The Effect of Shift Work on Sleep Patterns of Paramedics in Saudi Arabia

Figures & data

Table 1 The Baseline Sociodemographic Characteristics of Surveyed Paramedics

Variable	Category	Number	%
Age
	18 to 25 years	41	3.8
	26 to 35 years	562	52.23
	36 to 45 years old	467	43.24
	46 to 55 years old	3	0.28
	More than 55 years	3	0.28
Gender
	Male	776	72.12
	Female	300	27.88
Marital Status
	Single	350	32.52
	Married	725	67.37
	Others	1	0.09
Educational Level
	Diploma	2	0.19
	Bachelor	1068	99.25
	Master	6	0.57
	Ph.D. degree	0	0
Work Setting
	Hospital-based EMS	600	55.77
	Station-based EMS	476	44.23
Place of Work
	Government agency	474	44.05
	Private agency	602	55.95
Geographical Area of Work
	Urban	496	46.09
	Rural	580	53.91
Caffeine (cups per day)
	1 to 3 per day	767	71.28
	4 to 6 per day	302	28.06
	7–9 per day	6	0.57
	More than 9 per day	1	0.09
Working Hours
	Less than 24 hours per week	570	52.97
	24–48 hours per week	485	45.07
	48–72 hours per week	17	1.59
	More than 72 hours per week	4	0.37
Years of Experience
	Less than 1 year	313	29.09
	1–5 years	287	26.67
	6–10 years	469	43.58
	11–15 years	4	0.37
	More than 15 years	3	0.28

Table 2 The Patterns of Shift Work, Work Schedule, and Occupation Stress Among Paramedics

Variable	Category	Number	%
Number of Shifts Per Month
	Less than 7	28	2.60
	7–10 shifts	276	25.65
	11–15 shifts	764	71.00
	More than 15 shifts	8	0.75
Number of Night Shifts Per Month
	Less than 4	13	1.2
	4–8 shifts	578	53.71
	9–12 shifts	477	44.33
	More than 12 shifts	8	0.74
Number of Day Shifts Per Month
	Less than 4	271	25.18
	4–8 shifts	476	44.23
	9–12 shifts	319	29.64
	More than 12 shifts	10	0.95
Work Schedule
	Day shift 8 hours	570	52.97
	Evening and Night shift 8 hours	20	1.86
	Rotating shifts 8 hours (combination of day, evening, and night shifts)	11	1.03
	Day shift 12 hours	7	0.65
	Night shift 12 hours	4	0.37
	Rotating shifts 12 hours (combination of day, evening, and night shifts)	464	43.12
Off-Workdays Per Week
	One day	320	29.73
	Two days	216	20.07
	Three days	267	24.81
	Four days	266	24.72
	Five days	7	0.65
Occupational Stress
	No	568	52.78
	Yes	508	47.22

Table 3 The Association Between Insomnia and Shift Work Patterns Among Saudi Paramedics

Variable	Insomnia		Total	P
	No	Yes
Working Hours
Less than 24 hours per week	562 (98.08)	11 (1.92)	573 (100)	0.0001
24–48 hours per week	3 (0.62)	483 (99.38)	486 (100)
48–72 hours per week	2 (11.76)	15 (88.23)	17 (100)
Number of Shifts Per Month
Less than 7	3 (10.71)	25 (89.29)	28 (100)	0.0001
7–10 shifts	262 (94.93)	14 (5.07)	276 (100)
11–15 shifts	300 (39.19)	464 (60.81)	764 (100)
More than 15 shifts	1 (12.5)	7 (87.5)	8 (100)
Number of Night Shifts Per Month
Less than 4	1 (7.69)	12 (92.31)	13 (100)	0.0001
4–8 shifts	560 (96.74)	18 (3.26)	578 (100)
9–12 shifts	2 (0.42)	475 (99.58)	477 (100)
More than 12 shifts	1 (12.5)	7 (87.5)	8 (100)
Number of Day Shifts Per Month
Less than 4	261 (96.66)	10 (3.33)	271 (100)	0.0001
4–8 shifts	5 (1.04)	471 (98.96)	476 (100)
9–12 shifts	300 (94.04)	19 (5.96)	319 (100)
More than 12 shifts	1 (10)	9 (90)	10 (100)
Work Schedule
Day shift 8 hours	560 (98.26)	10 (1.74)	570 (100)	0.0001
Evening and Night shift 8 hours	2 (10)	18 (90)	20 (100)
Rotating shifts 8 hours (combination of day, evening, and night shifts)	1 (9.1)	10 (90.9)	11 (100)
Day shift 12 hours	0 (0)	7 (100)	7 (100)
Night shift 12 hours	0 (0)	4 (100)	4 (100)
Rotating shifts 12 hours (combination of day, evening, and night shifts)	0 (0)	464 (100)	464 (100)
Off-Workdays Per Week
One day	301 (94.72)	17 (5.28)	318 (100)	0.001
Two days	1 (0.5)	217 (99.5)	218 (100)
Three days	1 (0.37)	266 (99.63)	267 (100)
Four days	260 (97.74)	6 (2.26)	266 (100)
Five days	0 (0)	7 (100)	7 (100)

Notes: Data are presented as numbers (percentages). P: P-value.

