Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Sleep, mental health and physical health in new shift workers transitioning to shift work: Systematic review and meta-analysis

This systematic review and meta-analysis (PROSPERO registration CRD42022309827) aimed to describe how shift work impacts new workers' sleep, mental health, and physical health during the transition to shift work and to consolidate information regarding predictors of shift work tolerance (SWT) during this transition period. Inclusion criteria included: new shift workers; sleep, mental health, or physical health outcomes; prospective study design with the first timepoint assessing workers within three months of starting shift work; and written in English. Searches from six databases returned 12,172 articles as of August 2023. The final sample included 48 papers. Publication quality and risk of bias was assessed using the critical appraisal skills program. Forty-five studies investigated longitudinal changes in sleep, mental health, or physical health outcomes and 29 studies investigated predictors of SWT (i.e., better sleep, mental and physical health). Sleep and mental health outcomes worsened following the onset of shift work, while physical health did not significantly change. Pre-shift work mental health, sleep, and work characteristics predicted SWT later in workers' careers. Shift work adversely impacts new workers' sleep and mental health early in their career, and interventions before beginning shift work are needed to promote better SWT.

Factors affecting the psychomotor vigilance of nurses working night shift

BACKGROUND

Shifts and long working hours decrease the psychomotor vigilance of healthcare workers especially when working night shifts. Working night shifts adversely affects nurses' health and impacts patient safety.

AIM

The purpose of this study is to identify factors affecting the psychomotor vigilance of nurses working night shift.

METHODS

This descriptive cross-sectional study was carried out with 83 nurses who were working in a private hospital in Istanbul and voluntarily participated in this study between April 25 and May 30, 2022. Data were collected using "Descriptive Characteristics Form," "Psychomotor Vigilance Task," "Pittsburgh Sleep Quality Index," and "Epworth Sleepiness Scale." The "STROBE checklist" for cross-sectional studies was utilized in order to report the findings of the study.

RESULTS

When time-dependent variation of the nurses' psychomotor vigilance task performances on the night shift was examined, it was observed that the nurses' mean reaction time and number of lapses increased at the end of the night shift. Age, smoking, physical activity, daily water consumption, daytime sleepiness, and sleep quality were found as the factors affecting nurses' psychomotor vigilance.

CONCLUSION

The psychomotor vigilance task performances of nurses working night shift are affected by age and a variety of behavioral factors.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Suggestions for nursing policy include the implementation of workplace health promotion programs in order to increase the attention level of nurses in order to ensure employee and patient health and safety and create a healthy working environment.

Sleep deprivation and medication administration errors in registered nurses-A scoping review

AIM

To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs).

BACKGROUND

Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived-anecdotal reports suggest that this could result in an increased risk of error occurring.

DESIGN

A scoping review was conducted using the Prisma-ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors.

METHODS

A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies.

RESULTS

Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used.

CONCLUSION

Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption.

NO PATIENT OR PUBLIC CONTRIBUTIONS

Patient or public contributions were not required for this scoping review.

RELEVANCE TO CLINICAL PRACTICE

Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety.

A Two-Phased Telehealth Model to Treat Post-Traumatic Stress Disorder in a Health Care Worker due to the COVID-19 Pandemic: A Case Report

Background: We report a case describing the use of a two-step telehealth intervention to treat symptoms of post-traumatic stress disorder (PTSD) that developed in a frontline health care worker (HCW) during the COVID-19 pandemic. HCWs are at increased risk of adverse psychological outcomes, including PTSD, due to the nature of their work, which has been exacerbated by the global pandemic. Methods: This case represents the first successfully completed participant in a larger ongoing trial to address psychological distress, PTSD, and comorbidities in HCWs consequent to the COVID-19 pandemic. Following a two-step intervention of self-directed narrative writing delivered entirely online followed by prolonged exposure therapy using videoconferencing, the HCW displayed significant improvement in symptoms of PTSD, depression, anxiety, and substance use. Results: The treatment model described here offers preliminary support for a two-step remote delivery approach to meet the need for scalable self-directed distance technology-based mental health interventions for HCWs. This study is registered on clinicaltrials.gov (NCT04626050).

Imputing missing sleep data from wearables with neural networks in real-world settings

Sleep is a critical component of health and well-being but collecting and analyzing accurate longitudinal sleep data can be challenging, especially outside of laboratory settings. We propose a simple neural network model titled SOMNI (Sleep data restOration using Machine learning and Non-negative matrix factorIzation [NMF]) for imputing missing rest-activity data from actigraphy, which can enable clinicians to better handle missing data and monitor sleep-wake cycles of individuals with highly irregular sleep-wake patterns. The model consists of two hidden layers and uses NMF to capture hidden longitudinal sleep-wake patterns of individuals with disturbed sleep-wake cycles. Based on this, we develop two approaches: the individual approach imputes missing data based on the data from only one participant, while the global approach imputes missing data based on the data across multiple participants. Our models are tested with shift and non-shift workers' data from three independent hospitals. Both approaches can accurately impute missing data up to 24 hours of long dataset (>50 days) even for shift workers with extremely irregular sleep-wake patterns (AUC > 0.86). On the other hand, for short dataset (~15 days), only the global model is accurate (AUC > 0.77). Our approach can be used to help clinicians monitor sleep-wake cycles of patients with sleep disorders outside of laboratory settings without relying on sleep diaries, ultimately improving sleep health outcomes.

Adipocyte-derived exosomal miR-22-3p modulated by circadian rhythm disruption regulates insulin sensitivity in skeletal muscle cells

Circadian rhythm disruption leads to dysregulation of lipid metabolism, which further drive the occurrence of insulin resistance (IR). Exosomes are natural carrier systems that advantageous for cell communication. In the present study, we aimed to explore whether and how the exosomal microRNAs (miRNAs) in circulation participate in modulating skeletal muscle IR induced by circadian rhythm disruption. In the present study, 24-h constant light (12-h light/12-h light, LL) was used to establish the mouse model of circadian rhythm disruption. Bmal1 interference was used to establish the cell model of circadian rhythm disruption. And in clinical experiments, we chose a relatively large group of rhythm disturbance-shift nurses. We showed that LL-induced circadian rhythm disruption led to increased body weight and visceral fat volume, as well as occurrence of IR in vivo. Furthermore, exosomal miR-22-3p derived from adipocytes in the context of circadian rhythm disruption induced by Bmal1 interference could be uptaken by skeletal muscle cells to promote IR occurrence in vitro. Moreover, miR-22-3p in circulation was positively correlated with the clinical IR-associated factors. Collectively, these data showed that exosomal miR-22-3p in circulation may act as potential biomarker and therapeutic target for skeletal muscle IR, contributing to the prevention of diabetes in the context of rhythm disturbance.

Impact of shift work on dementia: a systematic review and dose-response meta-analysis

OBJECTIVES

Although shift work has been reported as having a link to dementia, evidence remains inconsistent, and a comprehensive dose-response meta-analysis of the association is still lacking. We therefore conducted this meta-analysis to explore the association between shift work and the risk of dementia.

STUDY DESIGN

Systematic review and dose-response meta-analysis.

METHODS

PubMed, Embase, and Web of Science databases were systematically searched. Fixed or random-effects models were used to estimate the summary relative risks (RRs) and 95% confidence intervals (95% CIs). Generalized least squares regression was used to estimate dose-response associations, and restricted cubic splines were used to examine possible linear or non-linear associations.

