# Cross-Sectional Analysis of Sleep Quality and Vascular Health in Shift- and Day-Working Nurses

## TL;DR

Poor sleep quality in shift-working nurses is linked to worse vascular health, suggesting sleep-based interventions could help reduce cardiovascular risk.

## Contribution

This study identifies sleep quality, not duration, as a key factor in vascular health among shift workers.

## Key findings

- Poor sleep quality correlates with reduced endothelial function and increased procoagulant activity.
- Shift workers show stronger associations between sleep quality and vascular markers.
- Sleep duration (TST) had no significant association with vascular outcomes.

## Abstract

Sleep disturbances and shift work are associated with increased cardiovascular risk, possibly through disruptions in endothelial and hemostatic function. While prior studies link acute sleep deprivation to vascular dysfunction, the impact of chronic sleep quality and circadian misalignment on endothelial health in healthy individuals, particularly shift workers, remains underexplored. The aim of this study was to examine the association between objectively measured sleep quality and endothelial/hemostatic function in healthy female hospital nurses, comparing shift and day workers, and considering time-of-day variation. In this repeated-measures study, 100 female nurses (51 shift, 49 day workers) aged 25–50 wore actigraphy devices for 7–14 days to assess total sleep time (TST), sleep efficiency (SEF), and wake after sleep onset (WASO). Endothelial function was measured using EndoPAT (Reactive Hyperemia Index—RHI). Hemostatic markers included plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (VWF), heparanase and heparanase procoagulant activity assessed by ELISA, and chromogenic assays in morning and evening. TST was not associated with any vascular outcomes. Poor sleep quality (low SEF, high WASO) was significantly associated with reduced RHI and elevated PAI-1 level, heparanase level, and heparanase procoagulant activity levels. Regression models revealed significant main effects of SEF and WASO on endothelial and coagulation markers, with some interactions depending on shift type and time of measurement. No significant associations were found for VWF. Impaired sleep quality, but not sleep duration, is associated with endothelial dysfunction and procoagulant activation, particularly among shift-working nurses. These findings suggest that sleep quality may play a critical role in vascular health and support the use of sleep-based interventions to reduce cardiovascular risk in shift-working populations.