European Journal of Cardiovascular Medicine

Healthcare workers constitute the backbone of the healthcare system and are often exposed to high levels of occupational stress due to long working hours, shift duties, and emotional burden. Sleep disturbances are common among HCWs due to irregular schedules and demanding work conditions.

Studies have shown that more than 50–60% of healthcare workers experience poor sleep quality, particularly those involved in shift work and emergency services.

Sleep disturbance is closely linked to psychological stress, anxiety, depression, and burnout. Poor sleep further exacerbates stress, creating a vicious cycle affecting both mental health and professional performance.

Despite increasing awareness, there is limited data from Indian settings assessing this relationship. Therefore, the present study aims to evaluate sleep disturbances and their association with psychological stress among healthcare workers.

Study Design and Setting

A hospital-based cross-sectional study conducted over 6 months in a tertiary care teaching hospital.

Study Population

Healthcare workers including doctors, nurses, and laboratory staff.

Sample Size

A total of 200 participants were included based on prevalence estimates from previous studies.

Inclusion Criteria

·         Healthcare workers aged ≥21 years

·         Working for ≥6 months

·         Willing to participate

Exclusion Criteria

·         Known psychiatric illness

·         Use of sleep medications

·          

Data Collection Tools

1.       Pittsburgh Sleep Quality Index (PSQI)

·         Measures sleep quality over the past 1 month

·         Score >5 indicates poor sleep

2      Perceived Stress Scale (PSS)

·         Measures perceived stress levels

·         Categorized as low, moderate, high

Statistical Analysis

·         Data analyzed using SPSS version 25

·         Chi-square test for association

·         Pearson correlation coefficient

·         p < 0.05 considered significant

Demographic Profile

·         Mean age: 32 ± 6 years

·         Females: 60%

·         Nurses: 45%, Doctors: 35%, Others: 20%

Prevalence of Sleep Disturbance

·         Poor sleep quality (PSQI >5): 58%

·         Common complaints:

·         Sleep latency (65%)

·         Night awakenings (52%)

·         Daytime dysfunction (48%)

These findings are consistent with previous studies reporting sleep disturbances in ~50–60% HCWs.

Psychological Stress Levels

·         Low stress: 38%

·         Moderate stress: 44%

·         High stress: 18%

Association Between Sleep and Stress

·         Significant association between poor sleep and high stress (p < 0.001)

·         Pearson correlation (r = 0.61)

The present study demonstrates a high prevalence of sleep disturbances (58%) among healthcare workers, which is in line with findings from global literature reporting prevalence rates ranging between 53% and 63%. This high burden reflects the demanding nature of healthcare professions, where irregular schedules, night shifts, and extended working hours are routine. In the current study, more than half of the participants reported poor sleep quality, highlighting sleep disturbance as a significant occupational health concern. These findings are comparable with previous studies conducted in both developed and developing countries, indicating that sleep-related issues among healthcare workers are a universal phenomenon rather than region-specific.

One of the key contributing factors identified in this study is shift work. Rotational and night shifts disrupt the normal circadian rhythm, leading to difficulty in initiating and maintaining sleep. Healthcare workers, particularly nurses and resident doctors, are frequently required to work during biologically inappropriate hours, which negatively impacts sleep quality. Long duty hours further compound this issue by reducing the total duration available for rest and recovery. In addition, the high-pressure environment, critical decision-making responsibilities, and emotional burden associated with patient care contribute significantly to occupational stress, which in turn affects sleep patterns.

The present study also found a statistically significant association between sleep disturbances and psychological stress, supporting the concept of a bidirectional relationship between these two variables. Individuals experiencing higher levels of stress were more likely to report poor sleep quality, while those with sleep disturbances were more vulnerable to increased stress levels. This cyclical interaction suggests that sleep and stress influence each other in a reinforcing manner. Physiologically, stress activates the hypothalamic–pituitary–adrenal (HPA) axis, resulting in increased cortisol levels, which interfere with the normal sleep–wake cycle. Conversely, inadequate or poor-quality sleep impairs emotional regulation and coping mechanisms, thereby increasing perceived stress.