RESULTS

Five articles (10 studies) with 72,999 participants and 23,067 cases were eventually included in the meta-analysis. The summary RRs and 95% CIs of dementia risk with shift work and night shift work versus daytime work were 1.13 (95% CI: 1.05-1.21, I2 = 46.70%) and 1.13 (95% CI: 1.03-1.24, I2 = 9.20%), respectively. The risk of dementia increased by 1% (RR = 1.01, 95% CI: 1.01-1.02, I2 = 41.3%) with each 1-year increase in the duration of shift work. We found a non-linear dose-response association between the duration of shift work and the risk of dementia (Pnon-linearity = 0.006). Though the shape of the curve was steeper with the duration of shift work <7 years, the increase was more gradual after 7 years.

CONCLUSION

Our findings suggest that shift work may be a risk factor for future dementia and that controlling the length of shift work is a feasible measure that may contribute to prevent dementia.

Concurrent trajectories of part-time work and sickness absence: a longitudinal cohort study over 11 years among shift working hospital employees

OBJECTIVES

To investigate the concurrent changes in part-time work and sickness absence (SA) in healthcare. Another aim was to investigate the role of age and sex on different concurrent trajectory groups.

DESIGN

Prospective cohort study.

SETTING

Public hospital districts (n=10) and cities (n=11) in Finland.

PARTICIPANTS

Payroll-based objective working hour data of the healthcare sector in Finland for 28 969 employees in 2008-2019 were used. The final sample included those working shifts with 3 consecutive years of data and without baseline (≥14 days) SA.

PRIMARY OUTCOMES

Part-time work (yes or no) and months of SA.

MEASURES

Group-based trajectory modelling to identify concurrent changes in part-time work, and months of SA while controlling the time-variant amount of night work and multinomial regression models for relative risk (RR) with 95% CIs were used.

RESULTS

Four-group trajectory model was the best solution: group 1 (61.2%) with full-time work and no SA, group 2 (16.9%) with slowly increasing probability of part-time work and low but mildly increasing SA, group 3 (17.6%) with increasing part-time work and no SA, and group 4 (4.3%) with fluctuating, increasing part-time work and highest and increasing levels of SA. Men had a lower (RR 0.49-0.75) and older age groups had a higher likelihood (RRs 1.32-3.79) of belonging to trajectory groups 2-4.

CONCLUSIONS

Most of the sample were in the trajectory group with full-time work and no SA. The probability of part-time work increased over time, linked with concurrent low increase or no SA. A minor group of employees had both an increased probability of part-time work and SA. Part-time work and other solutions might merit attention to promote sustainable working life among healthcare employees.

Sleep Quality and Its Relationship to Anxiety and Hardiness in a Cohort of Frontline Italian Nurses during the First Wave of the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has had a considerable impact on the psychological and psychopathological status of the population and health care workers in terms of insomnia, anxiety, depression, and post-traumatic stress disorder. The primary aim of this study was to describe and evaluate the impact of the pandemic on insomnia levels of a cohort of Italian nurses, particularly those involved in the care of COVID-19 patients. The secondary aim was to identify the interaction between insomnia and hardiness, anxiety, and sleep disturbances.

MATERIALS AND METHODS

A descriptive-exploratory study was conducted using an online survey during the first wave of the COVID-19 pandemic (March to July 2020). The questionnaire consisted of multiple-choice, open-ended, closed, and semi-closed questions. The psychometric tools administered were the Dispositional Resilience Scale (DRS-15), the State-Trait Anxiety Inventory (STAI-Y), and the Insomnia Severity Index (ISI).

RESULTS

a cohort of 1167 nurses fully completed the questionnaire (86.2% of total respondents). The insomnia scale survey showed an increase in post-pandemic scores compared to those before the pandemic, implying that insomnia levels increased after the first pandemic wave. Insomnia scores were directly correlated with anxiety levels (r = 0.571; p ≤ 0.05) and inversely correlated with hardiness levels (r = -0.324; p < 0.001). Multivariate analysis revealed the following protective factors: not having worked in COVID-19 wards, high levels of hardiness (commitment), and the presence of high pre-pandemic insomnia disorder. The main risk factor for insomnia reported in the analysis was a high anxiety score.

DISCUSSION AND CONCLUSION

Anxiety represented the main risk factor for insomnia severity in our sample, while hardiness was confirmed as a protective factor. Thus, it is necessary to design further studies to identify additional risk factors for poor sleep quality and to develop educational courses and strategies aimed at enhancing rest and sleep quality, especially for frontline nurses.

Pilot feasibility testing of biomathematical model recommendations for personalising sleep timing in shift workers

Sleep disturbances and circadian disruption play a central role in adverse health, safety, and performance outcomes in shift workers. While biomathematical models of sleep and alertness can be used to personalise interventions for shift workers, their practical implementation is undertested. This study tested the feasibility of implementing two biomathematical models-the Phillips-Robinson Model and the Model for Arousal Dynamics-in 28 shift-working nurses, 14 in each group. The study examined the overlap and adherence between model recommendations and sleep behaviours, and changes in sleep following the implementation of recommendations. For both groups combined, the mean (SD) percentage overlap between when a model recommended an individual to sleep and when sleep was obtained was 73.62% (10.24%). Adherence between model recommendations and sleep onset and offset times was significantly higher with the Model of Arousal Dynamics compared to the Phillips-Robinson Model. For the Phillips-Robinson model, 27% of sleep onset and 35% of sleep offset times were within ± 30 min of model recommendations. For the Model of Arousal Dynamics, 49% of sleep onset, and 35% of sleep offset times were within ± 30 min of model recommendations. Compared to pre-study, significant improvements were observed post-study for sleep disturbance (Phillips-Robinson Model), and insomnia severity and sleep-related impairments (Model of Arousal Dynamics). Participants reported that using a digital, automated format for the delivery of sleep recommendations would enable greater uptake. These findings provide a positive proof-of-concept for using biomathematical models to recommend sleep in operational contexts.

A Narrative Review of the Carcinogenic Effect of Night Shift and the Potential Protective Role of Melatonin

Since the IARC (International Agency for Research on Cancer) announcement in 2007 indicating the possibility of night-shift work carrying carcinogenesis risk, multiple studies on a global level have been conducted to investigate the correlation between night-shift work and cancer development. Circadian rhythm disruption and decreased melatonin production have been postulated as potential contributing factors. There is also growing evidence that night-shift workers tend to adopt unhealthier lifestyles which contribute to poorer health and increase the risk of developing diseases such as cancer. No experimental study has been specifically dedicated to testing specific methods that could decrease cancer risk in night-shift workers. While there are a few studies that investigate melatonin's concurrent use with chemotherapy in cancer patients, there is yet to be seen for studies that investigate melatonin specifically as a cancer prevention method. This narrative review aims to examine current evidence of healthcare night-shift work's risk in cancer incidence, potential pathogenesis, and its significance in clinical practice.

Marital status and living apart affect sleep quality in male military personnel: a study of the China's Navy during COVID-19

Background

Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions.

Methods

An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not.

Results

After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, p = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor.

Conclusion

Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.

