INTRODUCTION:

Sleep is an active, repetitive and reversible state of perceptual disengagement from the environment. It is a physiological process, essential to life. It serves several different functions such as growth and repair, learning and memory consolidation and all these occur throughout the brain and the body.³

Shift work disorder (SWD) is a sleep disorder characterized by sleepiness and insomnia, which can be attributed to the person’s work schedule. The diagnostic criteria for SWD, as defined by the American Academy of Sleep Medicine (AASM)‘s International Classification of Sleep Disorders-2 (ICSD-2) include: (i) complaints of insomnia or excessive sleepiness temporally associated with a recurring work schedule in which work hours overlap with the usual time for sleep, (ii) symptoms must be associated with the shift work schedule over the course of at least one month, (iii) sleep log or actigraphic monitoring for ≥ 7 days demonstrates circadian and sleep-time misalignment; (iv) sleep disturbance is not better explained by another sleep disorder, mental disorder, a medical or neurological disorder, medication use or substance use disorder⁴.

The WHO has added night shift workers to its list of probable carcinogens. The shift workers, especially the night shift workers in the hospitals and staff or emergency duties had health-related problems, and their work performance was also hampered.³

In fact, working after insufficient sleeping leads to excessive fatigue and sleepiness, which results in difficulty in concentration and performing a task and consequently caused an increase in the incidence of errors and the risk of accidents.²

NEED FOR THE STUDY:

The National Sleep Foundation defines shift work as a work that takes place on a schedule outside the traditional 09:00–17:00 daily. It can involve evening or night shifts, early morning shifts, and rotating shifts. It also defines shift work sleep disorder (SWSD) as a chronic condition that is directly related to a person’s work schedule. SWSD is considered a ‘circadian rhythm sleep disorder’ by the International Classification of Sleep Disorders - Third Edition (ICSD-3). A circadian rhythm is an oscillating biological rhythm that changes every 24 hours. Shift work is a term that refers to a broad range of non-standard work schedules, ranging from occasional on-call overnight duty, to rotating timetables, to stable, permanent night work, and to programmes demanding an early awakening from nocturnal sleep. Misalignment between core circadian physiology and the necessary work schedule is thought to be a primary cause of shift work schedule-induced sleepiness and sleep disruption.⁵

A study conducted in Shiraz University of Medical Sciences, Central with the aim to investigate prevalence of shift work disorders among security personnel of the hospitals. This case-control study was conducted among 130 security personnel as well as 130 unexposed employees among the security guards working day shifts and the office workers. The unexposed individuals were not working in shifts, but were similar to the shift workers regarding age and health status. Data were collected using SOS (Survey of Shift Workers) questionnaire as well as measuring height, weight, and blood pressure of the shift workers in their work shifts. The findings revealed a significant difference between the two groups regarding the increase in blood pressure, sleep disorders, dissatisfaction in individual, family, and social lives, as well as increase in psychological, cardiovascular, gastrointestinal, and musculoskeletal disorders. Moreover, these disorders were significantly higher among the shift workers. The study results suggest the necessity to pay more attention to the shift workers’ needs and problems, involving them in planning the shift schedules, and improving their working conditions.²

In general, the security personnel of the hospitals are among the shift workers and are exposed to health disturbing factors more than the other shift workers. Of course, since the hospitals' security systems are controlled by surveillance cameras in most of the industrialized countries, the shift working security personnel are not faced with such problems. Although a great number of studies have been conducted on shift working in Iran, the effect of disorders resulting from shift working on this group of shift workers has not been investigated yet. Moreover, shift working accompanied by the patients' companions' behavior and other problems can negatively affect the hospitals' security personnel.²

METHODS:

An institution based cross sectional study was conducted in February and March 2020 among 60 security personnel working in shifts at AIIMS Raipur. Non- probability Simple random sampling technique was adopted to select the sample. The sample size was 60. The tool used for the data collection was Standard Shift work index which comprised of six sections.

Data analysis:

Data were entered and analyzed with the help of Statistical Package for the Social Sciences software version 16.0. (SPSS Inc. SPSS for Windows, Chicago, Illinois, USA). Data were represented using appropriate tables and charts in the form of frequencies and percentages. Chi-square test was applied to find out statistical association as required.

