Association of Sleep Quality With Cardiovascular Disease Risk and Mental Health in Law Enforcement Officers

Investigating the linkages between food insecurity, psychological distress, and poor sleep outcomes among U.S. college students

OBJECTIVE

Research overwhelmingly demonstrates that sleep is key to human health and wellbeing. Several factors likely contribute to sleep quality, including factors, such as food security and low income. In addition, exposure to structural inequalities early in life likely have downstream effects upon multiple dimensions of health. The objective of this study is to fill gaps in literature by specifically examining the associations between childhood food insecurity, current food insecurity, psychological distress, and sleep among college students.

METHODS

QR codes were randomly distributed to students, linking them to an online quantitative survey. The survey measured sociodemographic variables, food security (current and childhood), diet, mental distress, and sleep quality. A total of n = 134 completed the entire survey. Data were analyzed using binary and multiple linear regressions, as well as cross-tabulations.

RESULTS

The findings revealed that psychological distress was the primary factor influencing sleep health (𝛽 = 1.51, p < .01). Students reporting higher childhood food insecurity were more likely to experience extreme psychological distress (OR = 4.61), food insecurity in college (OR = 8.41), and lack of stable housing (OR = 5.86).

CONCLUSION

This study demonstrates that potential linkages exist between childhood food insecurity, poor sleep, and greater psychological distress. While acknowledging the contribution of other factors, the study highlights the importance of addressing food insecurity in relation to sleep health, considering the significant impact of sleep to overall health and wellbeing.

The relationship between sleep quality, snoring symptoms, night shift and risk of stroke in Chinese over 40 years old

Objectives

To analyze the relationship between sleep quality, snoring symptoms, night shift and risk of stroke in Chinese population over 40 years old.

Methods

Based on the national screening and intervention program for high-risk population of stroke in 2016, 15,016 people completed the study of “the association between sleep and stroke,” 58,696 people completed the snoring questionnaire, and 58,637 people completed the night shift questionnaire.

Results

The proportion of coronary heart disease, hypertension, hyperlipidemia, diabetes, snoring, atrial fibrillation, stroke and high-risk group of stroke risk rating were higher in the group with poor sleep quality (p &lt; 0.05). The proportion of high blood pressure, hyperlipidemia, diabetes, atrial fibrillation, transient ischemic attack (TIA), or high-risk group of stroke risk rating was higher in snoring group (p &lt; 0.05). The body mass index (BMI), waist circumference, neck circumference, fasting blood glucose, triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL) and homocysteine (Hcy) levels in snoring group were higher than the non-snoring group, and high density lipoprotein (HDL) levels were lower (p &lt; 0.05). People with TIA, high risk for stroke, and high blood pressure were higher in night shift workers than non-night shift workers (p &lt; 0.05). The levels of BMI, fasting blood glucose, 2 h postprandial blood glucose, glycated hemoglobin, TG, TC, LDL, HDL and Hcy in night shift group were lower than the non-night shift group (p &lt; 0.05).

Conclusion

Sleep quality, snoring and night shift might be related to the risk factors of stroke.

Predictors, Mediators and Moderators of Police Work-Related Stress: A Scoping Review

Owing to the complication in organisation, the dangerous job nature and the rise of demonstrations and protests across the world in the past decade, police work-related stress has become a topic of global concern. This review aimed to provide an understanding of predictors, mediators and moderators of police work-related stress from a multi-level perspective. Using a scoping review approach underpinned by the six-stage methodological framework, studies were found from six electronic databases (MEDLINE, Web of Science, Sociological Abstracts, Scopus, PsycINFO and PsychiatryOnline) and grey literature sources. Thirty studies were yielded across 35,446 participants from 12 locations. This review contributes to a systematic understanding of the factors affecting police work-related stress by identifying six predictors, four mediators and three moderators. It then discusses limitations and future research.

Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research

BACKGROUND

The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers.

METHODS

We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue.

RESULTS

Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs.

CONCLUSIONS

In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.

