Annals of Occupational and Environmental Medicine

Original Articles

Mediation analysis of chronotype, sleep-related factors, and depressive symptoms among workers: a cross-sectional study: Seo Young Kim, Hyo Jeong Kim, Seong-Sik Cho, Min Young Park, Mo-Yeol Kang; Ann Occup Environ Med 2023;35:e47. Published online November 20, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e47

Abstract Abstract in Korean PDF Supplementary Material PubReader ePub: Background
This study aimed to examine the impact of chronotype on depressive symptoms and explore the mediating effects of sleep quality, pre-sleep cognitive arousal, and social jetlag in a sample of wage earners.
Methods
A total of 3,917 waged workers were surveyed online in July 2022. Logistic regression and mediation analysis were used to assess the relationship between chronotype (morningness, intermediate, and eveningness) and depressive symptoms (Patient Health Questionnaire ≥ 5), and the mediating effects of Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Pre-Sleep Arousal Scale (PSAS). All analyses were adjusted for age, education level, income level, marital status, coffee consumption, alcohol consumption, physical activity, occupation, employment status, and working hours to calculate odds ratios (ORs).
Results
The chronotypes of all the participants were divided into morningness (4.7%), intermediate (93.5%), and eveningness (1.8%). Multiple logistic regression analysis showed an increased risk of depression in the eveningness chronotype (OR: 2.96; 95% confidence interval [CI]: 1.51, 5.86). Regarding the mediation analysis, ISI mediated 28.44% (95% CI: 16.39–40.5), PSQI for 31.25% (95% CI: 19.36, 43.15), and PSAS-Cognitive Score (PSAS-C) for 23.58% (95% CI: 10.66, 36.50) of the association between chronotype and depressive symptoms. However, social jetlag did not significantly mediate this relationship. (percentage mediated = 0.75%, 95% CI: −3.88, 5.39)
Conclusions
Evening chronotypes exhibit an increased risk of depressive symptoms, which ISI, PSQI, and PSAS-C partially mediated. This suggests that interventions to improve sleep quality and maintain adequate sleep habits may effectively prevent and treat depression in employees with an eveningness chronotype.; 직장인의 크로노타입이 우울 증상에 미치는 영향과 수면 관련 요인의 매개 분석
목적
본 연구는 국내 임금 근로자를 대상으로 크로노타입이 우울 증상에 미치는 영향과 수면의 질, 수면 전 인지적 각성, 사회적 시차 등의 매개 효과에 대해 분석하고자 한다.
방법
2022년 7월 온라인 설문조사를 통해 모집한 만 19세 이상의 임금 근로자 3917명을 대상으로 분석을 시행하였다. 로지스틱 회귀분석으로 성별을 층화하여 크로노타입 (아침형, 중간형, 저녁형)과 우울증상 간의 관계를 살펴본 후, 매개효과 분석을 통해 불면척도, 수면의 질, 수면 전 각성 척도, 사회적 시차의 각각의 우울 증상에 대한 매개 효과를 계산했다. 모든 분석은 연령, 교육수준, 소득, 결혼 여부, 동거인 여부, 커피, 흡연, 음주, 신체활동, 직종, 고용형태, 근무 시간을 보정하였다.
결과
참가자는 아침형(4.7%), 중간형(93.5%), 저녁형(1.8%)으로 나뉘었다. 인구사회학적 특성 및 업무 관련 요인을 통제한 다중 로지스틱 회귀분석 결과, 저녁형 그룹에서 우울증상 오즈비는 2.95 (95% 신뢰구간: 1.51–5.86)로 아침형 그룹에 비해 높게 나타났다. 매개 분석 결과에서 불면 척도는 28.44% (95% 신뢰구간 16.39–40.5), 수면의 질은 31.25% (95% 신뢰구간 19.36–43.15), 수면 전 인지적 각성척도은 23.58% (95% 신뢰구간 10.66–36.50)를 매개하였다. 그러나 사회적 시차는 매개 효과가 0.75% (95% 신뢰구간 -3.88–5.39)로 유의하지 않은 것으로 나타났다.
결론
본 연구 결과에 따르면 저녁형 크로노타입을 가진 근로자들이 아침형 근로자보다 우울증상의 위험도가 증가하는 것으로 나타났으며, 이에 대한 매개 효과 분석에서는 불면 척도, 수면의 질과 수면 전 인지적 각성이 우울 증상을 부분적으로 매개하는 것으로 나타났다. 이는 저녁형 크로노타입 근로자들과 같은 우울증의 상대적 고위험군에서 수면의 질을 개선하고 수면 습관을 적절히 유지하도록 개입하는 것이 우울증의 예방 및 치료에 효과적일 수 있음을 시사한다.

