Occupational Outcomes Associated with Sleep Quality and Excessive Daytime Sleepiness: Results from a National Survey

Introduction: There are few population-level studies of the interactions between sleep quality/excessive daytime sleepiness (EDS) and occupational behavior. Here, we investigated the impact of sleep quality and EDS on occupational outcomes in a population-wide survey of adults in Saudi Arabia. Methods: A population-wide survey was administered to Saudi Arabian adults to assess sleep quality, EDS was measured using the Epworth Sleepiness Scale (ESS), and sleep-related absenteeism, sleep-related errors at work, and falling asleep at work in the preceding three months. Associations were evaluated using univariate analyses and binary logistic regression. Results: A total of 10,106 individuals completed all or part of the survey, of whom 8617 (85.3%) were employed. Of these, 28.7% and 8.8% of respondents reported "fairly bad" or "very bad" sleep quality in the preceding month. In binary logistic regression models, taking sleep medications was associated with absenteeism (odds ratio (OR) 1.92, 95% confidence intervals (CI) 1.67-2.22; p<0.001) and making errors at work (OR 1.89, 95% CI 1.62-2.20; p<0.001) but not falling asleep at work, and poor subjective sleep quality was associated with falling asleep at work (ORs 1.55, 95% CI 1.38-1.74; p<0.001). Severe EDS (ESS >16) was strongly associated with falling asleep at work (OR 3.39, 95% CI 2.51-4.48; p<0.001). Parameters associated with absenteeism, errors, and falling asleep at work were similar in blue- and white-collar workers. Discussion: This first population-wide study of sleep quality and EDS in Saudi Arabia provides a comprehensive portrait of the prevalence of sleep problems and their effects on occupational outcomes. Sleep-related absenteeism, work errors, and sleeping at work are common, mandating tailored fatigue-reduction strategies in every workplace and reinvigoration of public health messages on sleep.