Co-occurrence of sleep disturbances and perceived stress in law enforcement personnel: a systematic review and meta-analysis.

BACKGROUND: Police officers are exposed to chronic occupational stressors and circadian disruption, both of which are associated with impaired sleep and adverse psychological outcomes. Although prior studies have demonstrated an association between sleep disturbances and perceived stress, the magnitude of this relationship remain insufficiently synthesized. This study aimed to evaluate the association between sleep quality and perceived stress in law enforcement personnel. METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines and the Cochrane Handbook. PubMed, Web of Science, and Cochrane Library were searched for observational studies assessing sleep quality and perceived stress among police officers. Studies including participants with major psychiatric comorbidities were excluded. Data extraction and risk of bias assessment (Appraisal Tool for Cross-Sectional Studies (AXIS) tool were performed independently by two reviewers. Pooled estimates were calculated using standardized mean differences (SMD) under random-effects models, with heterogeneity assessed using the I2 statistic. RESULTS: Nine studies comprising 7550 police officers were included, with seven contributing to the meta-analysis. Poor sleep quality was associated with significantly higher perceived stress (SMD 0.76; 95% CI 0.60-0.91; I2=40.3%). Conversely, higher stress levels were associated with worse sleep outcomes (SMD 1.57; 95% CI 1.33-1.82; I2=0%). Sensitivity analyses confirmed the robustness of the results. Although funnel plots were visually inspected, formal assessment of publication bias was not feasible because of the limited number of included studies. CONCLUSIONS: There is an association between sleep quality and perceived stress among law enforcement personnel, suggesting a co-occurring cycle of physiological and psychological burden.