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Lise F, Shattell M, Garcia FL, Kincl L. Risk Factors for Chronic Non-Communicable Diseases of Long-Haul Truck Drivers during the COVID-19 Pandemic: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:897. [PMID: 39063474 PMCID: PMC11276728 DOI: 10.3390/ijerph21070897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Long-haul truck drivers are responsible for transporting goods valued at millions of dollars of the world economy, and may have their health affected by living and working conditions. This study analyzed and synthesized scientific findings about risk factors for the development of chronic non-communicable diseases in long-haul truck drivers. An integrative literature review was conducted. We identified 23 studies that met the inclusion criteria and evaluated the health of 7363 drivers. The biological risk factors identified were age, gender, race/ethnicity, genetics, and comorbidities, and were considered to be non-modifiable for chronic diseases. The behavioral risks considered to be modifiable were sedentary lifestyle, smoking, alcohol consumption, overweight, diet, stress, anxiety, and unfavorable socioeconomic conditions. Environmental risks involved working conditions such as the following: number of working hours per day, week, and month; time away from home; risk of musculoskeletal injury; and opportunities for rest, hours of sleep, and access to health services. The results were presented in two categories: (1) biological, behavioral, and environmental risks, and (2) general recommendations to promote physical, cognitive, and emotional health. Macro-structural changes are needed to reorganize work and rest, improve access to health services to control modifiable risk factors, and to support behavioral and environmental changes to reduce chronic non-communicable diseases and deaths.
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Affiliation(s)
- Fernanda Lise
- Nursing Faculty, Federal University of Pelotas, Pelotas 96010-610, RS, Brazil
| | - Mona Shattell
- College of Nursing, University of Central Florida, Orlando, FL 32826, USA;
| | - Flávia Lise Garcia
- Anthropology Faculty, Federal University of Pelotas, Pelotas 96010-770, RS, Brazil;
| | - Laurel Kincl
- College of Health, Oregon State University, Corvallis, OR 97331, USA;
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Jeon BM, Kim SH, Shin SH. Effectiveness of sleep interventions for rotating night shift workers: a systematic review and meta-analysis. Front Public Health 2023; 11:1187382. [PMID: 37427284 PMCID: PMC10323438 DOI: 10.3389/fpubh.2023.1187382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023] Open
Abstract
Background Sleep disturbance is a common issue among rotating night shift workers and is closely related to health risks. The present study aimed to determine the effectiveness of pharmacological and non-pharmacological sleep interventions for the management of sleep disturbance among rotating night shift workers. Methods For this systematic review and meta-analysis, we searched six electronic databases-EMBASE, CINAHL, Cochrane Library, PubMed, Scopus, and Web of Science-for randomized controlled trials and clinical trials published from January 1990 to June 2022. The quality of eligible studies was independently assessed by three authors using the Joanna Briggs Institute Critical Appraisal Checklist for randomized controlled trials and quasi-experimental studies. The meta-analysis was performed based on the random effects model using the Comprehensive Meta-Analysis software. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Of the 1019 studies retrieved, 30 met the inclusion criteria for the systematic review; 25 were selected for the meta-analysis. Sleep interventions were categorized as follows: pharmacological approach (n = 7), light therapy (n = 9), cognitive behavioral approach (n = 7), aroma or alternative therapy (n = 4), and shift schedule modification (n = 3). The overall mean effect size of the interventions was moderate (Hedges' g = 0.59; 95% confidence interval = 0.33-0.84, z = 4.50, p < 0.001). Conclusion Sleep interventions were effective in promoting sleep or reducing sleep disturbance among rotating night shift workers. These findings provide evidence of the effectiveness of various pharmacological and non-pharmacological sleep interventions for managing sleep health in the work environment of rotating night shift workers.
