Bangladesh Protocol Targets the Burden of Sleep Problems Among Physicians
Sleep disturbance among physicians has moved from an occupational inconvenience to a patient-safety issue, and the planned systematic review and meta-analysis in BMJ Open is designed to quantify that burden in Bangladesh. The protocol focuses on observational cross-sectional studies of physicians, a group already known to carry heavy clinical workloads, irregular schedules and emotional strain. Reported sleep-problem prevalence in Bangladesh has varied widely, ranging from 32% to 58%, leaving health systems without a stable estimate that can guide workforce planning or preventive policy.
Physicians are not just another adult population with disrupted rest. In clinical practice, insufficient or poor-quality sleep feeds into burnout, decision fatigue, impaired concentration and a higher likelihood of medical error. When the workday is built around night duty, emergency calls and long shifts, the biological cost accumulates quickly: circadian misalignment erodes alertness, sleep fragmentation weakens cognitive control and chronic fatigue can amplify anxiety and depressive symptoms. A pooled estimate from the Bangladesh literature may help distinguish a true occupational hazard from the noise created by small, isolated studies.
Cross-Sectional Evidence Will Be Sifted for Pooled Prevalence and Risk Factors
The review will search PubMed, Scopus, Web of Science, EMBASE, PsycInfo, ProQuest Medical, CINAHL, Google Scholar and BanglaJOL, along with grey literature identified through citation chaining. Eligible studies are restricted to observational cross-sectional designs published from database inception until 1 August 2025, with inclusion limited to studies using validated assessment tools and published in English or other major international languages. Review articles, case reports, case series, intervention studies, commentaries, preprints, meeting abstracts, protocols, unpublished articles and letters will be excluded.
That design choice is deliberate. Cross-sectional work cannot prove causation, but it can establish how common sleep problems are and how they cluster with measurable exposures such as workload, specialty, working hours or demographic factors when those variables are reported consistently. The protocol also seeks quantitative data on sleep duration, sleep quality and associated determinants, which should allow the authors to separate simple prevalence from the clinical texture of the problem. A physician who sleeps too little because of a short-term rotation is not the same as one with chronically poor sleep quality driven by sustained shift work, and a careful synthesis will need to preserve those distinctions.
Two independent reviewers will screen studies using the Rayyan platform, with disagreements settled by a third reviewer. That process is more than administrative hygiene; in a field with heterogeneous definitions and variable measurement tools, duplicate screening reduces selection bias and helps preserve consistency in eligibility decisions. Once the final set of studies is assembled, the team plans narrative synthesis alongside random-effects meta-analysis to generate pooled prevalence estimates. Forest plots and funnel plots will be used to visualize results and explore publication bias, while heterogeneity will be quantified with the I² statistic.
Heterogeneity May Be the Central Challenge in Interpreting the Pooled Estimate
The main statistical challenge will likely be heterogeneity. Sleep studies often differ in how they define insomnia, poor sleep quality or inadequate duration, and even validated tools can yield different prevalence figures depending on the threshold used. In Bangladesh, the physician workforce also spans multiple settings, from tertiary hospitals to more limited-resource environments, and those work patterns can shape sleep exposure in very different ways. A random-effects model is the appropriate starting point because it assumes the studies are not estimating one perfectly uniform effect.
Sensitivity analyses and subgroup analyses are planned when needed. Those secondary analyses may become the most clinically meaningful part of the review if the overall pooled estimate proves too broad to guide action. If sleep problems are consistently worse in particular specialties, training levels or work settings, policy responses could be more targeted than a generic call for better rest. The physiology is straightforward even when the epidemiology is messy: persistent sleep debt disrupts attention, executive function and emotional regulation, all of which matter directly in high-stakes medical care.
Study quality will be assessed with Joanna Briggs Institute critical appraisal tools for observational designs. That matters because prevalence estimates can be distorted by convenience sampling, poorly defined outcome measures or incomplete reporting of confounders. A study that measures sleep with a validated instrument in a clearly defined physician population carries more interpretive weight than one built on a narrow or vaguely described sample. The planned review cannot fix weak primary studies, but it can grade their influence and make the final estimate more defensible.
Occupational Health Policy May Depend on How Strong the Final Signal Proves to Be
The protocol is positioned at the intersection of occupational medicine, mental health and health-system safety. In practical terms, the final review could give hospital leaders and policymakers a clearer picture of whether sleep problems among Bangladeshi physicians are widespread enough to justify structured interventions such as shift redesign, duty-hour reform, fatigue mitigation strategies or access to sleep-focused support services. It may also sharpen future research priorities by identifying which determinants are repeatedly measured and which remain underexplored.
All statistical work will be conducted in Jamovi V2.7.6, R V4.3.2 with meta packages and GraphPad Prism V9.0.2. The protocol is registered in PROSPERO under CRD420251123294, a step that strengthens transparency and reduces the risk of selective analysis after data extraction begins. Because this is a protocol rather than a completed review, no pooled prevalence or definitive risk ranking is available yet.
The real test will come after the screening and extraction phases are complete. If the literature is sparse, inconsistent or too heterogeneous, the review may end with a cautious estimate rather than a crisp answer. Even so, a rigorously assembled synthesis could still expose where Bangladesh’s physician workforce is most vulnerable—and where better sleep may be one of the most practical ways to protect both clinician health and patient care.