|Year : 2017 | Volume
| Issue : 3 | Page : 168-173
Sleep quality among nurses in a tertiary hospital in North-West Nigeria
Ibrahim Aliyu1, Zainab F Ibrahim2, Lawal O Teslim3, Helen Okhiwu4, Igoche David Peter5, Godpower Chinedu Michael6
1 Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
2 Department of Nursing, Aminu Kano Teaching Hospital, Kano, Nigeria
3 Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
4 Department of Paediatrics, University of Jos Teaching Hospital, JOS, Nigeria
5 Department of Paediatrics, Aminu Kano Teaching Hospital, Kano, Nigeria
6 Department of Family Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||30-Oct-2017|
Department of Paediatrics, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
Background: Sleep is a necessity; it is nourishing, refreshing and healing. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. There is a dearth of local data on sleep disorders, especially among nurses. In this study, we evaluated the quality of sleep and the tendency of daytime sleepiness among nurses. Subjects and Methods: This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre Birnin Kebbi, Kebbi State; the study was carried out between October 2016 and February 2017. The Pittsburg Sleep Quality Index was used to determine poor sleepers; while the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness; 0–7 was considered normal, 8–9 represented average tendency of daytime sleepiness, 10–15 represented excessive daytime sleepiness, while 16–24 represented daytime sleepiness requiring medical intervention. P < 0.05 was set as statistically significant. Results: There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1. The age range was 18–50 years, with a mean age of 31.4 ± 8.6 years. The ESS score ranged from 0.0–17.0, with a mean score of 7.3 ± 3.5; while the Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7, and 61% of the nurses had a poor sleep quality. There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant (χ2 = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25–40-year-old group but this observation was also not statistically significant (χ2 = 2.259, df = 2, P = 0.334). Conclusion: Poor sleep quality is a problem among nurses, though less tendency to daytime sleepiness was observed in this report.
Keywords: Excessive sleepiness, poor sleep quality, sleep quality
|How to cite this article:|
Aliyu I, Ibrahim ZF, Teslim LO, Okhiwu H, Peter ID, Michael GC. Sleep quality among nurses in a tertiary hospital in North-West Nigeria. Niger Postgrad Med J 2017;24:168-73
|How to cite this URL:|
Aliyu I, Ibrahim ZF, Teslim LO, Okhiwu H, Peter ID, Michael GC. Sleep quality among nurses in a tertiary hospital in North-West Nigeria. Niger Postgrad Med J [serial online] 2017 [cited 2023 Mar 30];24:168-73. Available from: https://www.npmj.org/text.asp?2017/24/3/168/217405
| Introduction|| |
Sleep is a necessity; it is nourishing, refreshing and healing. Different ages have their tailored sleep pattern, structure and duration; the average sleep duration is 9–9.25 h in adolescents  while the average duration of sleep in adults is estimated to be between 7 and 8 h. Chinawa et al. in Southeastern and Oluwole  in Southwestern Nigeria reported average sleep duration of 6–7 h among undergraduates. The nursing profession is associated with busy and difficult work schedules, especially the running of shifts which has been associated with cardiovascular and metabolic complications. Health facilities in most developing countries are highly understaffed; therefore, nurses may be made to run more shifts than necessary, hence more stress and tendencies for error. This will be particularly alarming in nurses whose primary responsibility is to care for the sick; this is based on the delicate nature of their job which gives no room for mistakes, especially in times of decision-making and drug calculation and administration. Therefore, dysfunctional sleep patterns in them may result in excessive daytime sleepiness, associated with frequent nocturnal awakenings, impaired neurocognitive and psychomotor performance and poor judgement. The prevalence of sleep-related disorder among nurses has been variedly reported in different regions; Nazatul et al. reported a poor sleep quality of 57.8%, among nurses in Malaysian Hospitals. Chien et al. reported a prevalence of poor sleep quality of 75.8% of Chinese nurses; however, there is a dearth of local data on sleep disorders, especially among nurses. It is against this background that this study seeks to evaluate the quality of sleep among nurses. This study, therefore, hopes to determine and also the tendency of daytime sleepiness among nurses.
