association between work role stressors and sleep quality
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S Iwasaki, Y Deguchi, K Inoue; Association between work role stressors and sleep quality,
Occupational Medicine, Volume 68, Issue 3, 01 March 2018, Pages 171–176,
https://doi.org/10.1093/occmed/kqy021
Association between work role stressors and
sleep quality
S Iwasaki, Y Deguchi, K Inoue
Citation Occupational Medicine, 68(3): 171–176,
Issue Date 2018-03-01
Type Journal Article
Textversion Author
Right
This is a pre-copyedited, author-produced version of an article accepted for publication in
Occupational Medicine following peer review. The version of record : S Iwasaki, Y
Deguchi, K Inoue; Association between work role stressors and sleep quality, Occupational
Medicine, Volume 68, Issue 3, 01 March 2018, Pages 171–176, is available online at:
http://doi.org/10.1093/occmed/kqy021
URI http://dlisv03.media.osaka-cu.ac.jp/il/meta_pub/G0000438repository_ 14718405-68-3-171
DOI 10.1093/occmed/kqy021
SURE: Osaka City University Repository
http://dlisv03.media.osaka-cu.ac.jp/il/meta_pub/G0000438repository
Association between work role stressors and sleep
quality
Shinichi Iwasaki*, Yasuhiko Deguchi, Koki Inoue
Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka
City, Osaka, Japan
* Corresponding Author
Address: 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
Phone: +81-6-6645-3821
Fax: +81-6-6636-0439
Email: siwasaki@med.osaka-cu.ac.jp (SI)
Abstract
Background: Work-related stressors are associated with low sleep quality. However, few
studies have reported an association between role stressors and sleep quality.
Aims: To elucidate the association between role stressors (including role conflict and
ambiguity) and sleep quality.
Methods: Cross-sectional study of 234 daytime workers whose sleep quality was assessed
using the Pittsburgh Sleep Quality Index (PSQI). Work-related stressors, including role stressors,
were assessed using the Generic Job Stress Questionnaire (GJSQ). The association between sleep
quality and work-related stressors was investigated by logistic regression analysis.
Results: Eighty-six participants had poor sleep quality, based on a global PSQI score ≥6.
Multivariable logistic regression analysis revealed that higher role ambiguity was associated with
global PSQI scores ≥6, and that role conflict was significantly associated with sleep problems,
including sleep disturbance and daytime dysfunction.
Conclusions: These results suggest that high role stress is associated with low sleep quality,
and that this association should be considered an important determinant of the health of workers.
Key words: Role stressors, sleep quality, Pittsburgh Sleep Quality Index, job stressors, public
servants
Introduction
Sleep problems are common health-related complaints. Among Japanese adults, the
estimated prevalence of insomnia is 23.3% [1]. Poor sleep quality has additional public health
consequences in the workplace. Several studies have surveyed the relationship between
workplace stressors and sleep. Stressors resulting from an imbalance between high work demands
and low reward are related to shorter sleep duration and insomnia [2, 3].
In previous studies, the associations of job stressors based on the Demand-Control-Support
(DCS) model [4], and the relationship between role stressors and mental health problems, such as
depressive symptoms was studied [5]. The DCS model is a major job-stress model that is widely
used in the field of occupational health. According to the DCS model, jobs characterized by high
job demands (for example, work overload), low job control (for example, when decisions at work
are uncontrollable), and low social support (for example, lack of social support from supervisors
or co-workers during work hours) evoke the strongest stress reactions or strain (for example,
physical or mental exhaustion). Role stressors are some of the most commonly studied work
stressors and are related to role characteristics [6-8]. Role stressors include role ambiguity and
role conflict. Role ambiguity refers to vague and unclear expectations set for employees, such
that employees are uncertain of what is expected of them [9]. Role conflict refers to simultaneous
contradictory expectations from work colleagues that interfere with one another and make it
difficult to complete work-related tasks [9]. Role stressors are generally viewed as detrimental to
individual and organizational outcomes. It was subsequently reported that high role stress was
associated with aggression and depressive symptoms among public school teachers [5, 10].
However, there have only been few reports on the relationship between role stressors and sleep
quality [11-13].
