association between work role stressors and sleep quality

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

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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

http://doi.org/10.1093/occmed/kqy021

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: [email protected] (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


Job control 1 0.97-1.04



Role conflict 1 0.95-1.06


Sex 0.46 0.09-2.44

Age 1.02 0.98-1.07


Sleep duration

Quantitative workload 1 0.94-1.07

Job control 0.98 0.96-1.01



Role conflict 1 0.97-1.04


Sex 0.73 0.28-1.91

Age 0.98 0.95-1.01


Sleep efficiency


Job control 0.97 0.91-1.02



Role conflict 1.03 0.94-1.14


Sex 10.4 1.01-106.18 *

Age 1.06 0.98-1.14


Sleep disturbance


Job control 1.01 0.96-1.06



Role conflict 1.1 1.02-1.19 *


Sex 1.19 0.09-15.23

Age 1.04 0.97-1.11


Use of sleep medication


Job control 0.94 0.89-1.00 *





Sex 2.05 0.11-37.46

Age 1.09 1.00-1.19


Daytime dysfunction


Job control 0.99 0.96-1.03


Social support (coworker) 0.99 0.83-1.17



Sex 0.96 0.27-3.41

Age 0.98 0.94-1.02


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.

association between work role stressors and sleep quality

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