| Subjects and Methods|| |
This study was cross-sectional in nature involving 100 nurses working with Federal Medical Centre (FMC) Birnin Kebbi, Kebbi State; it was done between October 2016 and February 2017. Purposive sampling method was adopted. Using a poor quality sleep prevalence of 75.8% among nurses as reported by Chien et al., a sample size of 282 was calculated, and for a population <10,000 (N/1 + N/n), the sample size of 97.9 was calculated which was increased to 100 (target population of 150 nurses). All nurses who worked at FMC Birnin Kebbi were included in this study; however, nurses who were on annual/study leave at the time of this study and those with a known history of chronic illness such as diabetes mellitus and asthma that could affect sleep parameters or who were <1 month at work in the department and those who declined were excluded from the study.
The pittsburgh sleep quality index
PSQI was developed by Buysse et al. and also validated in Nigeria by Oshinaike et al. A PSQI total score >5 was considered diagnostic of poor sleep quality, and the Epworth Sleepiness Scale (ESS) was adopted to determine the presence of tendency of daytime sleepiness among the respondents; the results were interpreted as follows: 0–7 was considered normal, 8–9 was considered average tendency of daytime sleepiness, 10–15 meant the presence of excessive daytime sleepiness, while 16–24 represented daytime sleepiness requiring medical intervention. These scales were pretested among 15 selected nurses to ensure that the contents were understood.
Ethical approval was obtained from the Research Ethical Committee of FMC Birnin Kebbi on 30th August 2016 (protocol number: FMC/BK/HP/045/P/403/VOL. III). Informed consent was obtained from the study participants after a careful explanation of the research, and a self-administered questionnaire was then given.
Obtained data were entered into Statistical Package for the Social Sciences (IBM Inc. Armonk, New York, United States of America) version 20. The staffs' cadre, years of working experience, hours of work shift and hours of sleep were summarised using frequency tables and mean. The Chi-squared and Fisher's exact tests were deployed to compare categorical variables such as years of working experience with the tendency to daytime sleepiness and work hours with PSQI score, respectively, with P < 0.05 being set as statistically significant.
| Results|| |
There were 23 (23%) males and 77 (77%) females, with a male-to-female ratio of 0.3:1.
The age range was 18–50 years, with a mean age of 31.4 ± 8.6 years; age was classified into three age groups, namely; <25 years (22, 22%), 25–40 years (63, 63%) and >40 years (15, 15%).
[Table 1] shows that majority of the respondents were of the junior cadre (75%); their working hours ranged between 10 and 160 h in a week with a mean value of 46.0 ± 19.4 h; however, most of them work for 56 (88%) or less hours in a week and most had 5 years (63%) or less of working experience. Most of the respondents did not have the tendency of daytime sleepiness (53%); however, 61% of the respondents had poor sleep quality [Table 1].
|Table 1: Frequency distribution of the cadre, working hours, years of working experience and sleep quality of the respondents|
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The Pittsburg score ranged between 1 and 15, with a mean score of 5.7 ± 2.7. It took between 1 and 60 min, with a mean value of 21.7 ± 15.8 min for the respondents to fall asleep (sleep latency), and the sleeping hours' (sleep duration) range was between 1 and 10 h, with a mean of 6.2 ± 1.5. This study showed that respondents with poor sleep quality had higher mean sleep quality and latency [Table 2].
|Table 2: Expanded component of the Pittsburg Sleep Quality Index score of the respondents|
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The ESS score ranged from 0.0 to 17.0, with a mean score of 7.3 ± 3.5. Fifty-three respondents were consistently unlikely to have daytime sleepiness in all the components of ESS [Table 3].