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Affiliation(s)
- Bo Min Jeon
- College of Nursing, Kyungpook National University, Daegu, Republic of Korea
| | - Su Hyun Kim
- College of Nursing, The Research Institute of Nursing Science, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Hwa Shin
- Department of Nursing, Andong Science College, Andong, Republic of Korea
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Declercq I, Van Den Eede F, Roelant E, Verbraecken J. SHIFTPLAN: a randomized controlled trial investigating the effects of a multimodal shift-work intervention on drivers' fatigue, sleep, health, and performance parameters. Trials 2022; 23:662. [PMID: 35978435 PMCID: PMC9382013 DOI: 10.1186/s13063-022-06573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Shift work is commonly associated with health problems resulting from circadian misalignment and sleep restriction. About one in three shift workers is affected by insomnia and up to 90% report regular fatigue and/or sleepiness at the workplace. Epidemiological data shows that shift workers are at increased risk of cardiovascular disease, diabetes, obesity, breast cancer, mental-health problems, and shift-work disorder, which conditions typically lead to reduced work performance, processing errors, accidents at work, absenteeism, and reduced quality of life. Given these widespread and debilitating consequences, there is an urgent need for treatments that help improve the sleep, health, and functional performance of the shift-working population. The most common non-pharmacological recommendations are improved scheduling, bright-light exposure, napping, psychoeducation promoting sleep hygiene, and cognitive-behavioral techniques. The objectives of the present study are to investigate the effects of a multimodal shift-work intervention on perceived fatigue, sleepiness, physical and mental health, sleep parameters, and absenteeism. METHODS A randomized controlled interventional study comparing the two groups each comprising at least 80 drivers of a public transport company, using self-report questionnaires and health checks completed at intake and after 3 and 6 months following the start of the intervention or waiting-list period. The intervention consists of (a) healthy scheduling taking into account shift-rotation direction and speed, chronotype, resting time, and napping; (b) an education program specifically developed for shift workers; and (c) a dedicated information campaign for shift planners. The primary outcome is symptomatic burden in terms of sleepiness, and the key secondary outcome is symptomatic burden in terms of fatigue. Supplementary secondary outcomes are sleep parameters, absenteeism, general and clinical health, changes in mood, and anxiety. DISCUSSION Expected outcomes are significant improvements on all primary and secondary outcome parameters in the intervention group. To our knowledge, ours is the first randomized controlled study to systematically investigate the effects of a multimodal program on multiple health, sleep, and performance parameters in shift workers. Our research also aims at providing evidence-based practice guidelines for healthy scheduling in general and thus contribute to diminishing the serious health and economic burdens associated with shift work overall. TRIAL REGISTRATION EDGE registration number: 000339. CLINICALTRIALS gov NCT05452096.
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Affiliation(s)
- Inge Declercq
- Multidisciplinary Sleep Disorders Center, Antwerp University Hospital (UZA), Drie Eikenstraat 655 - 2650, Edegem, Belgium.
| | - Filip Van Den Eede
- Department of Psychiatry, Antwerp University Hospital (UZA), Drie Eikenstraat 655 - 2650, Edegem, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital (UZA), University of Antwerp, Edegem, Belgium
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Center, Antwerp University Hospital (UZA), Drie Eikenstraat 655 - 2650, Edegem, Belgium.,Medical Coordinator Multidisciplinary Sleep Disorders Center (UZA), LEMP FGGW UA, Antwerp University Hospital (UZA), Drie Eikenstraat 655 - 2650, Edegem, Belgium
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Dugdale Z, Eiter B, Chaumont Menéndez C, Wong I, Bauerle T. Findings from a systematic review of fatigue interventions: What's (not) being tested in mining and other industrial environments. Am J Ind Med 2022; 65:248-261. [PMID: 35184307 DOI: 10.1002/ajim.23334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Fatigue negatively impacts mineworker health and safety. In this paper, we identify fatigue interventions tested on industrial shiftworkers and explore their effects and the factors that may influence application in an industrial setting such as a mine site. METHODS This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A structured, systematic search of the literature was conducted to identify relevant studies published between 1980 and 2020. Researchers independently conducted article screening and study quality appraisals against pre-established criteria, and then extracted data and conducted a narrative synthesis of the included studies. RESULTS Seven intervention studies, out of 1651 articles initially screened, were retained for narrative synthesis. Four studies tested the alerting effects of bright-light treatment, one evaluated the effectiveness of blue-light blocking glasses at improving daytime sleep quality and nighttime vigilance, and two examined whether sleep hygiene and alertness management trainings improved sleep quality or alertness. There was substantial evidence for the use of bright-light treatments to improve night shiftworker alertness, but insufficient evidence to draw conclusions about the effectiveness of blue-light blocking glasses and sleep hygiene and alertness management trainings due to the small number of studies included. Shiftworkers were mostly male and employed in industrial subsectors such as production and manufacturing, oil and gas, and transportation. No mining-specific intervention studies were identified. CONCLUSIONS Future research is needed to identify effective fatigue risk management interventions for the mining industry as well as best practices for implementing these interventions with mineworkers.