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Association between sleep quality and type of shift work in Korean firefighters: Hyun-Jeong Oh, Chang Sun Sim, Tae-Won Jang, Yeon Soon Ahn, Kyoung Sook Jeong; Ann Occup Environ Med 2022;34:e27. Published online October 11, 2022; DOI: https://doi.org/10.35371/aoem.2022.34.e27

Abstract Abstract in Korean PDF PubReader ePub

Background

Shift work that interferes with normal sleep patterns, is known to be a cause of sleep disturbance and has been studied through various occupational groups. However, it is not known which shift type is better for sleep health.

Methods

This study included 568 firefighters. Sleep quality was evaluated using Pittsburgh Sleep Quality Index. Sleep quality was categorized into 2 groups; good quality (≤ 5 points) and poor quality (≥ 6 points). Demographic variables, depression, anxiety, type of shift, and job were collected by self-reported questionnaires. The χ² test, t-test, and multiple logistic regression analysis were used to evaluate the effect of shift type on the sleep quality of firefighters.

Results

Three hundred thirty-seven firefighters (59.3%) have poor sleep quality. Compared to day workers, the odds ratios (ORs) of poor sleep quality were 2.169 (95% confidence interval: 1.137–4.134) in 6-day cycle, 2.161 (1.150–4.062) in 9-day cycle, 1.805 (1.087–2.997) in 21-day cycle, and 1.485 (0.718–3.069) in 3-day cycle. The ORs of poor sleep quality were 1.697(1.021–2.823) in fire suppression and 2.325 (1.213–4.455) in emergency medical service compared to administration.

Conclusions

All shift work type except for the 3-day cycle was associated with poor sleep quality compared to day work.

한국 소방관에서 수면의 질과 교대근무 유형의 연관성
목적
소방관의 수면의 질에 어떤 교대근무 유형이 적합한지 결정하는 것이다.
방법
이 연구는 568명의 소방관을 포함하여 피츠버그 수면의 질 지수를 사용하여 수면의 질을 평가하였고, 다른 교란 요인은 자기보고형태의 설문지를 통해 수집하였다. 소방관의 수면의 질에 대한 교대근무 유형의 영향을 평가하기 위하여 카이제곱 검정, t-검정, 다중 로지스틱 회귀 분석을 사용하였다.
결과
337명(59.3%)은 나쁜 수면의 질을 가졌다. 주간 근무자와 비교했을 때, 나쁜 수면의 질에 대한 오즈비는 6주기에서 2.161 (95% 신뢰구간 1.137-4.134), 9주기에서 2.161 (1.150-4.062), 21주기에서 1.805 (1.087-2.997), 3주기에서 1.485 (0.718-3.069). 직무별로는 행정에 비해 화재진압 소방관의 수면의 질이 나쁠 오즈비는 1.697 (1.021-2.823)이었고, 구급업무 소방관은 2.325 (1.213-4.455)이었다.
결론
3주기를 제외하고 다른 형태의 교대근무에서 수면의 질은 주간근무에 비해 에서 나쁜 것으로 나타났다.