Sleep Disturbance and Occupational Fatigue in Emergency Nurses of Public Hospitals in Greece: A Cross-Sectional Study

The emergency department (ED) is a stressful workplace for nurses, due to heavy workload and work shifts, which affect sleep quality, causing occupational fatigue. As a result, nurses burn out and turn over and quality of care is impaired. The aim of this study was to investigate sleep disturbance (SD) and occupational fatigue (OF) in emergency nurses of public hospitals in Greece. This descriptive cross-sectional study was conducted in the ED of tertiary public hospitals in Greece from September 2019 to October 2021, after the approval from the scientific and ethical committee of hospitals and the full informed consent of participants. The Standard Shift work Index (SSI) questionnaire was used, which includes 12 question groups about sleep habits and OF evaluation for shift workers, as nurses. Two hundred and ten ED nurses were recruited for the purpose of the study. In this research their quality of life, sleep completeness, and fatigue levels were studied. A moderate level of SD (total score = 70.54) of nurses was found that was related to marital status, presence of children, and underlying diseases (p = 0.012, p = 0.024, and p = 0.002, respectively). OF was assessed at low levels (score = 27.34) and was mainly related to age, with younger nurses reporting less fatigue compared with older nurses. The effect of work shifts in SD and OF of ED nurses was well documented. ED nurses' OF was correlated with increased SD, age, and marital status. Further research is needed for a better assessment and understanding of the factors that influence SD and OF of ED nurses to plan a strategy to optimize sleep patterns of work shift ED nurses.

Mediating role of psychological flexibility in the effect of obsessive-compulsive symptoms on sleep quality among nurses during the COVID-19 pandemic

Front-line nurses suffered unprecedented mental distress and severe insomnia during the COVID-19 pandemic. Present study aimed to explore the relationship between obsessive-compulsive symptoms and sleep quality and examine the potential mediating role of psychological flexibility between obsessive-compulsive symptoms and sleep quality. A total of 496 nurses from a Chinese large-scale Class 3 A Comprehensive Hospital were included in an online cross-sectional survey and completed the revised obsessive-compulsive inventory (OCI-R), Multidimensional Psychological Flexibility Inventory (MPFI) and Pittsburgh Sleep Quality Index (PSQI). As predicted, obsessive-compulsive symptoms were negatively associated with psychological flexibility and sleep quality, and psychological flexibility was positively associated with sleep quality. In addition, the relationship between obsessive-compulsive symptoms and sleep quality was partially mediated by psychological flexibility, which can provide some reference for the treatment of the obsessive-compulsive disorder (OCD) and insomnia, and lead to improvements in clinical and psychotherapy planning.

Tagesschläfrigkeit bei Pflegepersonal

Hintergrund

Aufgrund von Arbeitszeiten, die außerhalb der normalen Tagesarbeitszeit liegen, kann es bei Pflegepersonal zu Störungen der inneren Uhr kommen. Durch zusätzliche Verpflichtungen im familiären Bereich kann sich möglicherweise eine Normalisierung der zirkadianen Störung bei weiblichen Pflegenden erschweren, da sie zu Hause nicht genug Zeit für Schlaf und Erholung finden.

Fragestellung

In der vorliegenden Arbeit soll explorativ untersucht werden, ob Beschäftigte in der Pflege ein höheres Risiko für Tagesschläfrigkeit haben als andere Berufsgruppen, die nicht im Schichtdienst arbeiten. Darüber hinaus soll ebenfalls explorativ analysiert werden, inwiefern das Geschlecht in Verbindung mit der Beschäftigung im Schichtdienst eine Rolle hinsichtlich der Tagesschläfrigkeit spielt.

Material und Methoden

Aus der 10.000er Baselinestichprobe der Hamburg City Health Study (HCHS) wurden alle Proband:innen selektiert, die beruflich in der Pflege tätig waren. Anhand des Alters, des Geschlechts und des Chronotyps wurden aus dem HCHS-Datensatz aktiv Beschäftigte im Verhältnis 1:3 gezogen, die aus Branchen mit vorwiegend keiner Schichtarbeit stammen (Kontrollen). Die Tagesschläfrigkeit wurde anhand des Epworth-Sleepiness-Scale-Fragebogens (ESS) erhoben.

Ergebnisse

In der Gesamtstichprobe der HCHS waren 4646 Personen aktiv beschäftigt. Unter diesen befanden sich 134 Personen, die angaben, in der Pflege zu arbeiten. Anhand des Matchings von 1:3 wurde ein Datensatz von 536 Personen erzeugt. Insgesamt konnte für 19 % der Stichprobe eine exzessive Tagesschläfrigkeit beobachtet werden, davon betroffen waren 25 % der Pflegenden und 17 % der Beschäftigten anderer Branchen. Weibliche Beschäftigte in der Pflege hatten im Vergleich zu Männern aus anderen Branchen ein statistisch signifikant erhöhtes Risiko für exzessive Tagesschläfrigkeit (OR 3,5; 95 % KI 1,32–9,23).

Diskussion

Anhand der Ergebnisse der bevölkerungsbezogenen Untersuchung zeigt sich, dass Pflegepersonal im Vergleich zu Branchen ohne Schichtarbeit öfter von Tagesschläfrigkeit betroffen ist. Inwieweit Frauen, die in der Pflege arbeiten ein noch höheres Risiko für Tagesschläfrigkeit besitzen, sollte in weiteren Studien anhand zusätzlicher Merkmale präziser untersucht werden.

Adaptation and validation of the Chinese version of the Sleep Quality Questionnaire

STUDY OBJECTIVES

Sleep quality is essential to health. The current study aimed to adapt and validate the Sleep Quality Questionnaire (SQQ) into Chinese language.

METHODS

The Chinese version of the SQQ (SQQ-C) was created following the guidelines for cross-cultural adaptation. Compliant with the COSMIN methodology, baseline data (N = 13,325) examined three validity domains and internal consistency, including content validity using the content validity index (CVI) and the cognitive debriefing and focus group (relevance, comprehensiveness and comprehensibility), construct validity using structural validity and cross‑sectional measurement invariance, and criterion validity using concurrent/convergent validity. Follow-up data (N = 3410) gathered within a mean of 168 (167-207) h interval were used to additionally assess longitudinal measurement invariance and test-retest reliability using intraclass correlation coefficient (ICC).

RESULTS

Scale-level CVI/Average was equal to 0.922; Item-level CVIs ranged from 0.889 to 1.000 (excellent), except for item 2 (0.556-fair). A panel of local experts and local participants during cognitive debriefing and focus group stated that it had sufficient relevance and comprehensibility but a slight deficiency in comprehensiveness. Confirmatory factor analysis indicated a stable two-factor structure encompassing Daytime Sleepiness Subscale and Sleep Difficulty Subscale from baseline to follow-up data. The SQQ-C-9 (without item 2) outperformed the SQQ-C-10 (full form). The SQQ-C-9 provided evidence of measurement invariance (strict) across subgroups (cohorts, gender, and age) and across time. The SQQ-C was negatively correlated with the Chinese Nonrestorative Sleep Scale and the Chinese Sleep Condition Indicator. Cronbach's alpha (α), McDonald's Omega (ω), and ICC, respectively, ranged from 0.712 to 0.838, 0.723 to 0.840, and 0.738 to 0.764 for total scale and each subscale.

CONCLUSION

The SQQ-C exhibits adequate psychometric properties and a stable two-factor structure, and should enable valuable assessments of sleep quality in clinical and research settings.

