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Association between insomnia and job stress: a meta-analysis

DOI:10.1007/s11325-018-1682-y
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Bing Yang
Bing Yang
Bing Yang
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Yongwei Wang
Yongwei Wang
Yongwei Wang
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Fangfang Cui
Fangfang Cui
Fangfang Cui
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Ting Huang
Ting Huang
Ting Huang
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Purpose: Insomnia has become one of the foremost health concerns among workers. Despite a significant number of epidemiological studies have reported on the correlation between insomnia and job stress, comprehensive evidence remains insufficient. Therefore, this research seeks to provide evidence with greater reliability, through summarizing relevant contemporary literature via a meta-analysis. Methods: Literature from across Europe and Asia that was of both a prospective and cross-sectional design was included, if well-controlled odds ratios were available. The meta-analysis was undertaken in accordance with the guidelines devised by PRISMA, including tests for publication bias and heterogeneity. Results: High job stress was associated with a greater risk of suffering from insomnia (random OR = 1.73, 95% CI 1.46-2.05), and the correlation between effort-reward imbalance and insomnia was statistically significant (random OR = 2.63, 95% CI 1.22-5.69). Higher demand was correlated to a relatively greater risk of insomnia (random OR = 1.35, 95% CI 1.20-1.51), while the pooled effect of low control was not found to be statistically significant. The summary random odds ratio of heavy workload was 2.76, and a pooled odds ratio of 1.67 (fixed, 95% CI 1.11-2.52) was calculated in low social support. With regard to the overall population, work-family conflict was correlated with insomnia (random OR = 2.32, 95% CI 1.53-3.51). The subgroup analysis provided comparable outcomes, for both males (fixed OR = 1.97, 95% CI 1.50-2.57) and females (random OR = 2.80, 95% CI 1.30-6.05). Egger's regression indicated that publication bias may be apparent in the syntheses of effort-reward imbalance, low social support, and work-family conflict (p < 0.05). Heterogeneity was caused by design, measuring the exposure or outcome, in addition to the region where the research was conducted. Conclusions: The correlation between insomnia and higher levels of job stress, effort-reward imbalance, high demand, heavy workload, and low social support was determined. Publication bias and heterogeneity were partially observed. Furthermore, future studies with improved methodologies and a focus on mechanisms are anticipated.
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EPIDEMIOLOGY •ORIGINAL ARTICLE
Association between insomnia and job stress: a meta-analysis
Bing Yang
1
&Yongwei Wang
1,2,3
&Fangfang Cui
1,2,3
&Ting Huang
4
&Peijia Sheng
5
&Ting Shi
1,2,3
&Chan Huang
1
&
Yajia Lan
1,2,3
&Yi-Na Huang
1,3
Received: 11 January 2018 /Revised: 5 March 2018 /Accepted: 22 March 2018 /Published online: 29 June 2018
#Springer International Publishing AG, part of Springer Nature 2018
Abstract
Purpose Insomnia has become one of the foremost health concerns among workers. Despite a significant number of epidemi-
ological studies have reported on the correlation between insomnia and job stress, comprehensive evidence remains insufficient.
Therefore, this research seeks to provide evidence with greater reliability, through summarizing relevant contemporary literature
via a meta-analysis.
Methods Literature from across Europe and Asia that was of both a prospective and cross-sectional design was
included, if well-controlled odds ratios were available. The meta-analysis was undertaken in accordance with the
guidelines devised by PRISMA, including tests for publication bias and heterogeneity.
Results High job stress was associated with a greater risk of suffering from insomnia (random OR = 1.73, 95% CI 1.46–2.05),
and the correlation between effort-reward imbalance and insomnia was statistically significant (random OR = 2.63, 95% CI 1.22–
5.69). Higher demand was correlated to a relatively greater risk of insomnia (random OR = 1.35, 95% CI 1.20–1.51), while the
pooled effect of low control was not found to be statistically significant. The summary random odds ratio of heavy workload was
2.76, and a pooled odds ratio of 1.67 (fixed, 95% CI 1.11–2.52) was calculated in low social support. With regard to the overall
population, work-family conflict was correlated with insomnia (random OR = 2.32, 95% CI 1.53–3.51). The subgroup analysis
provided comparable outcomes, for both males (fixed OR = 1.97, 95% CI 1.50–2.57) and females (random OR = 2.80, 95% CI
1.30–6.05). Egger’s regression indicated that publication bias may be apparent in the syntheses of effort-reward imbalance, low
social support, and work-family conflict (p< 0.05). Heterogeneity was caused by design, measuring the exposure or outcome, in
addition to the region where the research was conducted.