The Quality of Life and the Bio-Molecular Profile in Working Environment: A Systematic Review

Working life is characterised by various requirements and degrees of control in meeting these demands. The imbalance of these elements with workers’ resources can result in work-related stress involving the repeated activation of stress response systems. Modifications in the bio-molecular profile may represent a biological signature of individuals’ life experiences and provide evidence on pathways through which such stressors can result in health outcomes. The aim of our systematic review is to characterize the quality of life (QOL) and the bio-molecular profile in the working population, to highlight if the alteration observed might be related to the working conditions. The article query was performed on PubMed, Embase, and Cochrane CENTRAL and results have been presented according to three molecular pathways involved in the stress response: oxidative stress, inflammation, and neuroendocrine activation. The epidemiological sample has been sub-grouped into “clinical” and “non-clinical” populations according to the presence of a diagnosis of psychological disorders. Besides some critical issues, the review highlights the importance of developing a valid array of biological indicators, measurable in non-invasive matrices, sensitive to both derangements from physiological conditions and stress reduction, useful for identifying those groups at higher risk of health outcomes and, eventually, promoting workers’ wellbeing.

A Confirmatory Factor Analysis of the PROMIS Sleep Disturbance Among Law Enforcement Officers

Law enforcement officers (LEOs) are at increased risk for sleep disorders relative to the general population. Common LEO occupational stressors, including critical incidents and shift work, predict sleep disturbance, which in turn negatively impacts health, performance, and community safety. The Patient-Reported Outcomes Measurement Information System-Sleep Disturbance 4-item (PROMIS SD4) was developed to assess self-reported sleep quality, satisfaction, and difficulties falling asleep. Previous studies suggest PROMIS-SD short-forms (4-, 6-, and 8-item) have good psychometric properties; however, evaluation of this easily-administered measure in high-stress, frontline populations is limited. The primary goal of this study was to evaluate the validity and reliability of the PROMIS-SD4 in a sample of LEOs (N = 111). A confirmatory factor analysis suggests that the original one-factor solution, with a correlated error-term, provides an excellent fit to the data, SBχ²(2) = 1.62, p = .23, CFI = .99, RMSEA = .12, SRMR = .01. The PROMIS SD4 demonstrated good reliability (α = .85) and evidence of convergent validity correlations in the expected direction with domains of psychological distress, positive health outcomes, reactivity, and body experience (all p's < .05). Results suggest that the PROMIS-SD4 is a valid and reliable measure of sleep disturbance among LEOs.

Estimation of Cardiovascular Disease Risk Factors in the Undefined Participants of Campaign in Isfahan in 2017

Background:

The cardiovascular mortality rate in Iran has been reported 65% of all death recently. Despite the high prevalence of cardiovascular diseases (CVD) risk factors and its burden in developing countries, public awareness of CVD symptoms and its risk factors are very low, leading to poor control of these risk factors.

Methods:

Our study is a cross-sectional study that was conducted in an undefined sample of 163 individuals who participated in a public health campaign. We used a validated questionnaire containing demographic, cardiovascular history, family history, lifestyle (exercise, smoking, alcohol, and environment), stress, sleep, bowel toxicity, blood sugar, inflammation/pain, and diet parts for estimating total cardiovascular risk factor.

Results:

52.7% of our participants were male. The mean age of our participants was 42.6 ± 47.27 years. Half of our participants (50.3%%) were between 30 and 60 years. 12.3% of the participants were diagnosed with CVD. 12.8% were smokers and 25.8% were passive smokers. 73% of our participants had a high level of stress in their individual and work life. 35.5% of participants sleep less than 6 h per night. Half of them complained of initial or intermittent insomnia. 51.5% of our participants were at high or very high risk for CVD with three or more relative risks. There was a significant association between total cardiovascular risk and blood pressure, weight, sleep, and lifestyle in our population.

Conclusions:

More than half of our participants were on high or very high risk for CVD. The most common risk of CVD events in our participants is attributed to hypertension. Weight, sleep, and lifestyle were other modifiable risks that had a significant association with CVD in our study.

Sex differences in mental disorder symptoms among Canadian police officers: the mediating role of social support, stress, and sleep quality

Police officers, and specifically women officers, report elevated mental disorder rates relative to the general population, which may be impacted by sleep quality, policing-related stress, and social support. In a sample of Canadian police officers, sex was indirectly related to post traumatic stress, depression, generalized anxiety, panic, and social anxiety symptoms through its relationships with social support and sleep quality, but not through policing-related stress. Sex was indirectly related to problematic alcohol use symptoms through sleep quality only. Differences in clinical symptom severity between both sexes may be partially accounted for by the worsened sleep quality reported by women officers relative to their men counterparts. Conversely, general social support appears to be a protective, albeit insufficient, factor influencing the mental health of women police officers. Male and women police officers did not differ in their reports of policing-related stress. The current results underscore the importance of incorporating strategies to improve sleep practices into police workplace environments. Additionally, findings that general social support and policing-related stress do not help explain the trend of increased clinical severity reported by women police suggest that more research is still needed to identify and delineate other contributing factors.