Is cognitive behavioral therapy for insomnia (CBTi) efficacious for treating insomnia symptoms in shift workers? A systematic review and meta-analysis

Shift workers commonly report insomnia symptoms. Cognitive behavioral therapy for insomnia (CBTi) is the first line treatment for insomnia, however efficacy in shift workers is not well understood. This systematic review and meta-analysis evaluates existing trials of CBTi in shift working populations. A systematic literature search was conducted across seven electronic databases (n = 2120). Fifty-two full-text articles were reviewed and of these, nine studies (across ten publications with a total of 363 participants) were deemed suitable for inclusion. Heterogeneity was considerable between studies, with variability in study design, style and delivery of intervention, and follow-up times. Small sample sizes were common and attrition was high. Some studies modified aspects of CBTi for use in shift workers, while others were limited to psycho-education as part of larger intervention studies. Mean differences (MD) pre and post CBTi were modest for both the insomnia severity index (ISI; MD: -3.08, 95% CI: -4.39, -1.76) and the Pittsburgh sleep quality index (PSQI; MD: -2.38, 95% CI: -3.55, -1.21). Neither difference was of a magnitude considered to reflect a clinically significant improvement. Tailored approaches to CBTi are needed for shift workers to improve efficacy, ideally including co-production with workers to ensure interventions meet this population's needs.

A Scoping Review of Sleep Education and Training for Nurses

BACKGROUND

Shift work and resulting sleep impairment among nurses can increase their risk for poor health outcomes, occupational injuries, and errors due to sleep deficiencies. While sleep education and training for nurses has been recommended as part of a larger fatigue risk management system, little is known about training programs designed specifically for nurses.

OBJECTIVE

Investigate the literature for current sleep education or training programs specifically for shift working nurses, with intent to assess training content, delivery characteristics, and outcome measures.

DESIGN

A scoping review conducted October 2020 through September 2021.

METHODS

The bibliographic databases Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, PubMed, and NIOSHTIC-2 were searched using words such as "nurse," "sleep hygiene," "shift work," and "education". Studies were included if they: 1) were original research; 2) discussed sleep education, training, or sleep hygiene interventions; 3) included a study population of nurses engaging in shift work; 4) focused on sleep as a primary study measure; 5) were written in English language; and 6) were published in 2000 or later.

RESULTS

Search results included 17,237 articles. After duplicates were removed, 14,620 articles were screened. Nine articles were found to meet established criteria. All studies included sleep hygiene content in the training programs, with five studies adding psychological and/or behavior change motivation training to support change in nurse sleep habits. Three studies added specific training for nurses and for managers. Delivery modes included in-person training of various lengths and frequency, mobile phone application with daily engagement, an online self-guided presentation, and daily reading material coupled with audio training. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were the outcome measures most frequently used. Although studies demonstrated improved sleep measures, most were pilot studies testing feasibility.

CONCLUSION

Although there is a paucity of studies focused on sleep education and training for shift working nurses, we found the inclusion of sleep hygiene content was the only common characteristic of all nine studies. The variability in training content, delivery methods, and outcome measures suggests further research is needed on what constitutes effective sleep education and training for nurses.

Associations between the Timing and Nutritional Characteristics of Bedtime Meals and Sleep Quality for Nurses after a Rotating Night Shift: A Cross-Sectional Analysis

The purpose of this study was to investigate the associations of the timing and nutritional characteristics of bedtime meals with sleep quality in nurses after rotating night shifts. In total, 128 nurses from a university hospital in South Korea participated in this cross-sectional study. Data were collected on the first night of two or three consecutive routine night shifts. Participants recorded all food eaten before going to bed after work. An accelerometer was used to objectively measure sleep quality, and subjective sleep quality was assessed by self-report using the Korean version of the Verran and Snyder-Halpern Sleep Scale. The associations of timing and nutritional characteristics of bedtime meals with sleep quality after night shifts were analyzed using multivariate linear regression. A short time interval between meals and sleep was associated with longer objectively measured total sleep time (β = -0.37, p = 0.002), and the proportion of protein in meals was associated with better objectively measured sleep efficiency (β = 0.31, p = 0.007). The shorter the time interval, the better the subjective sleep quality (β = -0.23, p = 0.048), and high-calorie meals were positively associated with subjective sleep quality (β = 0.23, p = 0.043). Based on our findings, we encourage nurses to have protein-rich meals after night shifts and reduce the delay between meals and sleep. Although high-calorie meals were shown to have a positive effect on subjective sleep quality, it is necessary to confirm this effect through additional research.

Network structure of insomnia and depressive symptoms among shift workers in China

A bidirectional relationship between insomnia and depression has been observed. However, few studies have used network analysis to explore the interaction patterns in that association at the symptom level. This study aimed to estimate network structures of insomnia and depressive symptoms among shift workers, as well as to compare the differences in network properties between individuals without and with insomnia symptoms and/or at risk of depression. A total of 1883 shift workers were included in our study. Insomnia symptoms were evaluated by three items based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Scale. Network analyses were used for the statistical analysis. "Difficulty initiating sleep", "Hard to get started", and "Depressed mood" with higher expected influence (EI) values were identified as the most central symptoms within the insomnia-depressive networks among shift workers. The significant differences between individuals without and with insomnia symptoms and/or at risk of depression were observed in symptoms of "Difficulty initiating sleep" and "Hard to get started". "Depressed mood", "Difficulty initiating sleep", or "Hard to get started" were the most key symptoms that trigger and sustain the structure of insomnia and depressive symptom among shift workers. Hence, timely intervention for the above three symptoms in future research or clinical practice (e.g., cognitive behavioral therapy for insomnia) may be crucial in alleviating insomnia and depressive symptoms among shift workers.

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers: A longitudinal analysis with 8-year follow-up

Background

The association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working <35 h/week and working night shifts) and the extent to which these trajectories were predicted by employees' lifestyle and mental health.

Methods

Participants of this cohort study with a 8-year follow-up were 5,947 health care shift workers. We linked self-reports of health from three repeated surveys with objective pay-roll based data on working hours. Using group-based multi-trajectory analysis we identified concurrent trajectories for self-rated health and working hour patterns. We examined their associations with baseline lifestyle-related factors (smoking, at-risk alcohol use, obesity, and physical inactivity) and mental health (sleep problems and psychological distress) using multinomial regression analysis.

Results

Three combined trajectories of self-rated health and working <35 h/week and four combined trajectories of self-rated health and night work were identified. Unhealthy lifestyle and poor mental health were associated with trajectories of moderate and declining health. Sleep problems were linked with working <35 h/week. Younger age and good mental health were associated with a combined trajectory of good health and continued night shift work.

Conclusion

Trajectories of suboptimal and declining health are associated with trajectories of reducing working hours and leaving night work, and are more common in employees with unhealthy lifestyle, sleep problems, and psychological distress.

Night Work and Sustainable Working Life-A Prospective Trajectory Analysis of Swedish Twins

The aim was to investigate the changes in sustainable working life over 10-13 years of follow-up and the effect of baseline night work. Data from the Swedish national registers were used to define sustainable working life. Survey data in the 1998-2003 "SALT" with 34,680 twins or in the 2004-2006 "STAGE" with 19,637 twins were utilized to assess night work at baseline. Group-based trajectory and multinomial regression models were applied. The results of the SALT cohort yielded five trajectory solutions: stable sustainable working life (40%), stable lack of sustainable working life (25%), later decreasingly sustainable working life (15%), increasingly sustainable working life (14%), and early decreasingly sustainable working life (7%). In the STAGE cohort, four trajectories were detected: stable sustainable working life (83%), decreasingly sustainable working life (7%), stable lack of sustainable working life (5%), and increasing sustainable working life (5%). Night work was associated with the decreasing or increasing sustainable working life in the trajectory groups. To conclude, the largest parts of both cohorts followed trajectories of stable sustainable working lives. Night work was associated with both the trajectories of decreasing and increasing sustainable working lives.