Conclusions The correlation between insomnia and higher levels of job stress, effort-reward imbalance, high demand, heavy
workload, and low social support was determined. Publication bias and heterogeneity were partially observed. Furthermore,
future studies with improved methodologies and a focus on mechanisms are anticipated.
Keywords Insomnia .Job stress .Meta-analysis
Introduction
Insomnia is the most common sleep disorder, having be-
come one of the foremost health concerns for workers in-
ternationally. Over the previous 30 years, a large number of
epidemiological studies have investigated and reported on
the correlation between insomnia or sleep disturbance and
stressors in the workplace. Knudsen [16] investigated 1715
full-time employees, identifying a close relationship be-
tween work overload and insomnia, while role conflict,
as well as job latitude, was correlated with difficulty in
maintaining sleep. A further investigation [25] involving
1786 workers from 8 electrical appliance factories, apply-
ing both DCS and ERI on the same population, illustrated
the significant association between job stress and insomnia
*Yongwe i Wan g
wangyw_1980@sina.com
1
Department of Environmental Health and Occupational Medicine,
West China School of Public Health, Sichuan University,
Chengdu 610041, Sichuan, China
2
Department of Occupational Health, No.4 West China Teaching
Hospital, Sichuan University, Chengdu 610041, Sichuan, China
3
Occupational Health Emergency Key Laboratory of West China
Occupational Disease Hospital and No.4 West China Teaching
Hospital, Sichuan University, Chengdu 610041, Sichuan, China
4
Center for Test, West China Occupational Disease Hospital and No.4
West China Teaching Hospital, Sichuan University,
Chengdu 610041, Sichuan, China
5
Changji State Center for Disease Control and Prevention,
Changji 831100, Xinjiang, China
Sleep and Breathing (2018) 22:1221–1231
https://doi.org/10.1007/s11325-018-1682-y
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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... Mehrere Studien konnten zeigen, dass das Vorliegen einer psychischen Belastung mit einem vermehrten Auftreten von verschiedenen Symptomen und Erkrankungen, wie z. B. Schlafstörungen (Yang et al. 2018), Herz-Kreislauferkrankungen (Dragano et al. 2017;Eddy et al. 2017), depressiven Episoden (Wege et al. 2018;Araujo et al. 2019) und sogar Krebserkrankungen (Blanc-Lapierre et al. 2017) einhergehen kann. ...
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Work stress up to a certain limit serves as motivation however, when it crosses boundaries, it has a major impact on the physical and mental health of employee and as a result, the productivity of the employees' decreases. Overload, noise, poor lighting and poor office or workplaces cause problems such as reduced concentration and productivity. The purpose of this study is to gather information on effects of work stress on psychological well-being and job satisfaction. The methodology adopted in this study is the review of literature and extraction of data from various sources like articles, journals, and government websites and so on. The findings of the study suggest that there is an inverse relationship between work stress, psychological wellbeing and job satisfaction. A reduction in work stress enhances psychological well being and an enhanced psychological well being leads to high level of job satisfaction. The findings further suggests that work stress can be reduced by providing appropriate training by using advanced equipments & technology, proper breaks & naps, better working condition, competitive compensation and the like.
