BMJ Open: first published as 10.1136/bmjopen-2019-032239 on 29 December 2019. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 27, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2019-032239 on 29 December 2019. Downloaded from Sleep problems and related influencing factors among healthcare workers in tertiary public hospitals in Heilongjiang province ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2019-032239 Article Type: Research Date Submitted by the 09-Jun-2019 Author: Complete List of Authors: liu, huan; Harbin Medical University, Liu, jing; Harbin Medical University School of Public Health, Department of Social Medicine chen, mingxi; Harbin Medical University, Social Medicine tan, xiao; Harbin Medical University, Social Medicine zheng, tong; Harbin Medical University, Social Medicine Kang, Zheng; Harbin Medical University, Social Medicine; Gao, Lijun; Harbin Medical University, Social Medicine Jiao, Mingli; Harbin Medical University, Health policy Ning, Ning; Harbin Medical University, Social Medicine Liang, Libo; School of Health Management, Harbin Medical University, Social Medicine; Wu, Qunhong; Harbin Medical University, Social Medicine http://bmjopen.bmj.com/ Hao, Yanhua; Harbin Medical University, Social Medicine Healthcare worker, Tertiary hospitals, Sleep problems, Influencing Keywords: factors on September 27, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 34 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-032239 on 29 December 2019. Downloaded from 4 1 Title Page 5 6 7 2 8 9 3 Title 10 11 4 Sleep problems and related influencing factors among healthcare workers in tertiary 12 5 public hospitals in Heilongjiang province. 13 14 6 15 16 17 7 Author names, affiliations and email addresses 18 For peer review only 19 8 Huan Liu1, Jingjing Liu1, Mingxi Chen1, Xiao Tan1, Tong Zheng1, Zheng Kang1, 20 9 Lijun Gao1, Mingli Jiao2, Ning Ning1, Libo Liang1, Qunhong Wu1*, Yanhua Hao1*. 21 22 10 23 24 25 11 1Department of Social Medicine, School of Public Health, Harbin Medical University, 26 27 12 Harbin, Heilongjiang Province, China. 28 29 30 13 2Department of Health Policy, School of Public Health, Harbin Medical University, 31 32 33 14 Harbin, Heilongjiang Province, China. 34 35 15 36 37 16 http://bmjopen.bmj.com/ 38 39 17 Huan Liu, Department of Social Medicine, School of Public Health, Harbin Medical 40 41 18 University, Harbin, Heilongjiang Province, China. Email: [email protected] 42 43 19 Jingjing Liu, Department of Social Medicine, School of Public Health, Harbin Medical 44 20 University, Harbin, Heilongjiang Province, China. Email: [email protected] 45 on September 27, 2021 by guest. Protected copyright. 46 47 21 Mingxi Chen, Department of Social Medicine, School of Public Health, Harbin 48 49 22 Medical University, Harbin, Heilongjiang Province, China. Email: [email protected] 50 Xiao Tan, Department of Social Medicine, School of Public Health, Harbin Medical 51 23 52 24 University, Harbin, Heilongjiang Province, China. Email: [email protected] 53 54 25 Tong Zheng, Department of Social Medicine, School of Public Health, Harbin Medical 55 56 26 University, Harbin, Heilongjiang Province, China. Email: 57 58 27 [email protected] 59 60 28 Zheng Kang, Department of Social Medicine, School of Public Health, Harbin Medical For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 34 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-032239 on 29 December 2019. Downloaded from 4 1 University, Harbin, Heilongjiang Province, China. Email: [email protected] 5 6 2 Lijun Gao, Department of Social Medicine, School of Public Health, Harbin Medical 7 8 3 University, Harbin, Heilongjiang Province, China. Email: [email protected] 9 10 4 Mingli Jiao, Department of Health Policy, School of Public Health, Harbin Medical 11 University, Harbin, Heilongjiang Province, China. Email: [email protected] 12 5 13 6 Ning Ning, Department of Social Medicine, School of Public Health, Harbin Medical 14 15 7 University, Harbin, Heilongjiang Province, China. Email: [email protected] 16 17 8 Libo Liang, Department of Social Medicine, School of Public Health, Harbin Medical 18 For peer review only 19 9 University, Harbin, Heilongjiang Province, China. Email: [email protected] 20 21 