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. 2025 Oct 11;7(4):58.
doi: 10.3390/clockssleep7040058.

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

Gleb Saharov  1   2 , Barbara Salti  1 , Maram Bareya  1 , Anat Keren-Politansky  1 , Yona Nadir  1 , Tamar Shochat  2
Affiliations

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

Gleb Saharov et al. Clocks Sleep. .

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.

Keywords: coagulation; endothelial dysfunction; hemostatic; sleep efficiency; social jetlag; total sleep time.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Correlations between SE, WASO, and endothelial markers. Abbreviations: WASO = Wake After Sleep Onset; SE = Sleep Efficiency; LnRHI = Natural logarithm of Reactive Hyperemia Index; PAI-1 = Plasminogen Activator Inhibitor-1; HPA = Heparanase procoagulant activity.
Figure 2
Figure 2
PAI-1: Interaction between SEF and Work schedule by Measurement time. The figure was derived from the multiple regression model. The bars represent the standard error from the model.
Figure 3
Figure 3
Timeline of the study.
See this image and copyright information in PMC

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