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Objective Occupational stress is generally acknowledged as a global phenomenon with significant health and economic consequences. The medical worker is a vulnerable group at a high-level risk for depression symptoms. This study aimed to examine the mediating effect of worker-occupation fit (WOF) in relation to occupational stress and depression symptoms among 1988 medical workers in China. Methods A multi-center cross-sectional study was conducted during June and October 2020 in Henan Province, China. The participants were medical workers from four targeted hospitals (included one general and three specialized hospitals). The Depression, Anxiety, and Stress Scale (DASS-21 Scale), Worker-Occupation Fit Inventory (WOFI), as well as questions about demographic and occupational information were administered in questionnaires distributed to 1988 medical workers. Hierarchical linear regression analysis was used to examine the mediating role of worker occupation fit. Results In this study, there are 43.5% ( n = 864) of medical workers experienced depression symptoms. The mean score of WOF was 31.6 ± 7.1, characteristic fit, need supply fit and demand ability fit were 11.3 ± 2.5, 10.1 ± 2.7, 12.9 ± 2.2, respectively. The occupational stress was negatively related to worker occupation fit ( r = −0.395, P < 0.001), characteristic fit ( r = −0.529, P < 0.001), need supply fit ( r = −0.500, P < 0.001), and demand ability fit ( r = −0.345, P < 0.001). The occupational stress and depression symptoms have a positive relationship ( r = 0.798, P < 0.001). The proportion of worker occupation fit mediation was 6.5% of total effect for depression symptoms. Conclusion Occupational stress has been identified as a risk factor for depression symptoms. Practical strategies for improving medical workers' WOF level would help them better cope with various work-related stressors to reduce depression symptoms. Hospital administrators could reduce medical workers' depression symptoms by taking comprehensive measures to improve the WOF.
The association of relational and organizational job stress factors with sleep disorder: Analysis of the 3rd Korean working conditions survey (2011)
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Background Sleep disorder is a disease that causes reduction in quality of life and work efficiency of workers. This study was performed to investigate the relationship between job-related stress factor and sleep disorder among wageworkers in Korea. Methods This study was based on analysis of the 3rd Korean working conditions survey. We analyzed 35,902 workers whose employment status is wageworker. We classified the job-related stress factor into 12 sections. Logistic regression was performed to estimate the relationship between job-related stress factor and sleep disorder and Odds ratio and 95 % CI were calculated using the SPSS version 23.0 program. ResultsMany categories of Job-related stress factor were correlated with sleep disorder (8 of 12 for women, 10 of 12 for men). The results of the regression analysis, corrected for general and occupational characteristics, indicated that sleep disorder was significantly correlated with the following categories of job-related stress: discrimination experience (OR 3.37, 95 % CI = 2.49 ~ 4.56 in women, OR 1.96, 95 % CI = 1.53 ~ 2.51 in men), direct customer confrontation (OR 2.72, 95 % CI = 1.91 ~ 3.86 in women, OR 1.99, 95 % CI = 1.45 ~ 2.72 in men), emotional stress (OR 2.01, 95 % CI = 1.30 ~ 3.09 in men), work dissatisfaction (detailed) (OR 1.99, 95 % CI = 1.36 ~ 2.93 in men), work dissatisfaction (overall) (OR 2.30, 95 % CI = 1.66 ~ 3.20 in women, OR 2.40, 95 % CI = 1.88 ~ 3.08 in men), expression of opinion difficulty (OR 0.66, 95 % CI = 0.48 ~ 0.92 in women, OR 0.57, 95 % CI = 0.45 ~ 0.73 in men). ConclusionA number of studies have reported that stress affects sleep disorder. In this study, many factors suspected to increase the risk of sleep disorder were added to previously known job stress factors. In particular, this study found a strong correlation between work-associated sleep disorder and relational and organizational job stress factors. Sleep disorder may lead to large decreases in workers’ quality of life and work efficiency. Awareness and interventions are therefore required to reduce workplace stress; additional research of this topic is also required.
