{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:33:49Z","timestamp":1787240029298,"version":"build-2736575974"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study aims to investigate the prevalence and influencing factors of dry eye among Chinese nurses, and to explore the relationship between nurses\u2019 perceived stress, sleep quality and dry eye.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study adopted a cross-sectional survey design and distributed electronic questionnaires through Wechat platform. A total of 450 valid questionnaires from nurses across the country were collected. The survey included demographic and sociological information on nurses, dry eye symptoms (Ocular Surface Disease Index), sleep quality (Pittsburgh Sleep Quality Index), and perceived stress (Perceived Stress Scale). Generalized linear model was used to analyze the factors affecting the symptoms of dry eye in nurses. The Process plug-in in SPSS was used to conduct mediation analysis using Bootstrap method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 450 nurses included, the prevalence of dry eye reached 66%. Specifically, mild dry eye accounted for 27.56%, moderate dry eye accounted for 14.89%, severe dry eye accounted for 23.56%. Multivariate analysis revealed that years in nursing, hospital grade, contact lens and frame glasses wearing, sleep quality and perceived stress were influencing factors for dry eye. Mediation analysis revealed that the bootstrap 95% confidence interval for the mediating effect of PSS score on OSDI score via PSQI score does not include zero.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of dry eye in Chinese nurses is very high, and the proportion of moderate to severe dry eye is relatively large. Years in nursing and wearing contact lenses or rimmed glasses were risk factors for dry eye in nurses. The perceived pressure and sleep quality are the direct risk factors of dry eye, and the perceived pressure can also influence the occurrence and development of dry eye through the mediating effect of sleep quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1817895","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T15:11:53Z","timestamp":1776265913000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Sleep quality as a mediator between perceived stress and dry eye severity among Chinese nurses"],"prefix":"10.3389","volume":"14","author":[{"given":"Jie","family":"Ren","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Medicine, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"418","DOI":"10.3760\/cma.j.cn112142-20200316-00190","article-title":"Chinese dry eye expert consensus: definition and classification","volume":"56","year":"2020","journal-title":"Chin J Ophthalmol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1016\/j.ajo.2006.11.060","article-title":"Impact of dry eye syndrome on vision-related quality of life","volume":"143","author":"Miljanovi\u0107","year":"2007","journal-title":"Am J Ophthalmol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jtos.2021.05.006","article-title":"The physical and mental burden of dry eye disease: a large population-based study investigating the relationship with health-related quality of life and its determinants","volume":"21","author":"Morthen","year":"2021","journal-title":"Ocul Surf"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/S1542-0124(12)70043-5","article-title":"Utility assessment to measure the impact of dry eye disease","volume":"4","author":"Buchholz","year":"2006","journal-title":"Ocul Surf"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s12886-023-03249-w","article-title":"Prevalence of dry eye and Meibomian gland dysfunction in central and South America: a systematic review and meta-analysis","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7475\/kjan.2018.30.1.1","article-title":"Related factors of turnover intention among Korean hospital nurses: a systematic review and meta-analysis","volume":"30","author":"Lee","year":"2018","journal-title":"Korean J Adult Nurs"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1002\/nop2.670","article-title":"Impact of 12-hr shifts in general hospitals: study conducted in two intensive care units","volume":"8","author":"Fratissier","year":"2020","journal-title":"Nurs Open"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"7953","DOI":"10.3390\/ijerph18157953","article-title":"Comparison of fatigue, quality of life, turnover intention, and safety incident frequency between 2-shift and 3-shift Korean nurses","volume":"18","author":"Hong","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"351","DOI":"10.18502\/jovr.v18i4.14543","article-title":"Does long-term night shift work cause dry eye in hospital nurses?","volume":"18","author":"Bouyeh","year":"2023","journal-title":"J Ophthalmic Vis Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1016\/j.jad.2019.03.067","article-title":"Brief mindfulness-based stress management program for a better mental state in working populations\u2014happy nurse project: a randomized controlled trial","volume":"251","author":"Watanabe","year":"2019","journal-title":"J Affect Disord"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"61","DOI":"10.3390\/ijerph16010061","article-title":"Prevalence and risk factors of depression, anxiety, and stress in a cohort of Australian nurses","volume":"16","author":"Maharaj","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1001\/archinte.1993.00410180039004","article-title":"Stress and the individual. Mechanisms leading to disease","volume":"153","author":"McEwen","year":"1993","journal-title":"Arch Intern Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1016\/S0005-7967(99)00136-9","article-title":"Intrusive thoughts and their relationship to actigraphic measurement of sleep: towards a cognitive model of insomnia","volume":"38","author":"Wicklow","year":"2000","journal-title":"Behav Res Therapy"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1097\/ICO.0000000000001854","article-title":"Association between sleep quality, mood status, and ocular surface characteristics in patients with dry eye disease","volume":"38","author":"Wu","year":"2019","journal-title":"Cornea"},{"key":"ref15","first-page":"38","article-title":"Development and evaluation of Chinese version questionnaires of ocular surface disease