Many previous studies investigating job stressors and sleep problems have used simplistic
questions to estimate workers’ sleep conditions [5, 11, 12]. They usually use only one question to
assess sleep quality. The Athens Insomnia Scale (AIS) consists of eight items and is a simple way
to quantify sleep problems. However, these methods seem too simple to adequately evaluate sleep
problems when compared to other tools, such as the Pittsburgh Sleep Quality Index (PSQI), which
comprises 19 items to provide a global sleep quality score and seven component scores reflecting
different aspects of sleep [14]. The PSQI therefore offers a more comprehensive assessment that
can be used to estimate sleep quality in each component. Because of the limitations of methods
used in previous studies, a more comprehensive and detailed survey of the association between
sleep quality and work-related stressors is needed.
The purpose of this study was to elucidate the association between role stressors and sleep
quality, as estimated using more detailed self-report questionnaires. It was hypothesized that high
role stress (high role ambiguity and conflict) is associated with low sleep quality, including
subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of
sleep medication, and daytime dysfunction.
Methods
In this cross-sectional study, self-administered anonymous questionnaires were distributed
to 342 Japanese day-shift public servants (263 men and 79 women) who worked 8-hour days five
days per week and participated in a seminar on mental health in 2011. All participants provided
informed consent in writing to volunteer for this study and were instructed that there was no
reprisal for choosing not to participate.
The Human Subjects Review Committee at Osaka City University approved the protocol for
this study (authorization number: 1409). All data were stored only in a database, and the employer
did not have access to the data or know who participated in the study. This study conformed to
the tenets of the Declaration of Helsinki.
The PSQI was chosen to measure sleep disturbances. It is a standardized questionnaire
designed to assess sleep quality during the past month in clinical populations. The Japanese
version of the PSQI has sufficient reliability and validity [15]. The 19 self-rated questions assess
various factors related to sleep quality, including estimates of sleep duration and latency, as well
as the frequency and severity of specific sleep-related problems. These 19 items are grouped into
seven component scores (components 1-7), each of which is weighted equally on a 0-3 scale.
These components include subjective sleep quality, sleep latency, sleep duration, habitual sleep
efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction. The seven
component scores are then summed to yield a global PSQI score, which ranges between 0 and 21.
Higher scores indicate worse sleep quality [14].
In this study, global PSQI scores of ≤5 were used to distinguish good sleep quality from poor
sleep quality. This cut-off value is in accordance with the original PSQI report, wherein the
authors concluded that a global PSQI score of 6 or greater yielded a diagnostic sensitivity of
89.6% and specificity of 86.5% in distinguishing good vs. poor sleepers [14-17]. Participants with
sleep disturbance were defined as those with global PSQI scores ≥6 or component scores ≥2.
Subjects with global PSQI scores <6 or component scores <2 were considered to not have sleep
disturbance.
Job stressors were assessed using the Generic Job Stress Questionnaire (GJSQ), which was
developed by the National Institute for Occupational Safety and Health (NIOSH) [18]. The
Japanese version of the GJSQ has sufficient reliability and validity [19, 20]. The GJSQ was
chosen because it can be used to assess multilateral aspects of job stressors, including stress
reactions, at both the group and individual levels. The original authors of the GJSQ used
independent subscales to assess job stressors [18]. The focus was on four subscales (41 items):
role conflict, role ambiguity, quantitative workload, and job control. Two social support subscales
(from supervisors and co-workers, 8 items) were chosen as buffer factors, as per the DCS model
[21]. The item descriptions for the job control and social support items are positively oriented, so
that higher scores indicate lower stress. In contrast, all other items are negatively oriented, so that
higher scores indicate greater stress.
Role conflict measures how often workers experience role conflicts with each other. Role
ambiguity measures how clearly the worker understands what is expected of him or her for
adequate task performance or assumption of a role. Quantitative workload refers to the amount
of work that a person has to deal with on a daily basis. Job control refers to the extent to which
the individual feels that his or her tasks, workplace setting, and decisions at work are controllable.
Social support from supervisors and co-workers measures the existence of avenues for acquiring
social support during work time.
All study variables are presented as mean ± standard deviation. Independent t-tests were
used to examine differences in participant characteristics, GJSQ subscale scores, and global PSQI
score. The Mann–Whitney U test was used to determine differences in PSQI component scores
between individuals with global PSQI scores ≥6 and those with scores <6. Univariate logistic
regression analysis was used to estimate the odds ratios (ORs) and 95% confidence intervals (95%
CIs) for global PSQI scores ≥6 or individual component scores ≥2 in relation to the six GJSQ
subscales (quantitative workload, job control, role conflict, role ambiguity, social support from
supervisors, and social support from co-workers). A multivariable model was subsequently used
to estimate the ORs and 95% CIs for global PSQI scores ≥6 or individual component scores ≥2.