Citations

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Association of age and night flight duration with sleep disorders among Chinese airline pilots
Ruizi Shi, Fang Wang, Wanying Xu, Li Fu
Frontiers in Public Health.2023;[Epub] CrossRef
Working hours and the regulations for night shift workers
Tae-Won Jang
Annals of Occupational and Environmental Medicine.2023;[Epub] CrossRef

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Research Articles

Psychosocial factors affecting sleep quality of pre-employed firefighters: a cross-sectional study: MyeongSeob Lim, Solam Lee, Kwanghyun Seo, Hyun-Jeong Oh, Ji-Su Shin, Sung-Kyung Kim, Hee-Tae Kang, Kyeong-Sook Jeong, Sung-Soo Oh, Sang-Baek Koh, Yeon-Soon Ahn; Ann Occup Environ Med 2020;32:e12. Published online May 8, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e12

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Background

There have been no health-related studies of pre-employed firefighters without firefighter-specific job-related factors (FSJRF). This study aimed to evaluate the sleep quality of pre-employed firefighters and to examine the relationship between sleep quality and psychosocial factors.

Methods

We conducted a self-report questionnaire survey for 602 pre-employed firefighters at 3 Fire Service Academies after brief lecture about sleep. Sleep quality and psychosocial variables such as depression, anxiety, stress and social support were evaluated. The independent 2 sample t-test, χ² test and multiple logistic regression analysis were used to evaluate the effect of the variables on the sleep quality of pre-employed firefighters.

Results

Among a total of 602 people, 347 (57.6%) had good sleep quality and 255 (42.4%) had poor sleep quality. Pittsburgh Sleep Quality Index score of them was 3.29 ± 1.41) and 7.87 ± 2.20), respectively. 24 (4.0%) were evaluated to have insomnia by Insomnia Severity Index. Logistic regression analyses showed that the depression (adjusted odds ratio [aOR]: 5.940, 95% confidence interval [CI]: 3.124–11.292), anxiety (aOR: 4.233, 95% CI: 2.138–8.381), stress (aOR: 2.880, 95% CI: 1.915–4.330) and social support (aOR: 0.959, 95% CI: 0.939–0.980) have a significant effect on sleep quality after adjusted by sex, age, smoking status, drinking status, caffeine intake, past shift working and circadian rhythm type.

Conclusions

Depression, anxiety, stress and social support were associated with sleep quality among pre-employed firefighters. Repeated follow-up studies of pre-employed firefighters are needed to further assess their change of sleep quality and identify the FSJRF that may affect the sleep quality of firefighters.

Citations

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Screening for Comorbidity of Sleep Disorders in Career Firefighters
Nancy A. Hamilton, Julia Russell, Kareem Hamadah, Westley Youngren, Addie Toon, Thu A. Nguyen, Kevin Joles
Journal of Occupational & Environmental Medicine.2024; 66(1): 43. CrossRef
Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis
Amir Hossein Khoshakhlagh, Saleh Al Sulaie, Saeid Yazdanirad, Robin Marc Orr, Hossein Dehdarirad, Alireza Milajerdi
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Brett A Messman, Danica C Slavish, Madasen Briggs, Camilo J Ruggero, Benjamin J Luft, Roman Kotov
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Elizabeth L. Griffith, Ling Jin, Ateka A. Contractor, Danica C. Slavish, Anka A. Vujanovic
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Association between sleep quality and type of shift work in Korean firefighters
Hyun-Jeong Oh, Chang Sun Sim, Tae-Won Jang, Yeon Soon Ahn, Kyoung Sook Jeong
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Multidimensional sleep quality of dependent self-employment workers: Sang Ha Lee, Dukyun Kang, Junhyeong Lee, Uijin Kim, Seunghon Ham, Wanhyung Lee, Won-Jun Choi, Seong-Kyu Kang; Ann Occup Environ Med 2020;32:e6. Published online January 22, 2020; DOI: https://doi.org/10.35371/aoem.2020.32.e6

Abstract PDF PubReader ePub

Background

The number of workers in non-standard employment (NSE) is increasing due to industrial change and technological development. Dependent self-employment (DSE), a type of NSE, was created decades ago. Despite the problems associated with this new type of employment, few studies have been conducted on the effects by DSE on health, especially sleep quality. This study aims to determine the relationship between DSE and sleep quality.