|Table 3: Expanded component of Epworth Sleepiness Scale score of the respondents|
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The years of working experience had no statistically significant relationship with the tendency to be sleepy (‡χ2 = 11.841, P = 0.580) [Table 4] though more of those who had working experience of 5 years or less had tendency of excessive sleepiness, but the only case who needed medical help had worked for >20 years. However, poor sleep quality was most prevalent among those who had 5 years or less working experience; however, this observation was statistically significant (†χ2 = 10.787, P = 0.021). Similarly, the duty type had no statistical relationship to daytime excessive sleepiness ($χ2 = 1.409, P = 0.731), but there was a significant association with the sleep quality which was observed to be poor mostly in those with shift-based duty schedules (§χ2 = 4.786, df = 1, P = 0.046). Majority of the respondents sleep for <7 h in a day; however, most of them (39) were unlikely to be sleepy during their daily routines. Furthermore, the only reported case that needed medical help was of this category. However, this observation was not statistically significant ($$χ2 = 4.585, P = 0.174). Poor sleep quality was seen mostly among respondents who slept for <7 h and this observation was statistically significant (§§χ2 = 7.450, df = 1, P = 0.006). [Table 4] also shows that majority of those who work for 56 h or less were unlikely to be sleepy but this observation was not statistically significant (‡‡χ2 = 2.804, P = 0.428); however, poor sleep quality was prevalent among this group when compared with those who work for >56 h and this was statistically significant (††χ2 = 4.388, df = 1, P = 0.039). There was unlikely tendency of excessive sleepiness across all the age groups, though this was not statistically significant ($$$χ2 = 7.258, P = 0.283), and poor sleep quality was most prevalent among the 25–40-year-old group but this observation was not statistically significant (§§§χ2 = 2.259, df = 2, P = 0.334).
|Table 4: Job characteristics of the respondents and its relationship with the Epworth Sleepiness Scale and Pittsburg Sleep Quality Index scores|
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Majority of the respondents across the age groups worked for <56 h in a week; however, the ESS scores were predominately favourable for the age groups; though these were not statistically significant (χ2 = 1.833, P = 0.40; χ2 = 3.063, P = 0.17; χ2 = 1.224, P = 0.75 for the <25 years, 25–40 years and >40 years, respectively); furthermore, there were predominately poor sleepers in those working <56 h in a week; though these observations were not statistically significant. These were not statistically significant (χ2 = 5.867, P = 0.07; χ2 = 2.010 P = 0.14; χ2 = 0.536, P = 0.67 for the <25 years, 25–40 years and > 40 years, respectively) [Table 5].
|Table 5: Comparing age stratification and working hours with the Epworth Sleepiness Scale scores and Pittsburg scores|
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The ESS and the Pittsburg scores poorly correlated among the respondents; the Pearson correlation coefficient was r = 0.184, P = 0.07.
[Table 6] shows that those who work in the surgery department had more tendency for excessive daytime sleepiness followed by those in paediatric department; however, only one respondent needed medical intervention; but in the overall assessment, most of the respondents were unlikely to be sleepy; however, this observation was not statistically significant (‡χ2 = 16.890, P = 0.111). Poor sleep quality was observed in majority of the respondents from all the departments; however, those in Obstetrics and Gynaecology had equal representation of those with good and poor sleep quality while those from non-shift category had better sleep quality; this finding was reported to be statistically significant (†χ2 = 12.867, df = 4, P = 0.010). Among the core clinical departments, over 50% of the nurses in the departments of Medicine, Obstetrics and Gynaecology and Paediatrics were unlikely to have daytime sleepiness except surgery which had most unfavourable ESS score but this was not statistically significant (‡‡χ2 = 14.708, P = 0.060); however, poor sleep quality was noticeable among all core clinical departments, this observation was statistically significant (††χ2 = 8.651, df = 3, 0.034).
