deprivation is noted among the staff nurses which might lead to cognitive impairment in future. The factors like odd duty hours in night, stress, dehydration, thirst, hunger and working in PPE were the likely causes to cause sleep deprivation
Supporting Files
References
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