Association of Occupational Stress and Resilience with Sleep Quality Moderated by the HTR2A Gene rs6313 Polymorphism

Objectives: Occupational stress, resilience and 5-hydroxytryptamine receptor 2A gene (HTR2A) polymorphisms potentially influence sleep quality. However, evidence of their effects and relationships remains ambivalent and insufficient. Therefore, this study investigated the association of occupational stress, resilience, HTR2A polymorphisms, and their interactions with sleep quality. Methods: Using a cross-sectional design, 809 Chinese Han subjects (47% female and 53% male; age: 33.1 ± 6.3 years) were genotyped for HTR2A rs6313 polymorphism. Occupational stress, resilience and sleep quality were measured using Work Stress Scale, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index, respectively. Results: Higher occupational stress was significantly correlated with poorer sleep quality (odds ratio (OR) = 2.020, 95% confidence interval (CI): [1.736, 2.394], p = 0.00031), while higher resilience was significantly correlated with better sleep quality (OR = 0.610, 95% CI: [0.522, 0.697], p = 0.00047). Occupational stress played a mediating role in the association between resilience and sleep quality (indirect: β1β2 = −0.067, 95% CI: [−0.101, −0.041], p = 0.00045; direct: β3 = −0.119, 95% CI: [−0.205, −0.032], p = 0.008). The rs6313 polymorphism moderated the association between resilience and sleep quality (β6 = 0.786, 95% CI: [0.092, 1.422], p = 0.027), but not the indirect effect. Conclusions: Resilience is associated with better sleep quality both directly and by attenuating the negative correlation between occupational stress and sleep quality, and the rs6313 polymorphism is associated with modifying the relationship between resilience and sleep quality (but not occupational stress and sleep quality), which suggests potential distinct biological association patterns for resilience and stress. Subjects with TT and TC/CC genotypes had different sleep quality response to resilience, implying potential molecular mechanisms of resilience. Our findings provide implications for the prevention and intervention of stress-related sleep problems in occupational populations by targeting modifiable factors including occupational stress and individual resilience.