Exercise capacity, cardiovascular and metabolic risk of the sample of German police officers in a descriptive international comparison

Background: The police force has the mandate to protect citizens and enforce the law for public safety. Employment in the police force is recognized as a dangerous occupation and characterized by job-related physical hazards. Therefore, good health and adequate physical condition are necessary. This study aimed to determine cardiovascular, cardiorespiratory, and metabolic risk parameters of German police officers (POs) in comparison to POs from other nations. Methods: 55 male police officers from Germany participated in the survey. We examined anthropometric measurements, cardiovascular/metabolic risk factors and blood parameters. Additionally, we calculated 10-year cardiovascular risk using the Framingham Risk Score. The diagnosis of metabolic syndrome bases on the criteria of the International Diabetes Federation. We assessed cardiorespiratory status by exercise spirometry. Results: The analyzed group of POs demonstrated a high prevalence of pre obesity (BMI: 28.0±3.2 kg/m², waist circumference: 97.8±12.4 cm). 61.8 % of POs showed an increased waist circumference. POs showed high prevalence of abnormal values of triglyceride (n: 24, 43,6%), and systolic (n: 29, 52,7%) and diastolic (n: 27, 49%) blood pressure. The average 10-year cardiovascular risk (by Framingham) was classified as moderate (9.6 ± 7.4 %). 32 % (n: 18) of POs in our study group were diagnosed with metabolic syndrome. Maximal relative oxygen uptake of POs was 34.1 ± 8.0 ·ml/kg^-1 ·min^-1. Conclusions: To our knowledge, this study was one of the first to assess data on cardiovascular health, metabolic syndrome and cardiorespiratory status of police officers in Germany. The results of our study demonstrated an increased cardiovascular and metabolic risk and decreased cardiorespiratory fitness in German police officers. The present study results underline the need to implement health-promoting interventions and concepts like corporate sports activities or nutrition courses to counteract cardiovascular and metabolic risk factors. We have to reduce the subsequent development of cardiovascular and metabolic disease in this occupational group.

Global prevalence and risk factors for mental health problems in police personnel: a systematic review and meta-analysis

Police face an increased risk of developing mental health problems, yet reliable estimates of their psychological difficulties remain unknown. This systematic review and meta-analysis estimate the pooled prevalence and risk factors for mental health problems among police personnel worldwide. Three independent reviewers searched 16 databases and screened 11 506 articles published between January 1980 and October 2019. Eligible studies involved at least 100 active police professionals and used validated instruments to ascertain specific mental health problems. Estimates were pooled using random-effects meta-analyses. In total, 60 cross-sectional and seven longitudinal studies, involving 272 463 police personnel from 24 countries met criteria for inclusion. The overall pooled point prevalence was 14.6% for depression (95% CI 10.9% to 18.6%), 14.2% for post-traumatic stress disorder (PTSD; 95% CI 10.3% to 18.7%), 9.6% for a generalised anxiety disorder (95% CI 6.7% to 12.9%), 8.5% for suicidal ideation (95% CI 6.1% to 11.2%), 5.0% for alcohol dependence (95% CI 3.5% to 6.7%) and 25.7% for hazardous drinking (95% CI 19.6% to 32.4%). The strongest risk factor for depression and suicidal ideation was higher occupational stress, and the strongest risk factors for PTSD were higher occupational stress and avoidant coping strategies. Higher levels of peer-support were associated with significantly lower PTSD symptoms. Our findings suggest that the prevalence of mental health problems among police exceeds twice that previously reported in mixed samples of first responders, and is associated with poor social support, occupational stress and maladaptive coping strategies. Without effective intervention, psychological difficulties will remain a substantial health concern among police.

Burnout syndrome and sleep quality among military police officers in Piaui

Background

Military police officers are a distinct population group given they deal everyday with violence and crime. For this reason they are more susceptible to develop burnout syndrome, resulting in significant decrease of productivity and changes in the quality of sleep.