Methods

This study analyzed data of 50,250 wage workers from the fifth Korean Working Conditions Survey. Workers that did not respond or refused to answer any questions related to variables were excluded, and finally 36,709 participants were included in this study. A total of 2,287 workers (6.2%) were compared with non-DSE (34,422; 93.8%) workers, and multiple logistic regression analyses were applied.

Results

DSE status had a significant association with difficulty falling asleep (odds ratio [OR]: 1.331, 95% confidence interval [CI]: 1.178–1.504), difficulty maintaining sleep (OR: 1.279; 95% CI: 1.125–1.455), and extreme fatigue after waking up (OR: 1.331; 95% CI: 1.184–1.496). A multiple logistic regression of the variables for sleep quality in DSE showed a significant association with exposure to physical factors for all types of poor sleep quality as well as shift work for difficulty maintaining sleep with extreme fatigue after waking up. Long working hours and emotional labor were also associated with extreme fatigue after waking up.

Conclusions

This study shows a significant association between DSE and poor sleep quality, especially when workers were exposed to physical risk factors (noise, vibration, abnormal temperature, etc.) and shift work.

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Self-employment and health inequality of migrant workers
Deshui Zhou, Xin Wen
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Mental health symptoms among dependent contractors in Korea: a cross-sectional study based on the Fifth Korean Working Condition Survey
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International Journal of Environmental Research and Public Health.2021; 18(6): 3138. CrossRef

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Factors related with quality on sleep of daytime workers: Bu-il Kim, Seong-yong Yoon, Jin-seok Kim, Kuck-Hyeun Woo, Seong-yong Cho, Ho Lee, Jong-min An; Ann Occup Environ Med 2018;30:63. Published online October 23, 2018; DOI: https://doi.org/10.1186/s40557-018-0271-7

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Background

This study was conducted to identify the sleep status of daytime workers who do not work in shifts. This study analyzed factors affecting sleep duration and sleep quality.

Methods

This study was conducted on 1171 daytime workers at a manufacturing workshop. We used a self-administered questionnaire to investigate demographic variables, work type, working period, musculoskeletal symptoms and the Pittsburgh Sleep Quality Index to assess sleep. Regular health checkup was conducted for the worker’s clinical examination.

Results

The mean sleep duration was 6.36 h and the mean score on the Pittsburgh Sleep Quality Index was 4.46. Work type and obesity were related to sleep duration. Age, obesity and musculoskeletal pain were significantly related to sleep quality. The prevalence ratio of researcher group for short sleep duration was 1.27 (95% confidence interval: 1.02–1.58). The prevalence ratio of those aged 50 years and over was 0.47 (0.25–0.91) and of those in their 40s was 0.56 (0.35–0.91) for poor sleep quality compared to those in their 20s. The prevalence ratio of the obesity group for poor sleep quality was 1.53 (1.10–2.12). The prevalence ratio of musculoskeletal pain group for poor sleep quality was 1.92 (1.29–2.84).

Conclusions

Age, obesity and musculoskeletal pain were factors affecting the poor quality on sleep of daytime workers. In addition, work type related to short sleep duration.

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The relationship between serum vitamin D levels and sleep quality in fixed day indoor field workers in the electronics manufacturing industry in Korea: Young Saeng Jung, Chang Ho Chae, Young Ouk Kim, Jun Seok Son, Chan Woo Kim, Hyoung Ouk Park, Jun Ho Lee, Young Hoo Shin, Ho Sung Kwak; Ann Occup Environ Med 2017;29:25. Published online June 24, 2017; DOI: https://doi.org/10.1186/s40557-017-0187-7

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Background

Although recent studies have investigated the influence of vitamin D on sleep patterns, there is a lack of research on the relationship between vitamin D and sleep patterns in Korean workers. This study focused on the relationship between serum vitamin D levels and sleep in fixed day indoor field workers in the electronics manufacturing industry in Korea.