The analysis was adjusted for demographic variables (sex, age and marital status) and the six
GJSQ subscales. All statistical analyses were performed using the Statistical Package for the
Social Sciences version 23.0 (SPSS; IBM Software Group; Chicago, IL). P values <0.05 were
considered statistically significant.
Results
243 completed questionnaires were received (complete response rate, 71%). Nine night-shift
workers were excluded to eliminate any potential effects of shift work on sleep. Therefore, 234
daytime workers (mean age, 49.4 ± 10.7 years; range, 21-66 years; 31 [13%] women and 203
[87%] men) participated in this study. The demographic characteristics of the participants,
including age, sex, and marital status (single or married), were recorded (Table 1). Scores for role
ambiguity were significantly higher for participants with global PSQI scores ≥6 than for those
with global PSQI scores <6. Furthermore, scores for job control were significantly lower for
participants with global PSQI scores ≥6 than for those with global PSQI scores <6. There were
no differences in any other job stressors estimated using the GJSQ between those with global
PSQI scores <6 and those with PSQI scores ≥6.
The mean global PSQI score was 5.1 ± 2.6, and 83 participants (35%) had poor sleep quality,
as estimated by a global PSQI score of 6 or greater. Table 2 shows the extent of sleep problems,
as represented by a global PSQI score and the seven component scores, in participants divided
based on their scores on each component according to the cut-off score of 2. The numbers of
participants with PSQI component scores ≥2 and those with scores <2 are presented. The most
frequent sleep problem was inadequate sleep duration (54%).
Table 3 shows the results of the univariate and multivariable logistic regression analyses
using each GJSQ factor and individual factors as independent variables, and global PSQI score
≥6 as the dependent variable. In the univariate analysis, only role ambiguity was associated with
global PSQI score ≥6 (OR = 1.08, 95% CI = 1.03-1.14, range of 6-42). Similarly, in the
multivariable analysis, only role ambiguity was also associated with global PSQI scores ≥6 (OR
= 1.06, 95% CI = 1.01-1.12, range of 6–42, adjusted for sex, age and marital status).
Table 4 shows the results of the multivariable logistic regression analysis using each GJSQ
factor and individual factors as independent variables, and each PSQI component score ≥2 as a
dependent variable. Subjective sleep quality, sleep latency, sleep duration, and sleep efficiency
were not associated with any of the GJSQ subscale scores. Sleep disturbance was associated with
the role conflict score (OR = 1.10, 95% CI = 1.02-1.19, range of 8-56). Use of sleep medication
was associated with the job control scores (OR = 0.94, 95% CI = 0.89-1.00, range of 16-80) and
role conflict scores (OR = 1.10, 95% CI = 1.00-1.20). Daytime dysfunction was associated with
the role conflict scores (OR = 1.06, 95% CI = 1.01-1.11, range of 8-56).
Discussion
This cross-sectional study examined associations between job stressors and sleep quality. It
showed that high role stress was significantly associated with sleep problems, including problems
with global sleep quality, sleep disturbance, use of sleep medication, and daytime dysfunction.
In this study, role stressors were significantly associated with sleep problems. Fewer studies
have focused on role stressors and sleep quality than on other job stressors, and these results
support the existence of a relationship between role conflicts and sleep problems, including sleep
disturbance and daytime dysfunction. Previously, frequent role conflicts have been shown to be
associated with higher scores on the shortened version of the AIS [11]. The findings are consistent
with these results. Other studies have reported a positive association between role conflict and
difficulty initiating sleep in American workers [12]. Nonetheless, no relationship between role
conflict and sleep problems was reported among Japanese day-workers by Nakata and colleagues
[13]. These results differ from those in this study, where difficulty initiating sleep is identified as
sleep latency. However, these previous studies have often only used a single question to estimate
the presence of sleep problems and role conflict. Such simple questions may also fail to estimate
sleep quality and the existence of role stressors accurately. These methodological differences and
the characteristics of the included participants might explain the differences observed between
these results and those of previous studies.
The relationship between role ambiguity and sleep quality has not previously been addressed.
The present results, where greater role ambiguity was associated with poor global sleep quality,
suggest that there should be more of a focus on role ambiguity. The manner in which role stressors
affect sleep quality remains unknown. Role conflict is reported to be a situation where employees
face significant pressure from incompatible job demands, such as group interdependence,
different working styles in subordinates and supervisors, and different requirements from
individuals. These factors might cumulatively lower sleep quality. A previous cross-sectional
study of Japanese public-school teachers showed that high role conflict and role ambiguity were
significantly associated with high aggression [10] and the risk of depressive symptoms [5].
