Sleep disturbance and its associations with night shift work, anxiety symptoms, and depressive symptoms among urban operation-supporting workers: a cross-sectional study

Abstract

Sleep disturbance is common among occupational populations and may vary by work schedules and psychological burdens. However, evidence among urban operation-supporting occupational groups remains limited. This study aimed to compare the prevalence of sleep disturbance among healthcare, environmental sanitation, and transportation workers in Chongqing, China, and to examine the associations of night shift work, anxiety, and depressive symptoms with sleep disturbance. This study was based on the Health Literacy Surveillance Project for Key Occupational Groups in Chongqing (June–September 2022). Overall, 3,667 front-line workers were included. Sleep disturbance was assessed using the Chinese Center for Disease Control and Prevention sleep quality scale . Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-9 , respectively. Modified Poisson regression models with robust variance estimation were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Interaction terms were further included to examine occupational group differences. The prevalence of sleep disturbance was 94.1, 85.1, and 92.8% among healthcare, environmental sanitation, and transportation workers, respectively. After adjustment, environmental sanitation workers had a lower prevalence of sleep disturbance than healthcare workers (aPR = 0.904, 95% CI: 0.862–0.947, p  < 0.001), whereas transportation workers showed no significant difference (aPR = 0.996, 95% CI: 0.956–1.037, p  = 0.839). Night shift work (aPR = 1.025, 95% CI: 1.003–1.048, p  = 0.028) and anxiety symptoms (aPR = 1.094, 95% CI: 1.073–1.116, p  < 0.001) were associated with a higher prevalence of sleep disturbance. Depressive symptoms showed no statistical significance in the fully adjusted main model (aPR = 1.018, 95% CI: 0.999–1.038, p  = 0.068). The environmental sanitation sector significantly interacted with anxiety symptoms (aPR = 1.082, 95% CI: 1.030–1.136, p  = 0.002), suggesting a stronger anxiety-sleep disturbance association. No significant interactions were observed between occupational group and depressive symptoms or night shift work. Sleep disturbance was prevalent among urban operation-supporting occupational groups. Night shift work and anxiety symptoms were associated with sleep disturbance, with anxiety showing the most stable association. Depressive symptoms showed a weaker, model-dependent association. Sleep and mental health interventions may need to consider occupational context.