10 Qunhong Wu, Department of Social Medicine, School of Public Health, Harbin 22 23 11 Medical University, Harbin, Heilongjiang Province, China. Email: 24 25 12 [email protected] 26 27 13 Yanhua Hao, Department of Social Medicine, School of Public Health, Harbin 28 29 14 Medical University, Harbin, Heilongjiang Province, China. Email: [email protected] 30 31 15 32 33 16 *Corresponding authors: 34 35 17 Qunhong Wu 36 18 Postal address: Harbin Medical University, 157 Baojian Road, Nangang District, 37 http://bmjopen.bmj.com/ 38 39 19 Harbin, Heilongjiang, 150086, China; E-mail: [email protected]; Tel.: + 86-0451- 40 41 20 87502851; fax: + 86-0451-87502853 42 43 21 44 22 Yanhua Hao 45 on September 27, 2021 by guest. Protected copyright. 46 47 23 Postal address: Harbin Medical University, 157 Baojian Road, Nangang District, 48 49 24 Harbin, Heilongjiang, 150086, China; E-mail: [email protected]; Tel.: + 86-0451- 50 87502860; fax: + 86-0451-87502853 51 25 52 26 53 54 55 27 Keywords: Healthcare worker; Tertiary hospitals; Sleep problems; Influencing factors 56 57 28 Word counts 58 59 29 word count of the abstract: 276 60 30 word count of manuscript: 3934 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 34 BMJ Open 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-032239 on 29 December 2019. Downloaded from 4 1 Sleep problems and related influencing factors among healthcare 5 6 7 2 workers in tertiary public hospitals in Heilongjiang province: a 8 9 3 multi-level analysis 10 11 12 4 13 14 15 5 Abstract 16 17 6 Objectives: Sleep problems not only affect the health and work quality of healthcare 18 For peer review only 19 20 7 workers, but also it might bring risks to patients’ safety. China's tertiary hospitals 21 22 8 provide medical care for a large proportion of the Chinese population and therefore, 23 24 25 9 sleep quality of healthcare workers in these institutions increasingly becomes an issue 26 27 10 of paramount concern. We aim to conduct subjective evaluation on the sleep problems 28 29 30 11 and explore potential influencing factors among healthcare workers in tertiary hospitals 31 32 33 12 in China. 34 35 13 Design: A cross-sectional questionnaire survey study. 36 37 http://bmjopen.bmj.com/ 38 14 Setting: The study was conducted in 377 departments at 33 tertiary hospitals in 39 40 15 Heilongjiang Province. 41 42 43 16 Participants: A total of 4009 participants were invited. Ultimately, 3,810 participants 44 45 on September 27, 2021 by guest. Protected copyright. 46 17 completed valid questionnaires. Study participants included clinicians, medical 47 48 18 technicians, and administrative staffs. 49 50 51 19 Primary and secondary outcome measures: Participants completed a structured 52 53 20 questionnaire, which collected data regarding demographics, sleep problems, 54 55 56 21 employment, chronic pain, and healthy behaviors. A two-level logistic regression 57 58 59 22 model was conducted to examine determinants of sleep problems. 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 34 1 2 3 BMJ Open: first published as 10.1136/bmjopen-2019-032239 on 29 December 2019. Downloaded from 4 1 Results: In this study, we found that nearly half of the healthcare workers reported 5 6 7 2 having sleep problems. The two-level logistic model suggested a positive association 8 9 3 of sleep problems with headache (OR = 2.61, 95%CI = 2.24–3.04), working hours (OR 10 11 12 4 = 1.39, 95%CI = 1.18–1.64), and night shifts (OR=1.44, 95%CI=1.22-1.71). In contrast, 13 14 5 regular diet (OR = 0.50, 95%CI = 0.41–0.62), regular bowel movements (OR = 0.70, 15 16 17 6 95%CI = 0.56–0.87), and exercise (OR = 0.66, 95%CI = 0.54–0.81) protected against 18 For peer review only 19 20 7 sleep problems in healthcare workers. 21 22 8 Conclusions: Sleep problems are prominent among healthcare workers. The leading 23 24 25 9 factor associated with sleep problems was headache. Future studies should explore the 26 27 10 effects of interventions for sleep problems among healthcare workers. 28 29 30 11 Strengths and limitations of this study 31 32 33 12 · We recruited 3,810 healthcare workers from 377 departments at 33 tertiary hospitals 34 35 13 in Heilongjiang Province with a multi-stage stratified random sampling.