FINDINGS:

The results of the study are organized under the following headings:

A. Socio-Demographic characteristics among samples:

The demographic characteristics like age, gender, marital status and religion were analyzed using percentage distribution and shown in Table no 1

Table no 1: Frequency and distribution of socio-demographic variables among security guards N=60

Sr. No	Socio-demographic characteristics	No of respondents	Percentage (%)
1	Age (in years)
	21-30	26	43.33
	31-40	19	31.67
	41-50	9	15.00
	>50	6	10.00
2	Gender
	Female	21	35.00
	Male	39	65.00
3	Area of residence
	Rural	28	46.67
	Urban	21	35.00
	Semi urban	11	18.33
4	Educational status
	Primary	0	0.00
	Secondary	20	33.33
	Higher secondary	40	66.67
	Graduate and above	0	0.00
5	Religion of security guards
	Hindu	55	91.67
	Muslim	2	3.33
	Others	3	5.00
6	Type of family
	Joint family	28	46.67
	Nuclear family	32	53.33
7	Marital Status
	Married	52	86.67
	Separated/ Divorced/ Widower	8	13.33
8	Work experience in AIIMS Raipur
	1-5 years	41	68.33
	6-10 years	19	31.67
	> 10 years	0	0.00
9	Average number of night shifts per year in AIIMS Raipur
	< 60	3	5.00
	60 -90	15	25.00
	91-120	38	63.33
	>120	4	6.67

Table no 1 depicts frequency and percentage distribution of samples according to age, gender, religion, Type of family, Type of house, and educational status.

According to age, 26 (43.33 %) belong to 21 -30years, 19 (31.67%) belongs to 31-40year, 9 (15%) belonged to 41-50 years and 6 (10 %) were 50years and above.

According to Gender, 39 (65%) were male and 21 (35%) were females.

According to area of residence, 28 (46.67 %) were from rural area, 21 (35%) belongs were from urban and 11 (18.33 %) were from semi- urban area.

According to educational status, 20 (33.33 %) were having secondary level of education and 40 (67.67 %) were having higher secondary level of education. None of them had primary, graduate and above level of education.

Majority of security guards were Hindu by religion, 55 (91.67 %), 2 (3.33%) were Muslims and 3 (5 %) belonged to others.

According to type of family, 32(53.33%) were from nuclear family and 28 (46.67%) were from joint family.

According to Marital status, 52 (86.67 %) were married and 8 (13.33 %) were widower

Majority of security guards 41 (68.33%) had 1-5 years of work experience in AIIMS Raipur and 19 (31.67%) had 6-10 years of work experience in AIIMS Raipur. None of them had more than 10 years of work experience in AIIMS Raipur.

According to average number of nights shifts per year, 38 (63.33%) having 91-20 night shifts, 15 (25%) had 60-90 nights shifts, 4 (6.67%) had more than 120 night shifts and 3 (5%) had less than 60 night shifts per year.

B. Prevalence of Shift work Sleep disorders among samples:

Table no 2: Shift worker, feel hard to fall asleep after each shift N=60

Sr. no	Assessment shift	No. of security guards	Percentage (%)
1	Between successive morning shifts
	Almost never	34	56.67%
	Rarely	13	21.66%
	Sometimes	12	20.00%
	Frequently	1	1.67%
	Almost always	0	0.00%
2	Between successive afternoon shifts
	Almost never	35	58.33%
	Rarely	10	16.67%
	Sometimes	15	25.00%
	Frequently	0	0.00%
	Almost always	0	0.00%
3	Between successive night shifts
	Almost never	22	36.67%
	Rarely	15	25.00%
	Sometimes	11	18.33%
	Frequently	4	6.67%
	Almost always	8	13.33%
4	Between successive days off
	Almost never	33	55.00%
	Rarely	11	18.34%
	Sometimes	12	20.00%
	Frequently	2	3.33%
	Almost always	2	3.33%

The above table no 2 shows the frequency and percentage of security guards who find it difficult to fall asleep after each shift. In between successive morning shifts, 1 (1.67%) find it difficult to fall asleep.

8 (13.33%) always find it difficult to fall asleep, 4 (6.67%) frequent find it difficult to fall asleep, 11(18.33%) sometimes find it difficult to fall asleep, 15 (25%) rarely find it difficult to fall asleep and 22 (36.67%) never find it difficult to fall asleep in between successive night shift duty

2 (3.33%) always find it diffcult to fall asleep, 2 (3.33%) frequent find it diffcult to fall asleep, 12(20%) sometimes find it difficult to fall asleep, 11 (18.34%) rarely find it difficult to fall asleep and 33 (55%) never find it difficult to fall asleep in between successive day off.

Figure No 1: Prevalence of Shift work Sleep Disorder among security guards

Figure no 1 shows that out of 60 security guards, 53.04 % were suffering from shift work sleep disorder.