Therefore, role stressors may not only directly affect sleep quality, but also have secondary effects
on aggression and/or depressive symptoms.
Several limitations of the current study should be acknowledged when interpreting these
results. First, the study may have been biased due to the small sample size, single occupation of
the participants, and the unbalanced age and sex ratios. This may limit the generalizability of the
findings to other populations. Second, participants were recruited from employees who attended
a seminar on mental health, and the moderate response rate (71%) for this survey questionnaire
might have resulted in selection bias. Third, all measures are self-reported, and therefore, the
associations between role conflict and sleep quality may have been subject to reporting bias.
Furthermore, the duration of overtime and mental status, such as depressive symptoms and
alcohol consumption can affect sleep quality and the magnitude of perceived job stress. Further
studies should assess additional factors when considering sleep quality among employees. Finally,
in cross-sectional studies, the directions of cause and effect may be difficult to assess. In the
current study, poor sleepers perceived role stressors as more difficult than they should be. There
is a reciprocal relationship between job stressors, such as role stressors, and sleep. Further
investigation of these factors using studies with cohort or longitudinal designs is required.
Nonetheless, these results suggest that the management of role stressors is important for
addressing employees’ sleep problems in the workplace. According to role theory, role conflict
results from two or more sets of incompatible demands involving work-related issues [9, 30]. To
reduce role stress, it is necessary to implement changes in organizational policies, such as
clarifying the role and content of diversified work, sharing information, and accepting diversity
in the workplace. Such strategies would be expected to reduce the prevalence of sleep problems
among employees. In addition, interventions for sleep health, such as sleep hygiene training or
group cognitive behavioural therapy, may improve sleep and role problems.
In summary, this cross-sectional study investigated the relationship between role stressors
and sleep problems among Japanese public workers. It demonstrated that higher role stressors
were significantly associated with sleep problems, including poor global sleep quality, sleep
disturbance, use of sleep medication, and daytime dysfunction. The results suggest the importance
of efforts to reduce role stressors and the observation of sleep conditions among employees.
Key points:
l Role stressors have had less attention than other job stressors in studies evaluating the
relationship between job stressors and sleep quality.
l In this cross-sectional study, high role stress was found to lead to low sleep quality among
Japanese public servants.
l Efforts to reduce role stressors and the observation of sleep conditions among employees
are required to improve the health of workers.
Conflicts of Interest: None declared.
Acknowledgements: We would like to thank all participants.
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Table 1
Participants’ characteristics and job stressors estimated using the Generic Job Stress
Questionnaire
Characteristics Total Global PSQI <6 Global PSQI ≥6 P value
Sex, n (%)
Female 31 (13%) 23 8
Male 203 (87%) 128 75
Age 49.4 ± 10.7 50.1 ± 10.2 48.0 ± 11.6
Marital status, n (%)
Single 52 (22%) 32 20
Married 182 (78%) 119 63
Job Stressors
Quantitative workloada 36.1 ± 4.2 36.2 ± 3.9 36.0 ± 4.7 NS
Job controlb 45.9 ± 12.9 47.2 ± 12.0 43.9 ± 14.1 <0.05
Social support
(superior)b
14.7 ± 3.3 14.7 ± 3.4 14.6 ± 3.2 NS
Social support
(coworker)b
15.2 ± 3.0 15.3 ± 3.1 15.1 ± 2.7 NS
Role conflicta 27.6 ± 8.5 27.1 ± 8.3 28.5 ± 8.8 NS
Role ambiguitya 18.4 ± 6.0 17.5 ± 5.4 20.2 ± 6.5 <0.01
PSQI: Pittsburgh Sleep Quality Index; NS: not significant. Values are expressed as
mean ± SD.
a: Higher scores indicate greater stress. b: Higher scores indicate lower stress.
Table 2
Sleep problems estimated using the Pittsburgh Sleep Quality Index
Total Component score <2,
n (%)
Component score ≥2,
n (%)
Global PSQI 5.1 ± 2.6
Subjective sleep quality 1.1 ± 0.7 176 (75%) 58 (25%)
Sleep latency 0.6 ± 0.8 201 (86%) 33 (14%)
Sleep duration 1.5 ± 0.8 108 (46%) 126 (54%)
Sleep efficiency 0.2 ± 0.6 224 (96%) 10 (4%)
Sleep disturbance 0.8 ± 0.6 219 (94%) 15 (6%)
Use of sleep medication 0.2 ± 0.6 223 (95%) 11 (5%)
Daytime dysfunction 0.8 ± 0.8 199 (85%) 35 (15%)
PSQI: Pittsburgh Sleep Quality Index
Values are expressed as mean ± SD.
