Relationship Between Sleep Duration and Psychosocial Well-Being in Healthcare Personnel: Identification of Predictors and Vulnerability Patterns

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, 

This is really interesting paper. However, there are some small notes: 

1. The list on independent and dependent variables is missing
2. The conclusion is the most disappointing part. It is not common that is so short, the limitatitons and practical implications are far more stressed then key points of your own research.
3. In the Discussion, it should be taken into consideration not only marital status, but care about the other familly members, first of all children. Single people do not have such sort of responsibilities which basically make them possible to more take care about themeselves, i.e. to have more opportunities to make rest and live on their own. From your results, it seems that does not make them happy either and that they feel a bit unpurpose and lonly and dissapointed in people. However, you could think about role of gender roles part in this situation, since the profession you observed is mainly female oriented, all over the world. Simply, that is the situation in any medical system all over the world.

Author Response

First of all, we would like to thank you for your work, effort, and valuable comments. We have carefully addressed your suggestions. The list of independent and dependent variables has been included. We have revised the Conclusion and Discussion sections with special attention, as you indicated. We hope these changes adequately respond to your concerns. Thank you once again for your thoughtful and constructive feedback.

Reviewer 2 Report

Comments and Suggestions for Authors

Clearer and more linear

Confusing study with many inconclusive repetitions. No innovative and original elements. The methodology and statistical analysis is convoluted and unclear even in the tables and figures, the limitations try to justify the inconclusiveness of the, even the title does not clearly indicate the contents

Author Response

First of all, thank you for your work and effort. We have addressed your suggestions. We have worked with particular attention to clarify the text, especially the figures, tables, and the Conclusion section, as you indicated. The title has also been adjusted. We hope we have successfully addressed your concerns. Thank you again for your valuable input.

Reviewer 3 Report

Comments and Suggestions for Authors

I recommend that the authors identify more recent studies on the effect of sleep on leptin and ghrelin secretion (lines 63-66) with an impact on the increase in the incidence of obesity.

The authors are advised to make a correlation between the "Research published to date" (lines 72-73), which identifies the consequences of sleep deprivation and associates stress as a contextual factor in the negative health consequences. (lines 73-74), thus validating the quality of the study.

Author Response

First of all, thank you for your work and effort. We have addressed your suggestions. We have worked with particular attention to clarify the text, incorporating recent studies on the effect of sleep on leptin and ghrelin secretion and its impact on the increasing incidence of obesity, as you indicated. Likewise, we have expanded the review of research identifying the consequences of sleep deprivation and the association of stress as a contextual factor in the negative health outcomes. We hope we have adequately addressed your concerns. Thank you for your thorough review of our manuscript.

Reviewer 4 Report

Comments and Suggestions for Authors

Brief summary:

This cross-sectional study investigates the association between sleep duration and various psychosocial, behavioral, and occupational factors among 194 healthcare workers in Spain. Using validated questionnaires, the authors compare participants who sleep less than six hours per night with those who sleep six hours or more. The study finds that shorter sleep duration is associated with higher levels of depersonalization, emotional and physical stress symptoms, restrictive eating behaviors, and maladaptive coping mechanisms. A regression model identifies predictors of sleep duration, and network analysis illustrates the interconnectedness of the contributing factors.

 

General Concept Comments:

The manuscript addresses a highly relevant topic in occupational health, especially in the post-pandemic context, where healthcare professionals face increased psychosocial burdens. The integration of multiple validated scales and the use of network analysis are strengths. However, the manuscript would benefit from a more concise introduction, clearer methodological descriptions, improved data presentation, and a more explicit acknowledgment of limitations. While the findings are meaningful, the cross-sectional design limits causal inferences and should be interpreted with caution.

 

Specific comments:

Introduction:
The introduction provides a thorough review of relevant literature, but it is overly detailed in parts. Condensing the background to focus on the main objectives and the rationale for the study would improve clarity and reader engagement.

Methods:
1. More detail is needed regarding the sampling strategy and response rate. It is unclear how many individuals were invited versus how many ultimately participated.

2. The methodology should allow for replication; additional information on how questionnaires were administered and collected is essential.

3. The cut-off of six hours of sleep as a grouping criterion should be clearly justified based on prior evidence or clinical thresholds.

4. Some subscales (e.g., EAT-40 diet subscale) had low internal consistency (e.g., α = 0.42), which raises concerns about measurement reliability and should be addressed in the discussion.

5. The sample is notably unbalanced between the two groups (<6h: n=163; ≥6h: n=31). This disparity should be explicitly acknowledged as a limitation, as it could affect statistical power and validity of comparisons.

Results:

1. The presentation of results in tables needs improvement. A dedicated column for p-values should be included, especially for statistically significant comparisons.
2. Use additional horizontal lines in the tables to improve readability and visual separation of categories.
3. Some variables are presented in a highly condensed format, which could be difficult for readers to interpret; more spacing or visual clarity is recommended.

 

Discussion and limitations:

While the study acknowledges some limitations, additional issues should be considered:

1. Residual confounding (e.g., comorbid psychiatric conditions, medications, or baseline sleep disorders) may affect the results but are not addressed.
2. The overrepresentation of female nursing staff limits generalizability across other professional groups or gender distributions.
3. The dichotomization of sleep duration (<6 vs. ≥6 hours) may reduce sensitivity to detect more subtle sleep-health relationships. 

Comments on the Quality of English Language

The manuscript is generally well written and understandable. However, the language would benefit from light editing for grammar, clarity, and conciseness. Some sentences are overly long or redundant, particularly in the introduction and discussion sections, which may obscure key points.

Author Response

First of all, thank you for your work and effort. We have addressed your suggestions. We have worked with particular attention to clarify the text, providing a more concise introduction, clearer methodological descriptions, improved data presentation, and a more explicit acknowledgment of its limitations. The introduction has been streamlined, focusing on the objectives and rationale. The methodological aspects highlighted by the reviewer have been addressed. The presentation of the results has been improved. Regarding the discussion and limitations, we have worked in line with your indications. We hope we have adequately addressed your concerns. Thank you for your effort in reviewing our manuscript.

Round 2

Reviewer 4 Report

Comments and Suggestions for Authors

The authors have addressed my previous comments satisfactorily, and the manuscript has improved as a result.

Author Response

Thank you for your effort in reviewing our manuscript.