Lower Serum Calcium Levels Associated with Disrupted Sleep and Rest–Activity Rhythm in Shift Workers

Vitamin D deficiency is prevalent in many developed countries, and several studies suggest that vitamin D plays an essential role in brain function. A recent study showed that vitamin D deficiency was closely associated with daytime sleepiness and shorter sleep time. The relationshipbetween vitamin D levels and calcium levels is well established, and calcium level regulates slow-wave sleep generation. It is conceivable that the sleep disturbance in vitamin D deficiency may be due to an altered calcium level. Nonetheless, calcium levels, sleep disturbances, and activity rhythms have not been investigated directly. Therefore, we hypothesized that calcium and vitamin D levels might be important in regulating sleep and activity rhythm, and we analyzed the correlation with calcium levels by actigraphy analysis. Interestingly, a negative correlation was found between calcium level and sleep latency, total sleep time, use of sleep medicine, and daytime dysfunction among shift workers. In contrast, non-shift workers showed a negative correlation between the calcium level and the circadian phase. These findings suggest that low serum calcium levels may disrupt sleep–wake control and rest–activity rhythm, even if they are within the normal range.

Shift-work sleep disorder among health care workers at public hospitals, the case of Sidama national regional state, Ethiopia: A multicenter cross-sectional study

Introduction

Shift-work disrupts circadian rhythm, resulting in disturbed sleep time and excessive sleepiness during the work shift. Little is known about shift-work sleep disorder among health care workers in Ethiopia. This study examined the magnitude and associated factors of shift-work sleep disorder among health care workers in Public Hospitals in Sidama National Regional State, Southern Ethiopia.

Methods

An institution-based cross-sectional study was carried out on 398 health care workers selected using a systematic random sampling technique. A self-administered structured questionnaire consisting of insomnia, sleepiness scales and international classification of sleep disorder criteria items was employed. Epi data version 4.6 and Stata 14 were used for data entry and statistical analysis respectively. Binary logistic regression was fitted to determine associated factors and decision for the statistical significance was made at p<0.05 in the multivariable binary logistic regression.

Results

Three hundred and ninety-eight health care workers (female = 53%) were included in the analysis with a response rate of 94.8%. The prevalence of shift-work sleep disorder was 33.67% (95% CI: 29.17%-38.45%). Being married (AOR = 1.88 (1.01–3.28)), three-shift (AOR = 1.078 (1.00–3.16)), ≥11 night shifts per month (AOR = 2.44 (1.36–4.38)), missing nap (AOR = 1.85 (1.04–3.30)), daily sleep time < 7hours (AOR = 1.88 (1.05–3.38)), khat chewing (AOR = 2.98 (1.27–8.09)), alcohol drinking (AOR = 2.6(1.45–4.92)), and cigarette smoking (AOR = 3.32 (1.35–8.14)) were significantly associated with shift-work sleep disorder.

Conclusion

This study showed a high prevalence of shift-work sleep disorder. Two shift schedule, napping, and reduction of substance use might reduce shift-work sleep disorder.

Sleep of Healthcare Workers During the COVID-19 Pandemic and the Role of Atypical Work Schedules: A Scoping Review

The COVID-19 pandemic has negatively impacted the well-being of healthcare workers (HCWs). HCWs are highly exposed to shift work and their work schedules have been subject to increasing unpredictability since the start of the pandemic. This review aims to: (1) map the studies providing information about factors associated with sleep characteristics in HCWs working in the context of the COVID-19 pandemic during the first and second waves and (2) examine the state of the evidence base in terms of the availability of information on the influence of atypical work schedules. A literature search was performed in PubMed. Studies containing information about factors (demographic; psychological; occupational; COVID-19-specific; work schedule; lifestyle; medical; or other) associated with various sleep characteristics among HCWs working in the context of the COVID-19 pandemic were included. Particular attention was paid to the availability of information on the role of atypical work schedules on HCW sleep. Fifty-seven articles met the inclusion criteria. Most studies were reports of quantitative cross-sectional surveys using self-report measures. Associations between female sex, frontline HCW status, psychological factors, and poorer sleep were observed. Six studies included a measure of shift work in their analyses, 5 of which reported an association between shift work status and sleep. A wide range of factors were investigated, with female sex, frontline HCW status, and psychological factors repeatedly demonstrating associations with poorer sleep. Sleep was predominantly measured in terms of self-reported sleep quality or insomnia symptoms. Few studies investigated the influence of atypical work schedules on HCW sleep in the context of the COVID-19 pandemic. Research on this topic is lacking in terms of reliable and consistent measurements of sleep outcomes, longitudinal data, and knowledge about the influence of covariates such atypical work schedules, comorbidity, and medical history on HCW sleep.

Characteristics of Sleep Paralysis and Its Association with Anxiety Symptoms, Perceived Stress, PTSD, and Other Variables Related to Lifestyle in Selected High Stress Exposed Professions

Sleep paralysis (SP) is a hypnagogic or hypnopompic state associated with the inability to move while conscious. Recurrent isolated sleep paralysis (RISP) is a type of REM parasomnia. Individuals experiencing anxiety disorders, PTSD, exposure to chronic stress, or shift work are at risk of developing this sleep disorder. This study aimed to assess: (1) the prevalence, frequency, and symptomatology of SP, and (2) the impact of the severity of anxiety symptoms, perceived stress, and lifestyle mode variables on the frequency and severity of SP in four professional groups at high risk of SP (n = 844): nurses and midwives (n = 172), policemen (n = 174), teachers (n = 107), and a group of mixed professions—“other professions” (n = 391). The study used a battery of online questionnaires: the Sociodemographic and Health Status Questionnaire, the SP-EPQ, the PCL -5, the STAI-T, the PSWQ and the PSS-10. The prevalence of SP was the lowest among policemen (15.5%) and the highest in the group of “other professions” (39.4%). The association of SP with symptoms of PTSD and anxiety was confirmed in the group of nurses and “other professions”. Among other factors modulating the incidence and severity of SP were: age, BMI, smoking, alcohol consumption, sleep duration, and perceived stress. This study indicates that there exist links between SP and psychological and lifestyle factors, suggesting a complex etiology for this sleep disorder. Due to the high prevalence of SP in the studied groups of occupations, further research is necessary to develop preventive and therapeutic methods for SP.

Prediction of suicidal ideation in shift workers compared to non-shift workers using machine learning techniques

BACKGROUND

Shift work can affect sleep and increase the risk of suicide. This study attempted to predict suicidal ideation according to shift work by using machine learning techniques.

METHODS

We analyzed a total of 43,095 data conducted by using the 10-year Korean National Health and Nutrition Examination Survey (KHANES). Shift workers and daytime workers were categorized and analyzed using random forest (RF) and decision tree (DT) techniques of machine learning techniques.

RESULTS

Shift workers were more than twice as likely to have suicidal ideation as daytime workers. The RF model showed an accuracy of 91.6% for shift workers and 98% for daytime workers. In the DT technique, the rate of suicidal ideation was the highest among shift workers (82.7%) when they were depressed and had an EuroQol-5 Dimension (EQ-5D) score of less than 0.71.

LIMITATIONS

Shift work type was evaluated questionnaire and based on screening data, it was not possible to reflect recent changes in the work type and we evaluated for only suicidal ideation for suicide risk factors.

CONCLUSION

The variables influencing the suicide risk of shift workers and daytime workers differ. In the case of shift workers, negative factors such as depression and low quality of life are risk factors for suicide. Efforts are needed to reduce risk factors through administrative and policy interventions to manage workers' health by early screening.