Furthermore, sleep disturbances among healthcare workers have broader implications for mental health and professional functioning. Poor sleep quality has been linked to an increased risk of anxiety, depression, and burnout. Burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, is particularly concerning in healthcare settings as it directly affects the quality of patient care. Sleep-deprived healthcare workers are more prone to errors, reduced concentration, impaired judgment, and decreased productivity, which can compromise patient safety and clinical outcomes.

The findings of this study underscore the need for targeted interventions to address sleep disturbances and stress among healthcare workers. Institutional measures such as optimizing shift schedules, limiting consecutive night duties, and ensuring adequate rest periods can help mitigate sleep-related issues. Additionally, stress management programs, counseling services, and promotion of sleep hygiene practices can play a crucial role in improving overall well-being. Addressing these factors is essential not only for the health of healthcare workers but also for maintaining the efficiency and safety of healthcare delivery systems.

In conclusion, the high prevalence of sleep disturbances and their strong association with psychological stress observed in this study emphasize the urgent need for comprehensive strategies to improve sleep health and reduce occupational stress among healthcare workers.

The management in these cases are controversial with no universally accepted line of management .The younger patients are advised either lifestyle modifications in terms of avoiding strenuous work, exercise or games. These patients would require an annual follow up with either a thallium scan or stress echocardiogram . In patients who are aged more than 35 years, the risk of suffering cardiac death decreases significantly. In patients who require further management -surgical revascularisation or percutaneous intervention, with implantation of stents in the region of the compression are possible alternatives

Limitations

• Single-center study

• Self-reported questionnaires

• Cross-sectional design limits causality

Recommendations

• Implementation of stress reduction programs

• Sleep hygiene education

• Rotational shift management

• Mental health counseling services

1. İçten S, Koyuncu G. Sleep disturbances in healthcare workers. Bosphorus Med J. 2022.
2. Li Y, et al. Sleep disturbance and mental health in healthcare workers: a systematic review. Front Psychiatry. 2022.
3. Salari N, et al. Sleep disturbances among healthcare workers during COVID-19 pandemic. Global Health. 2020.
4. Kumari D, et al. Sleep disturbance in frontline healthcare workers. Int J Res Med Sci. 2023.
5. Shahzad S, et al. Stress and sleep in healthcare workers. Sci Rep. 2025.
6. Khan A, et al. Psychological distress and sleep problems. J Psychiatr Res. 2021.
7. Zhang C, et al. Sleep and mental health in healthcare workers. Psychiatry Res. 2020.
8. Lai J, et al. Mental health outcomes among healthcare workers exposed to COVID-19. JAMA Netw Open. 2020.
9. Pappa S, et al. Prevalence of depression, anxiety, and insomnia among healthcare workers. Brain Behav Immun. 2020.
10. Rajkumar RP. COVID-19 and mental health: a review of the existing literature. Asian J Psychiatr. 2020.
11. El Ghalib L, et al. Sleep disorders among healthcare workers. Int J Psychol Ther. 2025.
12. Wang S, et al. Association between sleep and psychological stress. Sleep Med. 2021.
13. Huang Y, et al. Insomnia and anxiety among healthcare workers. Sleep Health. 2020.
14. Deng J, et al. Stress and sleep disturbances in nurses. BMC Psychiatry. 2022.
15. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
16. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396.
17. World Health Organization. Mental health of healthcare workers. Geneva: WHO; Year.
18. Centers for Disease Control and Prevention. Sleep and health guidelines. Atlanta: CDC; Year.
19. Sleep disorders among healthcare workers. Indian J Psychiatry. Year.
20. Gupta R, et al. Sleep health in India. Sleep Med Rev. Year.
21. Singh A, et al. Burnout and sleep among healthcare professionals. Indian J Occup Environ Med. Year.
22. Sharma R, et al. Stress among doctors. J Clin Diagn Res. Year