Abstract
BACKGROUND: Globally, poor sleep is a significant public health problem. Healthy sleep is important for physical and mental well-being, particularly for individuals who work in environments with shift schedules. However, this issue has not been adequately addressed, especially in low-and-middle-income settings. This study examined sleep apnea and excessive daytime sleepiness among police officers in Kerala, India, and explored the factors associated with these conditions. METHODS: Using a cross-sectional study design, we collected data from 253 police officers selected from 14 police stations in Thiruvananthapuram district. Data on socio-demographic and occupational characteristics were collected using structured questionnaire and stress using the Police Stress Questionnaire. Sleep apnea and excessive daytime sleepiness (EDS) were assessed using the Berlin Scale and Epworth Sleepiness Scale, respectively. Both bivariate and multivariate analyses were used to identify associated factors with sleep apnea and EDS. RESULTS: Participants were predominantly male (89%), aged 30-55 years (mean: 42 years, SD:±6). The prevalence of operational stress was 75.5% [95% Confidence Interval (CI): 69.7-80.6], organizational stress 65.6% (CI:59.4-71.4), sleep apnea 15.0% (CI:10.8-20.0), and EDS 56.5% (CI:50.1-62.7). Sleep apnea was significantly higher among alcohol or tobacco users [unadjusted odds ratio (UAOR):2.16, CI:1.07-4.34]. Both operational stress (UAOR:4.41, CI:1.30-14.89) and organizational stress (UAOR:4.06, CI:1.52-10.84) were significantly associated with sleep apnea. EDS was more likely to be reported by officers from rural police stations (UAOR:3.09, CI:1.82-5.24), those with fewer years of experience (UAOR:1.65, CI:1.00-2.73), and among civil police officers (UAOR:2.15, CI:1.23-3.76) compared to their counterparts. The regression results indicated that those with diabetes or hypertension were significantly more likely to have sleep apnea (Odds Ratio (OR):8.41 95% CI: 3.20-22.10) compared to those without these conditions. Police officers from rural stations were more likely to experience excessive daytime sleepiness compared to their counterparts from urban areas (OR: 3.14, 95% CI: 1.80-5.47). CONCLUSIONS: A high prevalence of sleep disorders was observed among police officers, with strong associations to occupational stress and lifestyle factors. Based on the findings, we initiated behavioral interventions to improve sleep quality in this population.