职业紧张和轮班对铁路工务系统职工睡眠质量的影响

Effect of occupational stress and shift work on sleep quality of workers of permanent way system

[背景]职业紧张是职业人群健康的重要影响因素,研究发现职业紧张与不良睡眠质量相关。睡眠质量问题可增加乳腺癌、心脑血管疾病以及糖尿病等疾病的发生风险。铁路工务系统职工长期以轮班的方式工作,容易产生睡眠质量问题。[目的]了解职业紧张和轮班对铁路工务系统职工睡眠质量的影响,为保护和促进铁路工务系统职工的身心健康提供科学依据。[方法]于2018年12月-2019年4月期间,采用分层整群抽样方法选取福州铁路局符合纳入标准的铁路工务系统职工642人,进行问卷调查。采用工作内容问卷和匹兹堡睡眠质量指数量表对铁路工务系统职工的职业紧张状况和睡眠质量状况进行评价,其中工作内容问卷包括工作要求、自主程度和社会支持3个部分,当工作要求与自主程度得分的比值>1时判定为职业紧张;匹兹堡睡眠质量指数量表包含7个子项目,总分为21分,得分越高,睡眠质量越差,得分>7分时表示存在睡眠质量问题。采用logistic回归分析睡眠质量的影响因素,并将职业紧张和轮班作为2个交互项,调整混杂因素,评价职业紧张和轮班相乘交互作用对铁路工务系统职工睡眠质量的影响。[结果]共回收有效问卷627份,问卷有效回收率97.7%。男性职工592人,占94.42%;职业紧张职工263人,占41.95%;夜班职工229人,占36.52%。不同工龄、学历、吸烟和锻炼情况组的职工睡眠质量得分差异有统计学意义(P <0.05)。职业紧张组职工睡眠质量得分较无职业紧张组职工得分高(t=-2.433,P <0.05);与白班组职工相比,夜班组职工睡眠质量得分高(t=-7.921,P <0.05)。logistic回归分析发现,影响铁路工务系统职工睡眠质量的因素主要为轮班,其中夜班作业为危险因素(OR=3.878,95%CI:2.394~6.282)。交互作用分析结果显示,与无职业紧张+白班组职工相比,职业紧张+夜班组职工发生睡眠质量问题的风险最高(OR=4.883,95%CI:2.305~10.341)。[结论]夜班是铁路工务系统职工睡眠质量的危险因素,并且夜班和职业紧张同时存在时对职工睡眠质量的危害最大。

[Background] Occupational stress is an important health risk factor in occupational population, and is linked to poor sleep quality. Sleep disorder is associated with increased risks of breast cancer, cardiovascular disease, diabetes, and so on. Having long shift work, permanent way system employees are prone to have sleep quality problems.[Objective] This study aims to assess the effect of occupational stress and shift work on sleep quality of permanent way system workers, and provide a scientific basis for protecting and promoting their physical and mental health.[Methods] From December 2018 to April 2019, a stratified cluster sampling method was adopted to select 642 permanent way system employees of Fuzhou Railway Administration who met the inclusion criteria. The occupational stress and sleep quality of the participants were evaluated by the Job Content Questionnaire(JCQ) and the Pittsburgh Sleep Quality Index(PSQI) scale respectively. The JCQ contained job demand, job control, and social support;the score ratio of job demand to job control(D/C) > 1 indicated occupational stress. The PSQI scale contained seven components, providing an overall score of 21;higher scores was associated with worse sleep quality, and score > 7 indicated sleep quality problem. Logistic regression was used to analyze the influencing factors of sleep quality, and the effect of the interaction of occupational stress and shift work on sleep quality was also analyzed after adjusting for relevant confounding factors.[Results] A total of 627 valid questionnaires were returned, and the valid return rate was 97.7%. There were 592 male workers(94.42%), 263 workers with occupational stress(41.95%), and 229 night shift workers(36.52%). The PSQI scores differed among the subjects of different age, education, smoking, and exercise groups(P < 0.05). The score of sleep quality was higher in the occupational stress group than in the non-occupational stress group(t=-2.433, P < 0.05), and higher in the night shift workers than in the day shift workers(t=-7.921, P < 0.05). The logistic regression analysis results found that night shift was a risk factor affecting the sleep quality of permanent way system workers(OR=3.878, 95% CI: 2.394-6.282). The interaction analysis results showed that compared with the workers without occupational stress and with day shift, the workers with occupational stress and with night shift had a higher risk of having sleep quality problems(OR=4.883, 95% CI: 2.305-10.341). [Conclusion] Night shift is a risk factor affecting the sleep quality of workers of railway public works system, and the co-exposure to night shift and occupational stress is more harmful.