Multivariate robust Poisson regression models suggested that night shift (PR = 1.95, p < 0.05) and single marital status (PR = 2.25, p < 0.05) were significantly associated with increased prevalence of short sleep duration, after adjustment for age, weight, childcare, MSDs, depression, psychological demands, and intention to turnover (see Table 2). After adjustment for covariates, none of the work and health variables showed significant associations with poor sleep quality.
The study also reported a significant association between single marital status and short sleep duration. This is consistent with previous findings. The association between single marital status and short sleep duration has been reported in a large population study with Finnish adults (Lallukka et al., 2012). Another large population study of adults from Korea reported that being unmarried, including single and widowed/divorced status, was associated with abnormal sleep duration (Yoon et al., 2015).
On the other hand, the study found that MSDs, higher weight, and childcare responsibilities were associated with short sleep duration in the bivariate analyses, although these associations disappeared after adjusting for covariates. There may be a bidirectional relationship between sleep and MSDs (Koffel et al., 2016). Compromised or disrupted sleep is a known consequence of chronic pain (Kelly, Blake, Power, O'Keeffe, & Fullen, 2011), and individuals with MSDs that interfere with sleep are reported to perceive pain as more intense and have worse musculoskeletal outcomes (Schrimpf et al., 2015; Takahashi et al., 2015). Previous studies have reported associations between overweight/obesity and short sleep duration (Cappuccio et al., 2008; Wu, Zhai, & Zhang, 2014). Nurses, as informal caregivers of their own families, often sacrifice their sleep hours voluntarily to take care of their children and dependents, which explains the possible association between childcare responsibilities and short sleep duration.
Although the study had a small sample size, it received good response rate (71%) from the target population. The study is innovative because it assessed the associations between a comprehensive range of work and health variables with poor sleep outcomes and considered potential confounders in data analyses. There are several limitations. The generalizability of the results may be limited because all participants belong to a Northeastern State Correctional Healthcare System; therefore, the results may not be generalizable to other correctional healthcare systems in other states. The study was based on self-reported data on work, health, and sleep outcomes, causing potential recall and reporting bias. Because of the challenges of assessing a wide range of work, health, and sleep outcomes, the measurement of sleep lacked the use of a standard scale and the measurement of other variables used selected items from standard instruments, which may threaten the internal validity of the study (Polit & Beck, 2014). In addition, the cross-sectional design does not allow us to draw causal relationships; future analyses of longitudinal data will be needed to verify the study findings.
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