Joint sleep-quality and daytime-sleepiness screening classifications among emergency-deployed nurses: a secondary cross-sectional analysis
Year: 2026
Type: article
Abstract: Sleep quality and daytime sleepiness capture related but distinct aspects of nurses’ sleep health. We examined their joint screening classifications, agreement, and discordance among nurses deployed during the early COVID-19 emergency, when unfamiliar settings and intensive schedules constrained recovery. This secondary cross-sectional analysis included 414 nurses deployed from Fujian to Hubei, China, and surveyed from 19 March to 15 April 2020. The primary analysis combined archived Pittsburgh Sleep Quality Index (PSQI) scores > 7 and Epworth Sleepiness Scale (ESS) scores ≥ 10 into four screening classifications. Sensitivity analyses used alternative thresholds and data-cleaning assumptions. We calculated Wilson confidence intervals for proportions and bootstrap confidence intervals for Spearman correlation and Cohen’s κ. Exploratory generalized estimating equations jointly modeled standardized PSQI and ESS scores, with false discovery rate correction. Neither score was elevated in 221 nurses (53.4%); 124 (30.0%) had elevated PSQI only, 31 (7.5%) elevated ESS only, and 38 (9.2%) both. Scores were weakly correlated (ρ = 0.289, 95% confidence interval 0.195–0.374); descriptive κ was 0.124 (0.039–0.212), reflecting agreement beyond that expected from the marginal distributions. Among 69 nurses with ESS ≥ 10, 31 (44.9%) had PSQI ≤ 7; with the PSQI > 5 threshold, 14 of these 69 nurses (20.3%) remained below the sleep-quality cutoff. In adjusted analyses, frequent night shifts and prior sleep disorders were associated with higher PSQI, and snoring with higher ESS. Morningness and psychological distress were associated with both outcomes. None of the 13 between-outcome differences survived false discovery rate correction. Eight archived PSQI component values exceeded the standard range; capping these values did not change primary classifications. The two questionnaires identified incompletely overlapping groups, with discordance depending on the thresholds used. A practical next step is to prospectively evaluate, in similar emergency nursing settings, a staged, nonpunitive occupational-health pathway combining domain-specific assessment with review of work schedules, recovery opportunities, safety-sensitive symptoms, and referral when indicated, while measuring outcomes, staff burden, referral yield, and unintended consequences. Archived scoring uncertainty, self-report, and the historical cross-sectional design limit interpretation; the findings do not establish diagnostic accuracy, causal pathways, or patient-safety benefits. Clinical trial number: not applicable.
Source: BMC Nursing
Language: English
Topic: Sleep and related disorders
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7223470653
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