Review ArticlePrevalence of sleep disturbances in Chinese healthcare professionals: a systematic review and meta-analysis
Introduction
Sleep disturbances, one of the major health problems worldwide, encompass a variety of sleep complaints (eg, poor sleep quality, difficulties in initiating or maintaining sleep, early morning awakening, short or long sleep duration, excessive daytime sleepiness, etc.) [1], [2], [3]. There are a range of epidemiological studies showing that sleep disturbances are quite prevalent in the general population; moreover, the estimates of prevalence vary widely, ranging from 8.3% to 45% worldwide [3], [4], [5], [6].
Sleep is a fundamental human behavior, playing a vital role in maintaining homeostasis and promoting individuals’ physical and mental health. Sleep disturbances are associated with numbers of negative health and social outcomes [7]. It has been suggested that sleep problems were associated with fatigue, low quality of life, poor work performance [7], [8]. Additionally, some studies showed that sleep problems were highly associated with mental disorders [1], [9], [10], metabolic health [11], heart disease [12], and increased risk of mortality [13], [14].
Healthcare professionals, defined as health technicians who have obtained qualifications and worked in a medical institution, included doctors, nurses, and other medical personnel (eg, x-ray technicians) [15], [16]. The medical profession is considered to be a highly stressful occupation with long work hours, frequent night work, and shift duties [17], [18]. Comparing with the general population, healthcare professionals faced high risk of fatigue, burn-out, and appeared to be especially vulnerable to poor sleep [19], [20], [21]. In China, physician workload increased dramatically over the past few years, healthcare professionals suffered particularly heavy occupational stress. A survey conducted by the Chinese Medical Doctor Association reported that over 32% of Chinese healthcare professionals worked more than 60 h per week [22]. Poor sleep is a common phenomenon among Chinese healthcare professionals, which could result in negative personal health outcomes, poor-quality patient care and increased medical errors [1], [23], [24], [25]. However, the prevalence of sleep disturbances among Chinese healthcare professionals varies greatly across studies, ranged from 12.9% to 78% [26], [27]. A reliable estimate is important for informing efforts to prevent, treat, and identify causes of sleep disturbances among Chinese healthcare professionals [25]. In addition, examining the prevalence of sleep disturbances among healthcare professionals is also essential for policymakers taking effective measures to reduce the negative consequences caused by sleep disturbances, and eventually promote the development of health services in China [28].
The current review is a systematic, quantitative meta-analysis aimed at examining the pooled prevalence of sleep disturbances in Chinese healthcare professionals, and to explore the possible causes of the inconsistencies in the current estimates. The findings in this review may be impetus for health policy development in China and may inform the development of future research.
Section snippets
Search strategy
PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wan Fang database and Chinese Science & Technology journal database (VIP) were independently searched by two reviewers, with no restrictions on date or language of publication up until 25 May 2018. The following search terms were used: ‘Chinese’ (including China, Chinese.); ‘healthcare professionals’ (including physician, doctor, nurse, healthcare worker, etc.); and ‘sleep disturbance’ (including insomnia, sleep
Literature search
As shown in Fig. 1, a total of 10,906 references were identified. After excluding duplicates, 6272 articles were screened. After reviewing titles and abstracts, the full text of 230 articles were further shortlisted for eligibility assessment. Among them, 178 studies were excluded due to the following reasons: no data on prevalence (n = 35); duplicate publications (n = 8); convenience-sampling (n = 21); no information on sampling (n = 57) or response rate (n = 25); no data on healthcare
Discussion
This systematic review and meta-analysis appraised and synthesized the evidence on the prevalence of sleep disturbances among Chinese healthcare professionals. A total of 31,749 healthcare professionals in 52 papers were included, of which 14,710 were identified with sleep disturbances. The results showed that the pooled prevalence of sleep disturbances among Chinese healthcare professionals is 39.2% (95% CI: 36.0%–42.7%), which is much higher than the general population in China (9.2%–20.67%)
Conclusion
The pooled prevalence of sleep disturbances among Chinese healthcare professionals is 39.2% (95% CI: 36.0%–42.7%), which is much higher than the general population (9.2%–20.67%) in China. Higher sleep disturbance rates are associated with being female, lower cut-off of PSQI, later survey year, bigger sample size, standardized assessment tool, being a nurse, and shift work. Sample size and cut-off of PSQI were significant moderators for heterogeneity. Further research is needed to identify
Author contributorship
Study design: Dan Qiu, Shui-Yuan Xiao, Yu Yu. Data collection: Dan Qiu, Yu Yu, Rui-Qi Li, Yi-Lu Li. Analysis and interpretation of data: Dan Qiu, Rui-Qi Li, Yi-Lu Li, Shui-Yuan Xiao. Drafting of the manuscript: Dan Qiu, Shui-Yuan Xiao, Yu Yu. Critical revision of the manuscript: Shui-Yuan Xiao, Yu Yu. Approval of the final version for publication: all the authors.
Acknowledgements
This study was supported by China Medical Board for Shui-Yuan Xiao, Central South University, China, as part of the program for improving development of Mental Health Policy in China (CMB14-188). The funding agency did not take part in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
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