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Affiliation(s)
- Zoë Dugdale
- Spokane Mining Research Division National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention Spokane Washington USA
| | - Brianna Eiter
- Spokane Mining Research Division National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention Spokane Washington USA
| | - Cammie Chaumont Menéndez
- Division of Safety Research National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention Morgantown West Virginia USA
| | - Imelda Wong
- Division of Science Integration National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention Cincinnati Ohio USA
| | - Tim Bauerle
- Spokane Mining Research Division National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention Spokane Washington USA
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Shin S, Kim SH, Jeon B. Objective Assessment of Sleep Patterns among Night-Shift Workers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413236. [PMID: 34948844 PMCID: PMC8701940 DOI: 10.3390/ijerph182413236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
In this scoping review of the literature, we identified the types and the parameters of objective measurements to assess sleep patterns among night-shift workers. We conducted a literature search using electronic databases for studies published from 1991 to 2020 and charted and summarized key information. We included 32 studies in the review. Polysomnography was used in 6 studies and wearable sleep detection devices were utilized in 26 studies. The duration of sleep assessment using the wearable devices ranged from 1 day to ≥4 weeks, and more than half of the studies collected data for >2 weeks. The majority of the studies used subjective questionnaires, such as the Karolinska Sleepiness Scale, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index, in addition to objective sleep measurements. Total sleep time was the most common parameter, followed by sleep efficiency, sleep onset latency, and time or frequency of being awake. As the utilization of wearable devices to assess the sleep patterns of night-shift workers is expected to increase, further evaluation of device accuracy and precision, optimal data collection period, and key parameters is warranted.
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Affiliation(s)
- Seunghwa Shin
- Department of Nursing, Andong Science College, Kyungpook, Andong 36616, Korea;
| | - Su-Hyun Kim
- College of Nursing, Kyungpook National University, Daegu 41944, Korea;
- Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-420-4928; Fax: +82-53-421-2758
| | - Bomin Jeon
- College of Nursing, Kyungpook National University, Daegu 41944, Korea;
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Crowther ME, Ferguson SA, Vincent GE, Reynolds AC. Non-Pharmacological Interventions to Improve Chronic Disease Risk Factors and Sleep in Shift Workers: A Systematic Review and Meta-Analysis. Clocks Sleep 2021; 3:132-178. [PMID: 33525534 PMCID: PMC7930959 DOI: 10.3390/clockssleep3010009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Shift work is associated with adverse chronic health outcomes. Addressing chronic disease risk factors including biomedical risk factors, behavioural risk factors, as well as sleep and perceived health status, affords an opportunity to improve health outcomes in shift workers. The present study aimed to conduct a systematic review, qualitative synthesis, and meta-analysis of non-pharmacological interventions targeting chronic disease risk factors, including sleep, in shift workers. A total of 8465 records were retrieved; 65 publications were eligible for inclusion in qualitative analysis. Random-effects meta-analysis were conducted for eight eligible health outcomes, including a total of thirty-nine studies. Interventions resulted in increased objective sleep duration (Hedges' g = 0.73; CI: 0.36, 1.10, k = 16), improved objective sleep efficiency (Hedges' g = 0.48; CI: 0.20, 0.76, k = 10) and a small increase