Table 4 The Univariable and Multivariable Logistic Regression Analysis of Insomnia Risk Factors

Variable	Univariate Model				Multivariable Model
	Coefficient	P	95% CI		aOR	P	95% CI
Age	Reference group: 18–25 years
26–35 years	−9.16	0.001	−10.35	−7.97	–	–	–	–
36–45 years	(omitted)	–	–	–	–	–	–	–
46–55 years	(omitted)	–	–	–	–	–	–	–
> 55 years	(omitted)	–	–	–	–	–	–	–
Gender	Reference group: Male
Female	−5.67	0.001	−7.07	−4.27	–	–	–	–
Marital Status	Reference group: Single
Married	2.50	0.001	2.15	2.85	–	–	–	–
Others	(omitted)	–	–	–	–	–	–	–
Education	Reference group: Diploma
Bachelor	1.72	0.12	−0.43	3.87	–	–	–	–
Master	(omitted)	–	–	–	–	–	–	–
Ph.D.	(omitted)	–	–	–	–	–	–	–
Work Setting	Reference group: Hospital-based EMS
Station-based EMS	8.95	0.001	6.96	10.94	18.71	0.02	2.70	129.77
Place of Work	Reference group: Government agency
Private agency	−8.20	0.001	−9.63	−6.77	–	–	–	–
Region	Reference group: Urban
Rural	−7.69	0.001	−8.61	−6.78	–	–	–	–
Coffee Consumption	Reference group: 1–3 cups/day
4–6 per day	5.27	0.001	4.27	6.27	36.83	0.01	2.35	57.75
7–9 per day	(omitted)	–	–	–	–	–	–	–
> 9 per day	(omitted)	–	–	–	–	–	–	–
Working Hours	Reference group: < 24 hours
24–48 hours/week	8.02	0.001	6.82	9.21	–	–	–	–
48–72 hours/week	2.14	0.01	0.66	3.62	0.97	0.99	0.04	21.43
> 72 hours/week	(omitted)	–	–	–	–	–	–	–
Experience Years	Reference group: 18–25 years
1–5 years	−2.85	0.001	−3.28	−2.41	–	–	–	–
6–10 years	(omitted)	–	–	–	–	–	–	–
11–15 years	(omitted)	–	–	–	–	–	–	–
> 15 years	(omitted)	–	–	–	–	–	–	–
Shifts per Month	Reference group: < 7 shifts
7–10 shifts	−3.42	0.001	−3.98	−2.87	0.28	0.38	0.02	4.82
11–15 shifts	2.19	0.001	1.85	2.54	–	–	–	–
> 15 shifts	2.06	0.06	−0.04	4.16	–	–	–	–
Night Shifts per Month	Reference group: < 4 shifts
4–8 shifts	−8.21	0.001	−9.29	−7.12	–	–	–	–
9–12 shifts	8.17	0.001	6.74	9.60	–	–	–	–
> 12 shifts	2.06	0.06	−0.04	4.16	–	–	–	–
Day Shifts per Month	Reference group: < 4 shifts
4–8 shifts	7.25	0.001	6.31	8.19	–	–	–	–
9–12 shifts	−3.37	0.001	−3.86	−2.89	–	–	–	–
> 12 shifts	2.31	0.03	0.24	4.38	–	–	–	–
Work Schedule	Reference group: 8-hour day shift
8-hour evening/night shifts	2.33	0.001	0.86	3.80	21.93	0.01	5.15	93.33
8-hour rotating shifts	2.42	0.02	0.36	4.48	23.93	0.001	8.39	68.28
12-hour day shift	(omitted)	–	–	–	–	–	–	–
12-hour night shift	(omitted)	–	–	–	–	–	–	–
12-hour rotating shift	(omitted)	–	–	–	–	–	–	–
Off-Work Days	Reference group: 1 day
2 days	6.03	0.001	4.06	8.00	0.46	0.65	0.02	13.84
3 days	6.41	0.001	4.44	8.38	–	–	–	–
4 days	−4.27	0.001	−5.09	−3.45	–	–	–	–
5 days	(omitted)	–	–	–	–	–	–	–
Workday Time to Bed	Reference group: 1 hour
1–5 hours	0.33	0.01	0.09	0.57	–	–	–	–
> 5 hours	1.03	0.08	−0.14	2.19	0.01	0.01	0.00	0.25
Off-Workdays Time to Bed	Reference group: 1 hour
1–5 hours	−0.35	0.01	−0.59	−0.11	–	–	–	–
> 5 hours	1.59	0.01	0.33	2.85	2.90	0.43	0.21	39.91
Workday Sleep Duration	Reference group: < 4 hours
4–8 hours	8.11	0.001	6.69	9.54	–	–	–	–
8–12 hours	−7.60	0.001	−8.50	−6.69	–	–	–	–
> 12 hours	(omitted)	–	–	–	–	–	–	–
Off-Workdays Sleep Duration	Reference group: < 4 hours
4–8 hours	1.50	0.02	0.23	2.78	0.03	0.09	0.00	1.76
8–12 hours	−2.04	0.001	−2.99	−1.10	0.03	0.03	0.01	0.72
> 12 hours	(omitted)	–	–	–	–	–	–	–
Occupational Stress	Reference group: Absent
Present	8.97	0.001	7.79	10.16	9.31	0.001	5.60	15.53

Notes: - indicates that the variable was excluded from the model due to multicollinearity (defined as VIF score > 10).

Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; P, p-value.