Determinants of Sleep Disorders and Occupational Burnout among Nurses: A Cross-Sectional Study

Background: The aim of the study was to assess the determinants of the sleep disorders that occur among nurses working in a shift system by assessing the influence of sociodemographic factors, the impact of shift work, and the occurrence of occupational burnout. Methods: The study included 300 nurses who work shifts in the Silesian Region (Poland). The research was conducted using standardized research tools: the Karolinska Sleepiness Scale (KSS), the Epworth Sleepiness Scale (ESS), the Athens Insomnia Scale (AIS), and the Maslach Burnout Inventory (MBI). Results: Among the sociodemographic factors, in the KSS analysis, sleep disorders were most common in men (CI: 0.038; p < 0.001), in divorced individuals (CI: 1.436; p = 0.045), and in individuals who were overweight (CI: 1.927; p = 0.026). Multiple linear regression showed that sleep disorders (p < 0.001) were an independent predictor of MBI among nurses who worked shifts. Conclusions: Sleep disturbances affect the burnout of nurses who work shifts.

COVID-19 epidemic effects on sleep quality among health sector workers: A follow up study

Health care workers (HCWs) were vulnerable to sleep disturbances in normal circumstances. Poor sleep quality (PSQ) is common during the coronavirus disease 2019 (COVID-19) epidemic. The aim of this study is evaluation of sleep quality among healthcare workers during COVID-19 epidemic in a cohort study. In a follow-up study, we assessed sleep quality in 453 Iranian HCW participants in late-April 2021, after approximately 8 weeks of the epidemic of COVID-19. In order to compare the sleep quality in the two time intervals, during and before COVID-19, we used the recorded data of the same group of participants who were enrolled in a study named SHAHWAR (SHAhroud Health care Workers Associated Research) cohort that is focused on the health of HCWs who work at the Shahroud university of medical sciences. Data collection process in the SHAHWAR study started on October 2, 2019 and continued until February 19, 2020. Our results showed sleep quality worsened among shift-workers during COVID-19 outbreak; however, it was improved among non-shift staff. Sleep quality was more likely to be worsening if HCWs had shift-working roles [OR: 1.84(1.11-3.06), and if they experienced death in their families [OR: 5.06(1.60-12.80)]; however, having a paramedical role was a protective effect [OR: 0.52(0.27-092)], for poor quality sleep. Sleep quality worsened during the epidemic among HCWs. A greater impact, in terms of higher PSQI index, in this group of workers was seen in shift working staff.

Association between insomnia and subclinical atherosclerosis among Chinese steelworkers: a cross-sectional survey

Background

Insomnia is a common prevalent sleep disorder. Difficulty maintaining sleep or poor in quality in insomnia caused by disrupted or misaligned circadian rhythms may play an important role in the development of atherosclerosis. This study aimed to examine the association between insomnia and subclinical atherosclerosis in Chinese steelworkers.

Methods

A total of 3240 subjects from a large enterprise located in northern China were included in this study. The Athens Insomnia Scale (AIS) was used to assess the status of insomnia. Subclinical atherosclerosis was evaluated using ultrasonographic measurements of carotid plaque. Multivariable logistic regression was used to identify association between insomnia and carotid atherosclerosis.

Results

The overall prevalence of insomnia and carotid plaque were 35.3 and 31.7% in the study population. Compared with non-insomnia workers, significantly increased odds of carotid plaque were observed among insomnia workers after adjusting for potential confounders, odds ratio (OR) = 1.38, 95% confidence interval (CI): 1.17 to 1.63. Exposure to current shift work and insomnia simultaneously can significantly elevated the odds of carotid plaque.

Conclusion

Insomnia is associated with elevated odds of carotid atherosclerosis in male steelworkers. Insomnia problems of workers should receive further attention in occupational worker health interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00834-1.

Sleep Disturbances During Shift Work

Around 21% of workers reported working on shifts in 2017, and consequently, shift workers experience multiple sleep disturbances such as excessive sleepiness, insomnia, sleep deprivation, and social jet lag. These eventually lead to shift work disorder or exacerbation of other sleep disorders such as insomnia, obstructive sleep apnea, restless legs syndrome, and nonrapid eye movement parasomnia. Despite multiple interventions and guidelines, poor compliance to treatment is often encountered due to temporary relief of sleep disturbances provided by the treatment. Hence there is a need for comprehensive evaluation of those individuals who need to be awake during the night and asleep during the day.

Digging for data: How sleep is losing out to roster design, sleep disorders, and lifestyle factors

Shift workers employed at a remote mining operation may experience sleep loss, impaired alertness, and consequently negative health and safety outcomes. This study determined the sleep behaviors and prevalence of risk for sleep disorders among shift workers; and quantified alertness for a roster cycle. Sleep duration was significantly less following; night shift by 77 ± 7 min and day shift by 30 ± 7 min. The wake after sleep onset was less by 23 ± 3 min for night shifts and 22 ± 3 min for day shifts (p < 0.05 for all). The prevalence of risk for sleep apnea was 31%, insomnia was 8%, and shiftwork disorder was 44%. Average alertness for all working hours was 75%. Shiftwork in remote mining operations is a significant factor that leads to sleep loss and reduced alertness, which is exacerbated by the high prevalence of risk for sleep disorders.

The Association Between Morningness-Eveningness Preference, Depression, Anxiety and Insomnia Among Chinese Textile Workers With or Without Shift Work

OBJECTIVE

Circadian preference and mental health disorders are closely related to insomnia. This study aimed to evaluate insomnia symptoms in textile factory workers with different work schedules, and to investigate the association between insomnia, morningness-eveningness preference, anxiety, and depression.

METHODS

A total of 3,883 textile workers were assessed using the 3-items of Pittsburg Sleep Quality Index, Composite Scale of Morningness, Beck Anxiety Inventory, Center for Epidemiologic Studies-Depression Scale, and socio-demographic questionnaires.

RESULTS

The prevalence rate of insomnia in textile workers was 16.7% (N = 646), with 49.8% (N = 322) were shift workers. Among shift workers (N = 1,833), 9.5% had difficulty initiating sleep, and almost 9.0% suffered from early morning awakening, a rate significantly higher than among daytime workers. Logistics regressions revealed that work schedule was insignificantly associated with insomnia. Depression (OR = 1.034, 95% CI = 1.022-1.046) and anxiety (OR = 1.031, 95% CI = 1.018-1.043) positively predicted insomnia, whereas morningness preference (OR = 0.977, 95% CI = 0.960-0.995) decreased the likelihood of insomnia. Furthermore, mediation analysis showed that both anxiety and depression independently mediated the association between circadian preferences and insomnia in textile workers with or without shift work.

CONCLUSION

This study highlighted the insomnia, depression, and anxiety of textile factory workers in a Chinese textile factory. To improve insomnia symptoms, interventions to promote morningness circadian preference and reduce depressive and anxious symptoms among workers are encouraged.

Potential effects of shift work on skin autoimmune diseases

Shift work is associated with systemic chronic inflammation, impaired host and tumor defense and dysregulated immune responses to harmless antigens such as allergens or auto-antigens. Thus, shift workers are at higher risk to develop a systemic autoimmune disease and circadian disruption with sleep impairment seem to be the key underlying mechanisms. Presumably, disturbances of the sleep-wake cycle also drive skin-specific autoimmune diseases, but epidemiological and experimental evidence so far is scarce. This review summarizes the effects of shift work, circadian misalignment, poor sleep, and the effect of potential hormonal mediators such as stress mediators or melatonin on skin barrier functions and on innate and adaptive skin immunity. Human studies as well as animal models were considered. We will also address advantages and potential pitfalls in animal models of shift work, and possible confounders that could drive skin autoimmune diseases in shift workers such as adverse lifestyle habits and psychosocial influences. Finally, we will outline feasible countermeasures that may reduce the risk of systemic and skin autoimmunity in shift workers, as well as treatment options and highlight outstanding questions that should be addressed in future studies.