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Full-text available
Study Objectives: To prospectively assess sleep reactivity as a diathesis of insomnia, and to delineate the interaction between this diathesis and naturalistic stress in the development of insomnia among normal sleepers. Design: Longitudinal. Setting: Community-based. Participants: 2316 adults from the Evolution of Pathways to Insomnia Cohort (EPIC) with no history of insomnia or depression (46.8 ± 13.2 y; 60 % female). Interventions: None. Measurements and Results: Participants reported the number of stressful events they encountered at baseline (Time 1), as well as the level of cognitive intrusion they experienced in response to each stressor. Stressful events (OR = 1.13; p < .01) and stress-induced cognitive intrusion (OR = 1.61; p < .01) were significant predictors of risk for insomnia one year hence (Time 2). Intrusion mediated the effects of stressful events on risk for insomnia (p < .05). Trait sleep reactivity significantly increased risk for insomnia (OR = 1.78; p < .01). Further, sleep reactivity moderated the effects of stress-induced intrusion (p < .05), such that the risk for insomnia as a function of intrusion was significantly higher in individuals with high sleep reactivity. Trait sleep reactivity also constituted a significant risk for depression (OR = 1.67; p < .01) two years later (Time 3). Insomnia at Time 2 significantly mediated this effect (p < .05). Conclusions: This study suggests that premorbid sleep reactivity is a significant risk factor for incident insomnia, and that it triggers insomnia by exacerbating the effects of stress-induced intrusion. Sleep reactivity is also a precipitant of depression, as mediated by insomnia. These findings support the stress-diathesis model of insomnia, while highlighting sleep reactivity as an important diathesis.
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Interaction between serotonin transporter gene-linked polymorphic region (5-HTTLPR) and job-related stress in insomnia: A cross-sectional study in Sichuan, China
Article
Objective Insomnia, a widely occurring sleep disorder in modern society, has a large impact on life quality and work safety. A cross-sectional study was conducted to explore the possible link of serotonin transporter-linked polymorphic region (5-HTTLPR), job-related stress, and insomnia in West China. Methods Of the total 462 workers recruited, 177 had insomnia according to the Athens insomnia scale (AIS-5). The 5-HTTLPR genotypes were determined by polymerase chain reaction. Job-related stress was assessed for each participant by the General Job Stress Questionnaire. Results Unconditional logistic regression models showed that the 5-HTTLPR genotype was significantly associated with insomnia, and >80% increased risk per S allele was observed. High job-related stress had a higher risk for insomnia than low job-related stress (odds ratio [OR], 6.14; 95% confidence interval [CI], 3.94–9.59). Crossover analysis found significant job-related stress∗5-HTTLPR interaction. Compared to the individuals with both low job-related stress and SL/LL genotype, those with both higher job-related stress and SS genotype had a higher risk of insomnia (OR, 5.16; 95% CI, 3.13–8.54), whereas those with both low job-related stress and SS genotype showed a lower risk of insomnia (OR, 0.26; 95% CI, 0.08–0.74). The interaction remained statistically significant after the adjustment for the potential confounding factors. Conclusions The findings indicated that 5-HTTLPR could modify the effect of job-related stress on employees’ insomnia, suggesting that a work environment-based personalized intervention may be applied to prevent employees’ insomnia by alleviating job-related stress in the workplace.
Conflicts Between Work and Family Life and Subsequent Sleep Problems Among Employees from Finland, Britain, and Japan
Article
Purpose: Research on the association between family-to-work and work-to-family conflicts and sleep problems is sparse and mostly cross-sectional. We examined these associations prospectively in three occupational cohorts. Methods: Data were derived from the Finnish Helsinki Health Study (n = 3,881), the British Whitehall II Study (n = 3,998), and the Japanese Civil Servants Study (n = 1,834). Sleep problems were assessed using the Jenkins sleep questionnaire in the Finnish and British cohorts and the Pittsburgh Sleep Quality Index in the Japanese cohort. Family-to-work and work-to-family conflicts measured whether family life interfered with work or vice versa. Age, baseline sleep problems, job strain, and self-rated health were adjusted for in logistic regression analyses. Results: Adjusted for age and baseline sleep, strong family-to-work conflicts were associated with subsequent sleep problems among Finnish women (OR, 1.33 (95 % CI, 1.02-1.73)) and Japanese employees of both sexes (OR, 7.61 (95 % CI, 1.01-57.2) for women; OR, 1.97 (95 % CI, 1.06-3.66) for men). Strong work-to-family conflicts were associated with subsequent sleep problems in British, Finnish, and Japanese women (OR, 2.36 (95 % CI, 1.42-3.93), 1.62 (95 % CI, 1.20-2.18), and 5.35 (95 % CI, 1.00-28.55), respectively) adjusted for age and baseline sleep problems. In men, this association was seen only in the British cohort (OR, 2.02 (95 % CI, 1.42-2.88)). Adjustments for job strain and self-rated health produced no significant attenuation of these associations. Conclusion: Family-to-work and work-to-family conflicts predicted subsequent sleep problems among the majority of employees in three occupational cohorts.