Objective

To analyze the correlation between burnout syndrome and sleep quality relative among military police officers.

Method

Cross-sectional, descriptive and quantitative study conducted with 32 military police officers of the military police battalion of Teresina, Piaui, Brazil. Data collection was performed through administration of a questionnaire for sociodemographic data, the Masliach Burnout Inventory and the Pittsburgh Sleep Quality Index. Pearson's correlation was used for statistical analysis.

Results

The sample comprised 32 male military police officers, with average age 44.35±5.63 years old. Sleep duration exhibited highly significant, inverse and moderate correlation with emotional exhaustion (p=0.0003). Emotional exhaustion exhibited significant moderate correlation with sleep quality (p=0.004). Depersonalization exhibited significant, albeit weak correlation with sleep quality (p=0.03).

Conclusion

Burnout syndrome domains emotional exhaustion and depersonalization exhibited significant correlation with sleep quality.

Sleep Quality among Police Officers: Implications and Insights from a Systematic Review and Meta-Analysis of the Literature

Poor sleep is associated with bad health outcomes, worse wellbeing and decreases in performance, productivity and safety at work. Police officers are exposed to several risk factors including extended work schedules, shift work, occupational stress, dangerous and traumatic events and can, as such, develop sleep problems. The aim of the present study was to analyze the sleep quality among police officers. A systematic literature search, in PubMed/MEDLINE, PsycINFO, Scopus, ISI/Web of Science (WoS) and the Cochrane Library was conducted. Original articles, published in English, French, Italian, Spanish and Portuguese, the primary objective of which was the evaluation of the quality of sleep through the Pittsburgh Sleep Quality Index (PSQI) in Police Forces, were selected. From an initial sample of 1,149 studies, 13 articles were included in the meta-analysis (3,722 police officers). The pooled prevalence of bad sleep quality in police officers was 51% [95%CI 42–60%]. The pooled global score of the PSQI was 5.6 [95%CI 5.0–6.3], corresponding to a low average quality. At the meta-regressions, statistically significant associations could be found for work seniority (in terms of years of service) and being on shift. The poor quality of sleep in police officers could have negative consequences for workers’ health and for the safety of third parts. The implementation of health and sleep hygiene promotion programs in police forces is strongly recommended.

Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults

STUDY OBJECTIVES

There is limited information on the relationship between risk of cardiovascular disease and the joint effects of sleep quality and sleep duration, especially from large, prospective, cohort studies. This study is to prospectively investigate the joint effects of sleep quality and sleep duration on the development of coronary heart disease.

METHODS

This study examined 60,586 adults aged 40 years or older. A self-administered questionnaire was used to collect information on sleep quality and sleep duration as well as a wide range of potential confounders. Events of coronary heart disease were self-reported in subsequent medical examinations. Two types of Sleep Score (multiplicative and additive) were constructed to reflect the participants' sleep profiles, considering both sleep quality and sleep duration. The Cox regression model was used to estimate the hazard ratio (HR) and the 95% confidence interval (CI).

RESULTS

A total of 2,740 participants (4.5%) reported new events of coronary heart disease at follow-up. For sleep duration, participants in the group of < 6 h/d was significantly associated with an increased risk of coronary heart disease (HR: 1.13, 95% CI: 1.04-1.23). However, the association in the participants with long sleep duration (> 8 h/d) did not reach statistical significance (HR: 1.11, 95% CI: 0.98-1.26). For sleep quality, both dreamy sleep (HR: 1.21, 95% CI: 1.10-1.32) and difficult to fall asleep/use of sleeping pills or drugs (HR: 1.40, 95% CI: 1.25-1.56) were associated with an increased risk of the disease. Participants in the lowest quartile of multiplicative Sleep Score (HR: 1.31, 95% CI: 1.16-1.47) and of additive sleep score (HR: 1.31, 95% CI: 1.16-1.47) were associated with increased risk of coronary heart disease compared with those in the highest quartile.

CONCLUSIONS

Both short sleep duration and poor sleep quality are associated with the risk of coronary heart disease. The association for long sleep duration does not reach statistical significance. Lower Sleep Score (poorer sleep profile) increases the risk of coronary heart disease, suggesting the importance of considering sleep duration and sleep quality together when developing strategies to improve sleep for cardiovascular disease prevention.