|Table 6: Comparing the influence of department on the Epworth Sleepiness Scale and Pittsburg scores of the respondents|
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| Discussion|| |
The mean sleep latency amongst nurses in this study was slightly higher than that of the study by Chien et al., but we documented similar sleep duration. However, our sleep latency was higher than that of the finding of Lajoie et al. The mean ESS in this study was 7.3 ± 3.5 which was similar to that reported by Flo et al. among health workers without shift work disorder (SWD); however, our finding was higher than the 9.5 ± 3.9 reported by Flo et al. in individuals with SWD. Therefore, there was lower tendency of sleepiness among our respondents. Sixty-one percentage of our respondents were poor sleepers; this observation was similar to that of Hasson and Gustavsson  who reported progressive decline in sleep quality among nurses from their last years of training; this is higher than 33% reported by Kunzweiler et al. but lower than the 85% reported by Zamanian et al.
Extended work shift is becoming prevalent in most developing countries; 12-h shift is increasingly being experienced, setting aside the traditional 8-h shift; as a policy and on a larger scale, we still maintain the traditional 8-h shift in our hospitals. However instances of few extended shifts are still noticeable, and there was no significant relationship between working hours and the tendency of daytime sleepiness or the quality of sleep in our study. Similarly, age was not a significant factor in daytime sleepiness or the quality of sleep; unlike the report of Menon et al. which reported more daytime sleepiness and poor sleep quality among the older nurses.
Respondents in the core clinical departments of medicine, surgery and paediatrics had poor sleep quality; this may be attributed to the burden and stress associated with shift schedules, though this was not associated with predominant tendency to daytime sleepiness. This is a departure from the submission of Menon et al. who related poor sleep quality and excessive daytime sleepiness with sleep debt. However, the impact of department on sleep quality should be interpreted with caution because the influence of previous departmental rotations on their sleep quality cannot be completely ruled out; this was not investigated in this study, therefore it is considered a limitation. The absence of predominant daytime sleepiness in our study may be related to their job description; usually in our hospital, nurses are given 7 days' off duty after a 7-day night duty and 3 days' off duty after a 7-day afternoon duty (2 pm–7 pm) schedules; therefore, this may allow for correction of any possibly incurred sleep debt. Shift work may adversely affect sleep and work performance resulting in medical errors. Thirty percentage (23/78) of the respondents in our study who were on shift duties had more daytime sleepiness tendencies; similarly more of them had poor sleep quality. Our result was lower than the 62% reported by Nazatul et al. Years of working experience was not a predominant factor in the sleep quality or the tendency for daytime sleepiness in our study; this observation was similar to that of Chien et al.
Our study showed that the mean sleep quality and sleep latency were lower in the good sleeper group, this observation was also reported by Oshinaike et al. The correlation between ESS and PSQI scores was poor in this study; this observation was similar to that reported by Mondal et al. Why this is so is not completely understood; however while the ESS evaluates the tendency to daytime sleepiness using eight parameters relating to common daytime activities, the PSQI evaluates predominately the sleep quality but only a single parameter evaluates daytime dysfunction.
Some limitations were identifiable in this study; being a single-centre study makes generalisation of findings to other health facility a limitation. Variation in staff strength among hospitals which results in differences in frequency of work shift and the sampling method adopted is another limitation identified. Furthermore, the ESS and PSQI scores were based on the subjects self-report, therefore bias cannot be completely ruled out; the objective measure of sleepiness remains measuring sleep latency by multiple sleep latency test (MSLT). However, several investigators have documented correlations between ESS and MSLT-defined sleepiness., Furthermore, this study which is similar to that of Chien et al. did not emphasise on the type of work shift practiced in our institution which makes comparison with experiences in other institutions challenging. Therefore, this may form the focus of further studies.
| Conclusion|| |
Poor sleep quality is a problem among nurses. Though less tendency to daytime sleepiness was observed in this report, there is still the need to improve on the job schedules of nurses such as shorter shifting hours.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mindell JA, Owens JA, Carskadon MA. Developmental features of sleep. Child Adolesc Psychiatr Clin N
Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic disease in older adults: Results of the 2003 National Sleep Foundation Sleep in America Survey. J Psychosom Res 2004;56:497-502.