Self‐reported sleep quality, strain and health in relation to perceived working conditions in females
Article
Self-reported sleep quality, strain and health in relation to perceived working conditions in females The aims of this study were to examine self-reported sleep quality, perceived strain and health in relation to working conditions; the prevalence and severity of sleep disturbances and daytime distress arising from poor sleep in women on different work shifts. Furthermore, to see whether females with gastrointestinal symptoms, joint-, back- or muscle-pain and who are dissatisfied with working hours differ with regard to the above aspects. Finally, degree of strain-related symptoms and sleep difficulties were tested as predictors of sleep quality and general health outcome. Important research questions are whether registered nurses and those on rotating work shifts have greater sleep problems than others. A total of 156 females, aged 20–59 years, working at three different casualty departments, answered structured questionnaires. The results showed a persistently high rate of psycho-physiological long-term effects of stress related to working conditions. Thirty-four per cent were dissatisfied with their working hours, and exhibited significantly more mental strain, fatigue/excessive tiredness and inability to relax after work because of involuntary thoughts, in relation to working conditions than others did. Sixty-two females (39.7%) complained of insufficient sleep. The sleep quality outcome was significantly predicted by difficulty falling asleep (odds ratio 8.4), difficulty in falling asleep after nocturnal awakening (odds ratio 3.4) and perceived exhaustion (odds ratio 2.6). Females suffering from gastrointestinal symptoms and joint-, back- and muscle symptoms for several days in a week or even everyday were especially sensitive to worse sleep quality. Independent of work shifts, registered nurses exhibited a higher degree of mental strain and prolonged recovery in comparison with others. In conclusions, sleep initiation difficulties, troubled sleep and exhaustion significantly predicted reduced sleep quality outcome with decreased resilience to stress and vulnerability to psycho-physiological disorders in females working within the health care system.
Psychological Work Environment And Psychological Well-Being: Assessment Of The Buffering Effects In The Job Demand-Control-Support Model In BELSTRESS
Article
The Karasek Job Demand–Control model has as its central tenet the so-called ‘strain hypothesis’, stating that the most adverse health outcomes are to be expected in ‘high strain’ jobs characterized by high job demands and low job control. Later, this model was elaborated, stating that ‘isolated’ high strain workers experiencing low worksite social support are even more worse off. This is labelled the ‘iso-strain hypothesis’. However, in the literature, the question was raised whether a high level of job control may (1) mitigate or buffer the effects of high job demands on psychological well-being, or alternatively whether (2) a high level of social support may buffer the negative impact of high strain on psychological well-being. In this study among 16 335 male workers and 5084 female workers in Belgium, four indicators of psychological well-being are considered: feelings of depression, feelings of fatigue, sleep problems and use of psychoactive drugs. Both in men and in women, the general strain hypothesis and the iso-strain hypothesis alike are corroborated regarding the cross-sectional associations adjusted for age, level of education and living situation. This is most clear with respect to feelings of depression, less so with respect to the use of psychotropic drugs. The buffer hypotheses however are definitely not supported by our data. Copyright © 2002 John Wiley & Sons, Ltd.
