Shift work and sleep quality, cardiovascular risk, and occupational safety among healthcare workers in Saudi Arabia: a national cross-sectional study

BACKGROUND: Shift work is integral to healthcare delivery and is associated with circadian disruption, poor sleep, and adverse health and occupational safety outcomes. Evidence from Saudi Arabia remains limited, particularly regarding cumulative night shift exposure, cardiovascular risk, and occupational safety across multiple healthcare professions. OBJECTIVE: To examine the association between shift work and sleep quality and cardiovascular risk factors (primary outcomes), as well as perceived stress, obstructive sleep apnea (OSA) risk, and self-reported occupational safety outcomes (secondary outcomes) among Saudi healthcare workers (HCWs). METHODS: An analytical cross-sectional study (December 2025 -January 2026) recruited licensed HCWs via the Saudi Commission for Health Specialties (SCFHS). Participants completed a structured, self-administered, electronic questionnaire capturing demographics, work schedules, cumulative night shift exposure, and validated measures: Pittsburgh Sleep Quality Index (PSQI), Karolinska Sleepiness Scale (KSS), and Perceived Stress Scale (PSS-4). Multivariable logistic models were fitted sequentially (unadjusted, demographic-adjusted, fully adjusted). Dose-response analyses compared cumulative night shift exposure (< 5 vs. ≥5 years) with non-shift work. RESULTS: Among 868 respondents (response rate 57.9%), 73.8% were shift workers. Shift work was not independently associated with composite CVD risk factor burden (adjusted OR = 0.84, 95% CI: 0.49-1.44). However, shift workers had significantly poorer sleep quality (PSQI 11.2 ± 4.1 vs. 8.4 ± 3.6; adjusted OR = 2.29, 95% CI: 1.08-4.85) and greater sleepiness (KSS 4.7 ± 2.2 vs. 3.4 ± 1.9; Cohen's d = 0.61). A dose-response relationship was observed, with ≥ 5 years of night shift exposure associated with higher odds of poor sleep (adjusted OR = 3.03, 95% CI: 1.35-6.83; P-trend = 0.006). Elevated perceived stress was more common among shift workers but attenuated after adjustment (adjusted OR = 1.68, 95% CI: 0.94-3.02). No independent associations were observed with composite CVD risk factor burden (adjusted OR = 0.84, 95% CI: 0.49-1.44), obesity, or high OSA risk. Shift workers reported more cognitive impairment (61.5% vs. 40.2%) and near-miss incidents (28.3% vs. 10.9%), alongside lower perceived safety prioritization (2.9 ± 1.2 vs. 3.2 ± 1.0, p = 0.010). CONCLUSION: Shift work among Saudi HCWs is associated with impaired sleep and increased sleepiness, with evidence of cumulative exposure effects, but not with cardiovascular risk or OSA. The observed safety vulnerabilities underscore the need for longitudinal studies and targeted fatigue risk management strategies, and healthcare workforce planning that integrates shift-work exposure monitoring into occupational health policy.