Importance of testing the internal consistency and construct validity of the Pittsburgh Sleep Quality Index (PSQI) in study groups of day and night shift workers: Example of a sample of long-haul truck drivers in South Africa

Irregular work times promote inconsistent completion of the Pittsburgh Sleep Quality Index (PSQI) among shift workers. We aimed to demonstrate the importance of testing the internal consistency and construct validity of the PSQI and of the Epworth Sleepiness Scale (ESS) by presenting the methodology in a sample of long-haul truckers in South Africa. Internal consistency of the questionnaires was assessed by Cronbach's alpha (defined as raw alpha≥0.70), and construct validity by factor analysis. 302 participants (49.3%) reported at least one night shift/week. Overall, the PSQI and ESS's alpha were 0.42 and 0.85, respectively. The factors explained 19.6% of 57.0% of the variance. The PSQI's alpha was 0.46 in night shift workers and 0.38 in non-night shift workers. In this occupational group, the PSQI must be used with caution. Testing the internal consistency and construct validity among the assessed population seems necessary. Sleep questionnaires adapted to shift workers should be preferred.

The effectiveness of an individualized sleep and shift work education and coaching program to manage shift work disorder in nurses: a randomized controlled trial

STUDY OBJECTIVES

While insomnia and sleepiness symptoms are common in shift workers, 20-30% experience more severe symptoms and meet the criteria for shift work disorder (SWD). SWD can lead to impairments in cognitive function, physical and mental health, and reduced productivity and increased risk of workplace injury. The aim of this study was to deliver and evaluate a shift work individual management coaching program, focusing on sleep education, promoting good sleep hygiene, and providing individualized behavioral strategies to cope with shift schedules.

METHODS

A clustered randomized controlled trial of sleep education and sleep disorders screening was undertaken, based on hospital wards at a tertiary hospital in Melbourne, Australia. Participants identified as high risk for SWD underwent one of two 8-week programs; a shift work individualized management program (S.W.I.M.) or an active control. The primary outcome was ward-based sick leave. Secondary outcomes were SWD risk, sleep hygiene, insomnia, depression, and anxiety. A total of 149 nurses, across 16 wards (96% female, 34.66 ± 11.99 years) completed both baseline and follow-up questionnaires (23.9% were high risk SWD).

RESULTS

There was no significant reduction in sick leave between intervention and control wards (mean difference=1.2 days, p=.063). Improvements were seen in insomnia (p<.0001*), and depression (intervention, p=<.0001*, control, p=.023) in both groups, but were not significantly different between programs. Anxiety (p=.001. control p=.079) and FOSQ (p=.001 control p=.056) improved only for the intervention.

CONCLUSIONS

This SWD intervention trial did not reduce sick leave compared to the active control but there was an improvement. Improvements in sleep hygiene, insomnia, depression, and anxiety severity were seen for both groups. Future intervention trials should consider including both sleep and mental health interventions, strategies to avoid between group contamination and the duration of programs for optimal behavioral modification.

CLINICAL TRIAL REGISTRATION

Registry: Australian New Zealand Clinical Trials Registry; Identifier: ACTRN12616000369426.

Night-shift work, breast cancer incidence, and all-cause mortality: an updated meta-analysis of prospective cohort studies

OBJECTIVES

Night-shift work exposure is proposed to link to a wide range of health issues, especially cancer incidence, cancer-specific death, and all-cause death. However, the epidemiological associations among night-shift work exposure, breast cancer, breast cancer-specific death, and all-cause mortality remain inconclusive.

METHODS

We performed an updated systematic review and meta-analysis to confirm potential associations among night-shift work exposure, breast cancer, and all-cause mortality.

RESULTS

A total of 31 prospective cohort studies, involving 9.3 million participants, 31,244 incident breast cancer cases, 12,728 cancer-related deaths, 7882 cardiovascular deaths, and 30,807 all-cause mortalities were included. Overall, the summary RR of incident breast cancer in females for an increase of night-shift work was 1.029 (95% CI 1.003-1.055). Compared with standard day workers, night-shift workers had a statistically significantly increased RR (1.086, 95% CI 1.032-1.142) for breast cancer incidence in the subgroup of > 10 years exposure. Furthermore, a positive association was revealed in subgroup studies of rotating night-shift work (RR = 1.053, 95% CI 1.018-1.090). A significant increased risk of cardiovascular mortality was demonstrated in the night-shift work group (RR = 1.031; 95% CI 1.006-1.057).

CONCLUSION

Our systematic review and meta-analysis provided convincing evidence supporting positive associations among night-shift work exposure, breast cancer incidence, and cardiovascular mortality. Taken together, night-shift work exposure significantly increased the risk of breast cancer morbidity by 2.9% for total, 8.6% for the subgroup of more than 10 years night-shift work, and 5.3% for rotating night-shift work. In addition, night-shift work increased the risk of cardiovascular mortality by 3.1%.

Different reflections of the face mask: sleepiness, headache and psychological symptoms

Objectives. The COVID-19 pandemic has had significant physical and mental effects on healthcare workers. This study aims to evaluate the relationship between wearing face masks and headache, sleepiness, mood and anxiety symptoms in healthcare workers. Methods. A survey was administered to 365 healthcare workers working during the pandemic. The Beck depression inventory, the Beck anxiety inventory and the Epworth sleepiness scale were used to assess depressive symptoms, anxiety symptoms and daytime sleepiness, respectively. Participants were also asked about new-onset headaches. Results. Almost half of the participants (47.6%) reported new-onset headaches, and 23.2% reported excessive daytime sleepiness. The frequencies of depressive and anxiety symptoms were 43.7 and 59.2%, respectively. Sleepiness scores and new-onset headache frequency were higher in women and those using filtering facepiece respirators. A statistically significant positive correlation was found between mask-wearing duration, depressive and anxiety symptom scores, and sleepiness score. Conclusions. The present study has shown that many healthcare workers wearing face masks suffered from sleepiness, headaches and psychological symptoms during the COVID-19 pandemic. These findings indicate the importance of improving working conditions and planning psychological interventions for healthcare workers.

Personality Traits and Insomnia Symptoms in Shift Workers

The discrepancy between natural sleep-wake rhythm and actual sleep times in shift workers can cause sleep loss and negative daytime consequences. Irregular shift schedules do not follow a fixed structure and change frequently, which makes them particularly harmful and makes affected individuals more susceptible to insomnia. The present study compares insomnia symptoms of non-shift workers, regular shift workers, and irregular shift workers and takes into account the moderating role of the Big Five personality traits and levels of perfectionism. Employees of an Austrian railway company completed an online survey assessing shift schedules, sleep quality and duration, daytime sleepiness, and personality traits. A total of 305 participants, of whom 111 were non-shift workers, 60 regular shift workers, and 134 irregular shift workers, made up the final sample. Irregular shift workers achieved significantly worse scores than one or both of the other groups in time in bed, total sleep time, sleep efficiency, sleep duration, sleep quality, sleep latency, and the number of awakenings. However, the values of the irregular shifts workers are still in the average range and do not indicate clinical insomnia. Participants working regular shifts reported the best sleep quality and longest sleep duration and showed the least nocturnal awakenings, possibly due to higher conscientiousness- and lower neuroticism scores in this group. Agreeableness increased the effect of work schedule on total sleep time while decreasing its effect on the amount of sleep medication taken. Perfectionism increased the effect of work schedule on time in bed and total sleep time. Generalization of results is limited due to the high percentage of males in the sample and using self-report measures only.