index","volume":"33","author":"Chen","year":"2013","journal-title":"Rec Adv Ophthalmol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1001\/ARCHOPHT.118.5.615","article-title":"Reliability and validity of the ocular surface disease index","volume":"118","author":"Schiffman","year":"2000","journal-title":"Arch Ophthalmol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/1477-7525-2-44","article-title":"Comparison of the NEI-VFQ and OSDI questionnaires in patients with Sj\u00f6gren's syndrome-related dry eye","volume":"2","author":"Vitale","year":"2004","journal-title":"Health Qual Life Outcomes"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1080\/09273940701486803","article-title":"Ocular surface disease index for the diagnosis of dry eye syndrome","volume":"15","author":"Ozcura","year":"2007","journal-title":"Ocul Immunol Inflamm"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/BF02951625","article-title":"Reliability and validity of Pittsburgh sleep quality index","volume":"29","author":"Liu","year":"1996","journal-title":"Chin J Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3870\/j.issn.1001-4152.2022.22.018","article-title":"Tools for assessing perceived stree in nursing staff: a literature review","volume":"37","author":"Tian","year":"2022","journal-title":"J Nurs Sci"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1097\/ICO.0000000000003374","article-title":"Prevalence and correlates of dry eye in a German population sample","volume":"43","author":"Munch","year":"2024","journal-title":"Cornea"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/ICL.0000000000000968","article-title":"Awareness, prevalence, and knowledge of dry eye among internet professionals: a cross-sectional study in China","volume":"49","author":"Fan","year":"2023","journal-title":"Eye Contact Lens"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.jtos.2017.05.003","article-title":"TFOS DEWS II epidemiology report","volume":"15","author":"Stapleton","year":"2017","journal-title":"Ocul Surf"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1080\/08164622.2024.2380077","article-title":"Dry eye disease as an occupational risk factor in operating room nurses","volume":"108","author":"Acar","year":"2024","journal-title":"Clin Exp Optom"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1177\/23779608221127948","article-title":"Prevalence and risk factors associated with symptomatic dry eye in nurses in Palestine during the COVID-19 pandemic","volume":"8","author":"Allayed","year":"2022","journal-title":"SAGE Open Nurs"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"482","DOI":"10.3109\/13697137.2010.539724","article-title":"Effects of estradiol\u2013drospirenone on ocular and nasal functions in postmenopausal women","volume":"14","author":"Coksuer","year":"2011","journal-title":"Climacteric"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1186\/s12886-023-03085-y","article-title":"The effects of female sex hormones on the human cornea across a woman\u2019s life cycle","volume":"23","author":"Kelly","year":"2023","journal-title":"BMC Ophthalmol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1016\/j.jtos.2019.04.004","article-title":"The relationship between occupation and dry eye","volume":"17","author":"Bazeer","year":"2019","journal-title":"Ocul Surf"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.29011\/2688-9501.101305","article-title":"Health promotion and eye vision health for nurses","volume":"5","author":"De Natale","year":"2022","journal-title":"Int J Nurs Healthc Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1007\/s40123-020-00282-6","article-title":"Face mask-associated ocular irritation and dryness","volume":"9","author":"Moshirfar","year":"2020","journal-title":"Ophthalmol Ther"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e21699","DOI":"10.1097\/MD.0000000000021699","article-title":"Investigation of dry eye symptoms of medical staffs working in hospital during 2019 novel coronavirus outbreak","volume":"99","author":"Long","year":"2020","journal-title":"Medicine"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"5995","DOI":"10.1073\/pnas.1118355109","article-title":"Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk","volume":"109","author":"Cohen","year":"2012","journal-title":"Proc Natl Acad Sci"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"889","DOI":"10.2147\/NDT.S81515","article-title":"High prevalence of sleep and mood disorders in dry eye patients: survey of 1,000 eye clinic visitors","volume":"11","author":"Ayaki","year":"2015","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1016\/j.sleep.2015.06.021","article-title":"The association between sleep duration and dry eye syndrome among Korean adults","volume":"16","author":"Lee","year":"2015","journal-title":"Sleep Med"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.autneu.2005.12.001","article-title":"Loss of parasympathetic innervation leads to sustained expression of pro-inflammatory genes in the rat lacrimal gland","volume":"124","author":"Nguyen","year":"2006","journal-title":"Auton Neurosci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1007\/s11325-018-1682-y","article-title":"Association between insomnia and job stress: a meta-analysis","volume":"22","author":"Yang","year":"2018","journal-title":"Sleep Breath"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"101556","DOI":"10.1016\/j.smrv.2021.101556","article-title":"Improving sleep quality leads to better mental health: a meta-analysis of randomised controlled trials","volume":"60","author":"Scott","year":"2021","journal-title":"Sleep Med Rev"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/HNP.0000000000000667","article-title":"Effects of auricular acupressure on nurses\u2019 perceived stress, sleep quality, and presenteeism: a single-blind, randomized controlled trial","volume":"39","author":"Sim","year":"2025","journal-title":"Holist Nurs Pract"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1817895\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T15:11:56Z","timestamp":1776265916000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1817895\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":40,"alternative-id":["10.3389\/fpubh.2026.1817895"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1817895","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"article-number":"1817895"}}