Self-evaluations of factors promoting and disturbing sleep: An epidemiological survey in Finland
Article
The purpose of this epidemiological survey (N = 1600) was to describe the factors which middle-aged urban people in Finland perceived as promoting or disturbing sleep. The response rate was 75%. The results suggested that quality of sleep is determined by numerous factors; social and psychological factors, health status, external sleeping conditions, life style and living habits. Every third respondent felt that exercise had a positive impact on sleep. Second in importance were reading and listening to music. Furthermore, sauna, shower and bath, stability in life, psychological factors, positive experience in work, satisfactory sexual life and good and quiet sleeping environment were reported to have positive effects on sleep. Men considered work-related pressure and fatigue (20%) as the most important factor disturbing falling asleep or quality of sleep. In women's ranking work problems appeared no sooner than in the third place. Women reported worries, interpersonal problems, and marital and family discord as the most disturbing factors to sleep (37%). Coffee in the evening had a negative effect on falling asleep. Although a 'nightcap' was considered to improve relaxation on falling sleep, men ranked alcohol as the fourth disturbing factor. Other disturbing factors were stress, irregularities in everyday life because of social events, travelling or atypical catnaps. Eating and exercising too heavily or too late in the evening were found to disturb sleep. On the other hand, temporary lack of exercise seemed to impair the quality of sleep. As external factors disturbing sleep the subjects considered noise light, too high room temperature, tight clothing, unfamiliar sleeping environment and restless children.(ABSTRACT TRUNCATED AT 250 WORDS)
Effect of the Interaction Between Employment Level and Psychosocial Work Environment on Insomnia in Male Japanese Public Service Workers
Article
Background Little is known about the combined risk of socioeconomic status and psychosocial environment for insomnia. Purpose The purpose of this study was to investigate the combined risk of employment level and psychosocial work environment for insomnia in a large Japanese male working population. Method We investigated 5,951 male employees aged 34–59 years from two local governments in Japan. Data were obtained from a questionnaire distributed in advance of their annual health check-up. Employment level was categorized as higher-level non-manual workers, lower-level non-manual workers, and manual workers. Psychosocial work environment was assessed using the Demand-Control Model and the Effort-Reward Imbalance Model (ERI). Insomnia was assessed using the Athens Insomnia Scale. Results The results showed that 1,382 (23.2 %) participants suffered from insomnia. Lower employment level was significantly associated with a higher risk of insomnia. Job strain (ratio of job demand to job control), E/R (ratio of job effort to job reward), and OC (over commitment) were also significantly associated with insomnia. The relative excess risk due to the interaction between employment level and psychosocial environment (job strain, E/R, and OC) was 0.09 (95 % CI −0.57 to 0.76), 2.61 (0.74 to 4.48), and 3.14 (0.82 to 5.45), respectively; synergy index = 1.07 (0.66 to 1.74), 1.99 (1.37 to 2.90), and 2.25 (1.46 to 3.46), respectively. Conclusion We found supra-additive interactions between employment level and psychosocial environment, assessed by the ERI (E/R and OC). Our findings suggested that lower level workers are more vulnerable to an adverse psychosocial environment than those at a higher level.
Predicting changes in sleep complaints from baseline values and changes in work demands, work control, and work preoccupation—The WOLF-Project
Article
  • Dec 2011
Stress as a cause of disturbed sleep is often taken for granted, but the longitudinal evidence is limited. The aim of this study was to evaluate new cases of poor sleep as a function of changes in reported work demands, work control, and work preoccupation. Longitudinal study of change with measures occurring twice within a 5-year interval during a period when the prevalence of impaired sleep was increasing in Sweden. The sample of companies was taken from northern Sweden (Norrland) and included 3637 individuals from the "WOLF Norrland" longitudinal cohort, collected through company health services. During the measurement period, 16% of those studied developed new cases of impaired sleep. Logistic regressions adjusted for demographics, work environment factors, and disturbed sleep at T1 period one showed a significant increase in new cases for high work demands and high work preoccupation (OR=1.37; Ci=1.09-1.72 and OR=1.80; CI=1.42-2.28, respectively). The analysis of change in the predictors showed effects of a change from low to high work demands (OR=1.39; Ci=1.00-1.95) on new cases of impaired sleep. Consistent high work demands (high at both points) showed a similar increase (OR=1.49; Ci=1.06-2.11) but no effect was seen for reduced demands. Change in work preoccupation yielded stronger effects with OR=2.47 (1.78-2.47) for increased work preoccupation and OR=3.79 (2.70-5.31) for consistent high work preoccupation. Also, a reduction in work preoccupation was associated with a reduction in new cases of disturbed sleep. Control at work was not related to sleep. Stratification with respect to gender mainly led to fewer significant results (particularly for women) due to larger confidence intervals. It was concluded that self-reported work preoccupation predicts subsequent impairment of sleep and that increased preoccupation is associated with new cases of impaired sleep. Similar, but weaker, results were obtained for work demands.