Methods

The 1472 subjects who were included in this study were selected from fixed day workers in the electronics manufacturing industry who had received a worker’s special health examination at a hospital in Changwon, South Gyeongsang Province between January 2015 and December 2015. Nighttime workers and those who showed symptoms of depression were excluded from this study. The sociodemographic and lifestyle variables of the participants were investigated, including age, sex, marital status, level of education, body mass index, smoking habits, alcohol consumption habits, and regular exercise. Work-related factors were evaluated, such as employee tenure and occupational stress. Serum 25-hydroxyvitamin D was measured as an indicator of vitamin D levels, and quality of sleep was evaluated using the Pittsburgh Sleep Quality Index (PSQI) translated into Korean.

Results

The subjects had a mean serum vitamin D level of 13.70 ± 5.93 ng/mL. Vitamin D deficiency, defined as a serum vitamin D level of <10 ng/mL, was found in 24.8% of males and significantly more frequently in females (47.6%). Poor sleep quality was reported by 19.8% of participants with serum vitamin D levels ≥10 ng/mL and by 21.7% of those with serum vitamin D levels <10 ng/mL, which was a significant difference (P = .007). Multiple logistic regression analysis adjusting for significant variables found that poor sleep quality was more likely in those with vitamin D deficiency than those with higher serum vitamin D levels (odds ratio = 1.36; 95% CI, 1.01–1.82). A comparison of serum vitamin D levels and PSQI components showed that the mean scores for subjective sleep quality, sleep latency, and sleep duration were significantly higher in the vitamin D-deficient participants, indicating that the vitamin D-deficient participants had poorer sleep quality.

Conclusions

This study investigated serum vitamin D levels in fixed day indoor field workers in the manufacturing industry in Korea and analyzed the relationship of vitamin D deficiency with sleep quality. A significant correlation was found between serum vitamin D deficiency and poor sleep quality. Based on the results of this study, sleep disorder management for workers can be improved by providing regular examinations checking their serum vitamin D levels and supplying vitamin D to workers with serum vitamin D deficiency to enhance their quality of sleep.

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Comparison of sleep quality based on direction of shift rotation in electronics workers: Youil Shon, Seungho Ryu, Byung-Seong Suh, Soo-Geun Kim, Won-Sool Kim, Hee-Seung Son, Hee-Yun Kim, Han-Seur Jeong; Ann Occup Environ Med 2016;28:37. Published online September 5, 2016; DOI: https://doi.org/10.1186/s40557-016-0122-3

Abstract PDF PubReader ePub

Background

Previous studies have reported the effects of direction of shift rotation on sleep, however, the findings are inconsistent. In this study, we investigated sleep quality related to direction of shift rotation using large-scale data from shiftwork-specific health examinations of electronics workers.

Methods

This study included 4750 electronics workers working in a rotating 3-shift system who completed a medical examination for shift workers survey from January 1 to December 31, 2014, at a general hospital. The subjects were categorized into one of two groups according to direction of shift rotation. We compared sleep quality index between the subjects who worked in forward rotation and backward rotation systems.

Results

Backward rotation was positively associated with prevalence of poor sleep quality. In the multivariable-adjusted model, when comparing backward rotation to forward rotation, the odds ratio (OR) with 95 % confidence interval (95 % CI) for poor sleep quality was 1.95 (1.58–2.41). After stratifying by gender, the ORs (95 % CIs) for poor sleep quality in male and female was 1.92 (1.47–2.49) and 2.13 (1.47–3.08), respectively. In subgroup analyses, backward rotation was significantly associated with poor sleep quality in workers ≥30 years of age compared with workers <30 years of age (adjusted OR 2.60 vs. 1.89, respectively; P for interaction <0.001).

Conclusions

Our study supports that a backward rotation system is associated with poor sleep quality. Forward rotation systems should be considered to reduce sleep problems.

Citations

Citations to this article as recorded by

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