Chinawa JM, Chukwu BF, Obu HA. Sleep practices among medical students in Pediatrics Department of University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria. Niger J Clin Pract 2014;17:232-6.
] [Full text]
Oluwole OS. Sleep habits in Nigerian undergraduates. Acta Neurol Scand 2010;121:1-6.
Lajoie P, Aronson KJ, Day A, Tranmer J. A cross-sectional study of shift work, sleep quality and cardiometabolic risk in female hospital employees. BMJ Open 2015;5:e007327.
Knutson KL, Spiegel K, Penev P, Van Cauter E. The metabolic consequences of sleep deprivation. Sleep Med Rev 2007;11:163-78.
Gaba DM, Howard SK. Patient safety: Fatigue among clinicians and the safety of patients. N
Engl J Med 2002;347:1249-55.
Rocha FL, Guerra HL, Lima-Costa MF. Prevalence of insomnia and associated socio-demographic factors in a Brazilian community: The Bambuí study. Sleep Med 2002;3:121-6.
Nazatul SM, Saimy I, Moy FM, Nabila AS. Prevalence of sleep disturbance among nurses in a Malaysian government hospital and its association with work characteristics. JUMMEC 2008;11:66-71.
Chien PL, Su HF, Hsieh PC, Siao RY, Ling PY, Jou HJ, et al.
Sleep quality among female hospital staff nurses. Sleep Disord 2013;2013:283490.
Buysse DJ, Reynolds CF 3rd
, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
Oshinaike O, Akinbami A, Ojelabi O, Dada A, Dosunmu A, John Olabode S, et al.
Quality of sleep in an HIV population on antiretroviral therapy at an urban tertiary centre in Lagos, Nigeria. Neurol Res Int 2014;2014:298703.
Johns MW. A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep 1991;14:540-5.
Flo E, Pallesen S, Magerøy N, Moen BE, Grønli J, Hilde Nordhus I, et al.
Shift work disorder in nurses – Assessment, prevalence and related health problems. PLoS One 2012;7:e33981.
Hasson D, Gustavsson P. Declining sleep quality among nurses: A population-based four-year longitudinal study on the transition from nursing education to working life. PLoS One 2010;5:e14265.
Kunzweiler K, Voigt K, Kugler J, Hirsch K, Bergmann A, Riemenschneider H, et al.
Factors influencing sleep quality among nursing staff: Results of a cross sectional study. Appl Nurs Res 2016;32:241-4.
Zamanian Z, Nikeghbal K, Khajehnasiri F. Influence of sleep on quality of life among hospital nurses. Electron Physician 2016;8:1811-6.
Geiger-Brown J, Trinkoff AM. Is it time to pull the plug on 12-hour shifts?: Part 1. The evidence. J Nurs Adm 2010;40:100-2.
Menon B, Karishma HP, Mamatha IV. Sleep quality and health complaints among nursing students. Ann Indian Acad Neurol 2015;18:363-4.
] [Full text]
Mondal P, Gjevre JA, Taylor-Gjevre RM, Lim HJ. Relationship between the Pittsburgh Sleep Quality Index and the Epworth Sleepiness scale in a sleep laboratory referral population. Nat Sci Sleep 2013;5:15-21.
Reynolds CF 3rd
, Coble PA, Kupfer DJ, Holzer BC. Application of the multiple sleep latency test in disorders of excessive sleepiness. Electroencephalogr Clin Neurophysiol 1982;53:443-52.
Chervin RD, Aldrich MS. The Epworth sleepiness scale may not reflect objective measures of sleepiness or sleep apnea. Neurology 1999;52:125-31.
Aurora RN, Caffo B, Crainiceanu C, Punjabi NM. Correlating subjective and objective sleepiness: Revisiting the association using survival analysis. Sleep 2011;34:1707-14.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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