C. Association of Shift work Sleep disorders with socio-demographic variables of security guards:

Table No 4: Association between demographic variables and sleep disturbance score among security guards N=60

Sr. No	Demographic variables	Shift work Sleep disorder
Sr. No	Demographic variables	No of respondents	Mean	SD	One way ANOVA F-test/t-test
1	Age (in years)
	21-30	26	63.00	13.79	F=0.05 P=0.97(NS)
	31-40	19	63.84	12.66
	41-50	9	64.89	7.61
	>50	6	64.00	7.01
2	Gender
	Female	21
	Male	39
3	Area of residence
	Rural	28	64.46	12.83	F=0.57 P=0.56(NS)
	Urban	21	61.48	12.73
	Semi urban	11	65.73	7.21
4	Educational status
	Primary	0	0.00	0.00	t=0.18 P=0.85(NS)
	Secondary	20	64.05	10.08
	Higher secondary	40	63.45	12.85
	Graduate and above	0	0.00	0.00
5	Religion of security guards
	Hindu	55	62.95	11.92	F=1.45 P=0.21(NS)
	Muslim	2	66.50	3.54
	Others	3	74.67	11.93
6	Type of family
	Joint family	28	66.97	9.91	*t=5.54 P=0.03(S)**
	Nuclear family	32	59.86	13.01	*t=5.54 P=0.03(S)**
7	Marital Status
	Married	52	63.25	11.77	t=0.66 P=0.51(NS)
	Separated/ Divorced/ Widower	8	66.25	13.32	t=0.66 P=0.51(NS)
8	Work experience in AIIMS Raipur
	1-5 years	41	63.90	11.67	t=0.05 P=0.81(NS)
	6-10 years	19	63.11	12.73
	> 10 years	0	0.00	0.00
9	Average number of night shifts per year in AIIMS Raipur
	< 60	3	56.67	17.21	*F=5.75 P=0.02(S)**
	60 -90	15	62.00	10.88
	91-120	38	64.58	12.07
	>120	4	66.25	12.76

P≤0.05 significant

Table no 3 shows the association between demographic variables and sleep disturbance score among security guards. Joint family security guards and more night work per year having security guards are having more sleep disturbance score than others. It was assessed using one-way analysis of variance F-test and independent t-test.

CONCLUSION:

The study concluded that In between successive morning shifts, 1 (1.67%) find it difficult to fall asleep. 8 (13.33%) always find it difficult to fall asleep, 4 (6.67%) frequent find it difficult to fall asleep, 11(18.33%) sometimes find it difficult to fall asleep, 15 (25%) rarely find it difficult to fall asleep and 22 (36.67%) never find it difficult to fall asleep in between successive night shift duty. 2 (3.33%) always find it difficult to fall asleep, 2 (3.33%) frequent find it difficult to fall asleep, 12(20%) sometimes find it difficult to fall asleep, 11 (18.34%) rarely find it difficult to fall asleep and 33 (55%) never find it difficult to fall asleep in between successive day off. Prevalence of shift work sleep disturbance among the security guards population is 54.03%. Joint family security guards and more night work per year having security guards are having more association with shift work sleep disorder score than others.

CONFLICT OF INTEREST:

Nil.

INFORMED CONSENT:

A well-explained consent was obtained in the written form from all the participants before commencing the study.

ETHICAL CLEARANCE:

Ethical clearance was obtained from the Institutional Ethics Committee of AIIMS Raipur before conducting the study.

REFERENCES:

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2. Zamanian Z, Dehghani M, Mohammady H, Rezaeiani M, Daneshmandi H. Investigation of Shift Work Disorders among Security Personnel. Int J Occup Hyg. 4(2):39-42.

3. Nag K, DattaA, Karmakar N, Chakraborty T, Bhattacharjee P. Sleep disturbance and its effect on work performance of staffs following shift duites: A cross- sectional study in medical college and hospital of Tripura. Med J DY Patil Vidyapeeth 2019; 12:211-6

4. Surekha Anbazhagan, Naveen Ramesh, Catherine Nisha, and Bobby Joseph Shift work disorder and related health problems among nurses working in a tertiary care hospital, Bangalore, South India Indian J Occup Environ Med. 2016 Jan-Apr; 20(1): 35–38.

5. Haile KK, Asnakew S, Waja T, et al. Shift work sleep disorders and associated factors among nurses at federal government hospitals in Ethiopia: a cross-sectional study. BMJ Open 2019; 9: e029802.

Received on 18.11.2020 Modified on 14.12.2020

Int. J. Nur. Edu. and Research. 2021; 9(1):80-84.

DOI: 10.5958/2454-2660.2021.00020.X