Table 3
Univariate and multivariable logistic regression analyses of risk factors for global PSQI
score ≥6
Crude model Adjusted modela
Range OR 95% CI P OR 95% CI P
Quantitative workload 17-55 0.99 0.93-1.05 0.97 0.90-1.04
Job control 16-80 0.98 0.96-1.00 0.99 0.96-1.01
Social support
(superior)
4-20 0.99 0.92-1.08 1.06 0.94-1.19
Social support (co-
worker)
4-20 0.99 0.90-1.08 0.99 0.87-1.12
Role conflict 8-56 1.02 0.99-1.05 1.01 0.98-1.05
Role ambiguity 6-42 1.08 1.03-1.14 ** 1.06 1.01-1.12 *
Sexb 0.45 0.16-1.26
Age 0.99 0.95-1.02
Marital statusb 1.1 0.51-2.42
OR: odds ratio; CI: confidence interval; * P < 0.05, ** P < 0.01
a: Adjusted for all listed variables
b: The reference value for sex is male and that for marital status is married.
Table 4
Multivariable logistic regression analysis of risk factors for higher Pittsburgh Sleep
Quality Index component scores
Variable OR 95% CI P
Subjective sleep quality
Quantitative workload 1.02 0.94-1.10
Job control 0.98 0.95-1.01
Social support (superior) 1.06 0.93-1.21
Social support (co-worker) 0.9 0.78-1.03
Role conflict 1.02 0.98-1.07
Role ambiguity 1.05 0.99-1.11
Sex 0.34 0.10-1.19
Age 0.99 0.96-1.02
Marital status 1.27 0.54-3.04
Sleep latency
Quantitative workload 0.94 0.85-1.04
Job control 1 0.97-1.04
Social support (superior) 1.05 0.89-1.25
Social support (co-worker) 1.01 0.85-1.20
Role conflict 1 0.95-1.06
Role ambiguity 1.05 0.98-1.13
Sex 0.46 0.09-2.44
Age 1.02 0.98-1.07
Marital status 1.42 0.49-4.15
Sleep duration
Quantitative workload 1 0.94-1.07
Job control 0.98 0.96-1.01
Social support (superior) 1.02 0.91-1.13
Social support (co-worker) 1.01 0.89-1.13
Role conflict 1 0.97-1.04
Role ambiguity 1.01 0.96-1.06
Sex 0.73 0.28-1.91
Age 0.98 0.95-1.01
Marital status 1.7 0.79-3.66
Sleep efficiency
Quantitative workload 0.94 0.80-1.11
Job control 0.97 0.91-1.02
Social support (superior) 1.23 0.92-1.65
Social support (co-worker) 0.86 0.66-1.11
Role conflict 1.03 0.94-1.14
Role ambiguity 1.05 0.93-1.20
Sex 10.4 1.01-106.18 *
Age 1.06 0.98-1.14
Marital status 0.48 0.06-3.60
Sleep disturbance
Quantitative workload 0.89 0.78-1.02
Job control 1.01 0.96-1.06
Social support (superior) 1.02 0.80-1.30
Social support (co-worker) 0.96 0.76-1.21
Role conflict 1.1 1.02-1.19 *
Role ambiguity 1.09 0.98-1.21
Sex 1.19 0.09-15.23
Age 1.04 0.97-1.11
Marital status 0.22 0.02-2.10
Use of sleep medication
Quantitative workload 0.98 0.84-1.14
Job control 0.94 0.89-1.00 *
Social support (superior) 1.07 0.79-1.45
Social support (co-worker) 0.91 0.69-1.20
Role conflict 1.1 1.00-1.20 *
Role ambiguity 1.08 0.95-1.22
Sex 2.05 0.11-37.46
Age 1.09 1.00-1.19
Marital status 0.41 0.03-5.17
Daytime dysfunction
Quantitative workload 1.03 0.94-1.13
Job control 0.99 0.96-1.03
Social support (superior) 1.01 0.86-1.18
Social support (coworker) 0.99 0.83-1.17
Role conflict 1.06 1.01-1.11 *
Role ambiguity 1.05 0.98-1.12
Sex 0.96 0.27-3.41
Age 0.98 0.94-1.02
Marital status 0.9 0.33-2.47
OR: odds ratio, CI: confidence interval, * P < 0.05
Adjusted for all listed variables
Reference value for sex is male and that for marital status is married.
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