in both subjective sleep duration (Hedges' g = 0.11; CI: -0.04, 0.27, k = 19) and sleep quality (Hedges' g = 0.11; CI: -0.11, 0.33, k = 21). Interventions also improved perceived health status (Hedges' g = 0.20; CI: -0.05, 0.46, k = 8), decreased systolic (Hedges' g = 0.26; CI: -0.54, 0.02, k = 7) and diastolic (Hedges' g = 0.06; CI: -0.23, 0.36, k = 7) blood pressure, and reduced body mass index (Hedges' g = -0.04; CI: -0.37, 0.29, k = 9). The current study suggests interventions may improve chronic disease risk factors and sleep in shift workers; however, this could only be objectively assessed for a limited number of risk factor endpoints. Future interventions could explore the impact of non-pharmacological interventions on a broader range of chronic disease risk factors to better characterise targets for improved health outcomes in shift workers.
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Affiliation(s)
- Meagan E Crowther
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Sally A Ferguson
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Grace E Vincent
- The Appleton Institute, CQUniversity, 44 Greenhill Road, Wayville, SA 5034, Australia; (S.AF.); (G.EV.)
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Adelaide Campus, Wayville, SA 5034, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health (AISH): A Flinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
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Moessinger M, Stürmer R, Mühlensiep M. Auditive beta stimulation as a countermeasure against driver fatigue. PLoS One 2021; 16:e0245251. [PMID: 33428673 PMCID: PMC7799808 DOI: 10.1371/journal.pone.0245251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022] Open
Abstract
Objective Fatigue in road traffic can occur after long driving times or during night-time driving and can lead to a dangerous decrease in vigilance or microsleep. As a countermeasure, the effectiveness of brain stimulation by means of frequency-modified music is investigated. Small frequency shifts between two different sounds simultaneously perceived by both ears (e.g. 400 and 418 Hz) stimulate the brain to increase activity in the stimulated range (e.g. 18 Hz). Methods The effects of acoustic brain entrainment (ABE) in the EEG beta range (12–20 Hz) were compared to placebo during day and night driving (n = 40 each) in 80 subjects. The effects were examined at the subjective (Karolinska Sleepiness Scale, KSS), physiological (EEG) and performance level (test battery for attention testing, TAP). The test drive took place on the motorway. Sequence of events with measurement times: Preparation in the laboratory (60 min; TAP & KSS), driving (90 min day/ 180 min night; KSS every 30 min), beta/placebo stimulation while driving (20 min), rest (20 min; TAP & KSS), driving (60 min; KSS every 30 min), end of driving (40 min; TAP & KSS). EEG was recorded continuously (Fz, Cz, Pz, C3, C4) and analyzed for 10 min time windows. Results The subjective fatigue rating in the KSS decreased significantly after ABE compared to placebo. This was still significant about 100 minutes after stimulation. The ABE led to a significant increase in EEG beta activity compared to placebo. This was still significant about 80 minutes after stimulation. Furthermore, the ABE led to a significant decrease in theta activity compared to placebo. This was still significant about 70 minutes after stimulation and was more pronounced during daytime driving. Faster reaction times were observed for the ABE compared to the placebo condition during day and night driving. The faster reaction times were partly significant for the ABE still 80 minutes after stimulation. Conclusion Positive effects of ABE during driving could be demonstrated on the subjective, physiological and performance level. The effect was more pronounced during the day than at night. No negative side effects of Beta Stimulation were observed. The stimulation in the beta frequency range led to an increase of beta activity in the EEG.