Poor Sleep Quality in Nurses Working or Having Worked Night Shifts: A Cross-Sectional Study

Night shifts are part of clinical care. It is unclear whether poor sleep quality of nurses working both consecutive night shifts and day shifts after quitting night shifts is common. In this cross-sectional study, Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality as study outcome. Univariable and multivariable linear and logistic regressions were performed to compare PSQI score and prevalence of poor sleep quality between 512 nurses currently working consecutive night shifts and 174 nurses having worked night shifts in the past. The prevalence of poor sleep quality was 62.11% in nurses working consecutive night shifts and 55.75% in nurses having worked night shifts before. In multivariable regressions with adjustment for potential confounders, compared with nurses working consecutive night shifts, nurses having worked past night shifts reported decreased PSQI score [mean difference: −0.82 (95% CI: −1.27 to −0.38, p < 0.001)] and lower poor sleep quality [odds ratio (OR): 0.49 (95% CI: 0.29 to 0.80, p = 0.005)]. In nurses working consecutive night shifts, a rising curve that plateaued at the end was observed between years of consecutive night shifts and PSQI score, p = 0.004. To explore the change in PSQI score after quitting night shift, we constructed a hypothetical prospective cohort from the cross-sectional data. Here, 98 pairs of nurses with consecutive and past night shifts were matched for the number of night shift years, religion, marital status, living condition, hypertension, and hyperlipidemia. In each pair, a hypothetical change in PSQI score was calculated between the two types of nurses and hypothetical years after quitting night shifts was obtained from the matched nurse with past night shifts. A U-shaped curve between change in PSQI and years after quitting night shifts was observed, p = 0.007. The rising curve and U-shaped curve together formed an S-shaped curve, which mapped the change in sleep quality. These results based on the hypothetical cohort constructed from cross-sectional data suggested the presence of persistent poor sleep quality in night shift nurses. Also, we support early and continuous sleep hygiene education and reflection for an optimal strategy for when to cease working night shifts with regard to sleep-related problems.

The cognitive impact of guard shifts in physicians: a before-after study

OBJECTIVE

We intend to evaluate the change of different cognitive functions after a guard shift in physicians.

METHODS

A descriptive observational study was performed. The study population included Spanish physicians who were asked to complete before and immediately after their guard shift the following tests: Digit Span, TMT-A, TMT-B, Symbol Digit, Stroop, Free and Cued Selective Reminding, creep and formal fluency, Visual Orientation and Space Perception tests, and the Leeds Sleep Questionnaire.

RESULTS

Thirty subjects were included in the study among which 43.3% were female. The mean subjective impression of the guard shift was 4.47/10 (2.57) and was correlated with the number of sleep hours during the guard shift (r = 0.72, p < 0.001). Statistically significant differences in the comparison between pre- and post-guard period results were found for the Symbol Digit test (88.27 vs. 81.47, p = 0.005), Digit Span test (7.43 vs. 7.00, p = 0.025), Free and Cued Selective Reminding Test (22.73 vs. 21.20, p = 0.002), categorical fluency (39.03 vs. 34.53, p = 0.008), and phonemic fluency (19.57 vs. 16.13, p = 0.001).

CONCLUSIONS

The realization of guard shift was associated with a lower yield in several cognitive functions, especially in tasks related to executive function and attention.

Impact of shift work on the risk of depression

We studied the association between shift work and depressive symptoms in the prospective Heinz Nixdorf Recall Study, considering various demographic, lifestyle and work-related factors. Depressive symptoms were assessed using the Center for Epidemiologic Studies-Depression (CES-D)-Scale (≥17 points defined as high symptoms) and the Patient Health Questionnaire (PHQ) with a cutoff ≥9, or prescription of an anti-depressant. The definition of shift work included work hours outside 7:00 to 18:00, whereas night work was defined as a shift including work between 0:00 and 5:00. Poisson regression with robust error variances was calculated to estimate relative risks (RR) and 95% confidence intervals (CI), adjusted for age at follow-up, diurnal preference, monthly household income and education. Analyses were stratified by sex. We performed various sensitivity and stratified analyses to test the robustness of our results. At baseline, 1,500 gainfully employed subjects, 45-73 years of age and without a history of depression, were included. Until the 5-year follow-up, 896 participants were observed, and 486 participants survived through the 10-year follow-up. Although most analyses did not reach the level of formal statistical significance, women working night shifts tended to show increased relative risks for depressive symptoms according to the PHQ (RR = 1.78; 95% CI 0.71-4.45), in particular when working night shifts for ≥20 years (RR = 2.70; 95% CI 0.48-15.4). Stratification by age group revealed no increased risks among women above 60 years of age. Stratified analyses indicated that over-commitment was associated with higher risks for depressive symptoms among women (RR = 4.59; 95% CI 0.95-22.2 in the CES-D and RR = 12.7; 95% CI 2.89-56.1 in the PHQ). Exclusion of subgroups for the purpose of sensitivity analyses generally strengthened associations in women, whereas little evidence for an increased risk of depression remained among male shift workers. In summary, negative effects on depression were suggested among female shift workers, although results were based on small numbers. Among men, we did not identify consistently increased risks for depressive symptoms in relation to shift work.

Paid Sick Leave and Sleep: An Analysis of US Adult Workers

OBJECTIVE

This study examines links between paid sick leave benefits and sleep as an indicator of well-being.

METHODS

Using data from 12,780 employed adult US workers in the 2018 National Health Interview Survey, the relationship between paid sick leave and sleep was explored while controlling for demographic and health status variables.

RESULTS

Logistic multiple regression analyses revealed that compared with workers without paid sick leave, workers with paid sick leave had significantly higher odds of staying asleep, lower odds of feeling rested, and marginally significantly higher odds of having little trouble falling asleep. The groups did not differ regarding the odds of taking sleep medication or getting the ideal amount of sleep.

CONCLUSION

The findings suggest a link between sleep quality and access to paid sick leave, adding to a growing list of health and well-being variables associated with paid sick leave benefits.

Physical activity and sleep: An updated umbrella review of the 2018 Physical Activity Guidelines Advisory Committee report

Physical activity (PA) is widely considered to improve sleep, but a comprehensive review of the research on this topic has not been performed. In this umbrella review, conducted initially for the 2018 Physical Activity Guidelines for Americans Advisory Committee and updated to reflect more recent research, we examined whether PA enhances sleep outcomes across the lifespan as well as among individuals with sleep disorders. Systematic reviews and meta-analyses were utilized to assess the evidence. We also examined dose-response considerations and whether the association between PA and sleep was moderated by various factors (e.g., timing, sociodemographic characteristics). We found strong evidence that both acute bouts of PA and regular PA improved sleep outcomes. Moderate evidence indicated that longer bouts of PA (both acute and regular) improved sleep, and that the effects of PA on sleep outcomes were generally preserved across adult age groups and sex. Finally, moderate evidence demonstrated that PA improved sleep in adults with insomnia symptoms or obstructive sleep apnea. Several important areas in need of future research were also identified. Overall, the review supported the claim that PA improves sleep, but highlighted gaps that need to be addressed to facilitate more widespread utilization of PA for improving sleep.