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Affiliation(s)
- Michèle Moessinger
- Groupe Renault, Direction de la Recherche / User Experience, Guyancourt, France
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Pilkington-Cheney F, Filtness AJ, Haslam C. A qualitative study exploring how city bus drivers manage sleepiness and fatigue. Chronobiol Int 2020; 37:1502-1512. [PMID: 32869696 DOI: 10.1080/07420528.2020.1812623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleepiness is an important consideration for workplace safety, especially in relation to shift work. There is limited understanding of how practical applications of countermeasures are used to manage sleepiness in a professional setting. One under-researched group is city bus drivers. This qualitative study investigated the use of individual sleepiness countermeasures within a sample of city bus drivers. Nine semi-structured focus groups were convened to explore the broader experience and management of sleepiness (n = 62, largest proportion aged 45-54 y, mean bus driving experience 13.3 y). The conversations of the focus groups were audio-recorded (total: 682 min) and transcribed anonymously verbatim. Discussions specifically relating to personal countermeasure use were isolated from the original transcripts, creating nine new transcripts for a targeted analysis on the topic of individual countermeasure use. Thematic analysis identified two main themes: (1) strategies used to counteract sleepiness and (2) barriers to individual countermeasure use, each with several subthemes. A variety of countermeasures were used, including strategies with limited potential for counteracting sleepiness, such as opening a window, drinking water, talking, stretching, and consuming forms of sugar. Workplace restrictions, such as access to facilities, limitations of food/drink consumption, and tight schedules, were the strongest influences on countermeasure choice. It is important that bus drivers have access to, and are aware of the effectiveness of, countermeasures to manage sleepiness during shift work. It is vital that the actions of drivers and shift workers are better understood in the planning of organizational countermeasures.
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Affiliation(s)
- Fran Pilkington-Cheney
- Transport Safety Research Centre, School of Design & Creative Arts, Loughborough University, Loughborough, UK
| | - A J Filtness
- Transport Safety Research Centre, School of Design & Creative Arts, Loughborough University, Loughborough, UK
| | - C Haslam
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
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Soprovich AL, Seaton CL, Bottorff JL, Duncan MJ, Caperchione CM, Oliffe JL, James C, Rice S, Tjosvold L, Eurich DT, Johnson ST. A systematic review of workplace behavioral interventions to promote sleep health in men. Sleep Health 2020; 6:418-430. [DOI: 10.1016/j.sleh.2020.04.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 01/06/2023]
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Chellappa SL, Morris CJ, Scheer FAJL. Effects of circadian misalignment on cognition in chronic shift workers. Sci Rep 2019; 9:699. [PMID: 30679522 PMCID: PMC6346005 DOI: 10.1038/s41598-018-36762-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/22/2018] [Indexed: 01/07/2023] Open
Abstract
Shift work is associated with increased human operational errors, presumably due to the circadian timing system that inhibits optimal cognitive function during the night. Circadian misalignment, which is the misalignment between the circadian pacemaker and behavioral/environmental cycles, impairs cognitive performance in non-shift workers. However, it remains uncertain whether the adverse cognitive consequences of circadian misalignment are also observed in chronic shift workers. Thus, we investigated the effects of circadian misalignment on cognitive performance in chronic shift workers. Using a randomized, cross-over design that simulated day shift work (circadian alignment) and night shift work (circadian misalignment), we show that circadian misalignment increases cognitive vulnerability on sustained attention, information processing and visual-motor performance, particularly after more than 10 hours of scheduled wakefulness. Furthermore, their increased levels of subjective sleepiness and their decreased sleep efficiency were significantly associated with impaired sustained attention and visual-motor performance. Our data suggest that circadian misalignment dramatically deteriorates cognitive performance in chronic shift workers under circadian misalignment. This increased cognitive vulnerability may have important safety consequences, given the increasing number of nighttime jobs that crucially rely on the availability of cognitive resources.
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Affiliation(s)
- Sarah L Chellappa
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA. .,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
| | - Christopher J Morris
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Frank A J L Scheer
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA. .,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA, 02115, USA.
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