Influence of rotating shifts and fixed night shifts on sleep quality of nurses of different ages: a systematic literature review and meta-analysis

The objective of this study was to understand the influence of rotating shifts and fixed night shifts on the sleep quality of nurses using a systematic literature review and meta-analysis and to determine whether the sleep quality of nurses working rotating shifts or fixed night shifts differs from that of nurses working fixed day shifts. We conducted a meta-analysis on literature that had used the Pittsburgh Sleep Quality Index (PSQI) to gauge sleep quality and had been published between 2000 and 2020 in the Cochrane Library, CINAHL, MEDLINE, and PubMed databases. This study was conducted in accordance with PRISMA, and the quality of the literature was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross Sectional Studies. CMA 3.0 was employed for data analysis, and meta-regression analysis was conducted to examine the differences between the PSQI scores of nurses working fixed day shifts and those working rotating shifts or fixed night shifts. Following assessment, a total of 29 papers (34 items of data) were analyzed. The papers included a total of 3,935 nurses who worked fixed day shifts, 3,777 nurses who worked rotating shifts, and 1,559 nurses who worked fixed night shifts. Our subgroup analysis indicated that the sleep quality of nurses working rotating shifts was poorer than the sleep quality of nurses working fixed day shifts; the standardized mean difference (SMD) was 0.38 (95% CI: 0.24-0.52, p< .001), and the meta-regression analysis found that the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts was significantly smaller than the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts (β = -0.368, p= .011). The sleep quality of nurses working fixed night shifts was also poorer than the sleep quality of nurses working fixed day shifts; the SMD was 0.58 (95% CI: 0.38-0.78, p< .001), and the meta-regression analysis revealed that the difference in sleep quality between nurses over 40 years old working fixed night shifts and those working fixed day shifts was not significantly different from the difference in sleep quality between nurses 40 years old or younger working fixed night shifts and those working fixed day shifts (β = -0.118, p= .608). This meta-analysis found that both nurses working rotating shifts and those working fixed night shifts had poorer sleep quality than those working fixed day shifts and that age influenced the difference in sleep quality only between nurses working rotating shifts and those working fixed day shifts; the difference in sleep quality between nurses 40 years old or younger working rotating shifts and those working fixed day shifts was greater than the difference in sleep quality between nurses over 40 years old working rotating shifts and those working fixed day shifts.

Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis

OBJECTIVES

Work-related musculoskeletal disorders (WMSDs) are common occupational injuries for nurses. Furthermore, rotating and irregular shift work may exacerbate muscle tension and pain in nurses. The objective of this study was to examine the differences between fixed day shift (FDS) nurses and rotating and irregular shift (RS + IS) nurses in WMSDs using a systematic literature review and meta-analysis.

METHODS

Databases including PubMed, CINAHL, Cochrane Library, EBSCOhost, and Google Scholar were searched for relevant studies published between 2010 and 2020 using the target keywords.

RESULTS

This study obtained data on a total of 18 199 nurses, among which 12 786 comprised the RS + IS group and 5413 constituted the FDS group. The result of the heterogeneity test was Q = 79.27 (P < .001) and I squared = 57.11%, indicating that heterogeneity existed among the studies. Subgroup analyses were also conducted with four groups: neck pain (n = 1818), shoulder and upper limb pain (n = 2525), back pain (n = 11 962), and hip and lower limb pain (n = 1894). Significant differences were found between the RS + IS group and the FDS group with regard to back pain, with the forest plot presenting an odds ratio equaling 1.40 (95% CI: 1.19-1.64, P < .001).

CONCLUSIONS

This meta-analysis indicated that RS + IS nurses are more likely to experience back pain associated with WMSD than are FDS nurses. The results can serve as a reference to the clinical management for work improvement and thereby reduce or prevent the adverse effects of rotating and irregular shift work on back pain experienced by nurses.

Morning and evening salivary melatonin, sleepiness and chronotype: A comparative study of nurses on fixed day and rotating night shifts

AIMS

To compare morning and evening salivary melatonin levels, sleep quality and chronotype between nurses working fixed day shifts and those working rotating night shifts.

BACKGROUND

Rotating night shift work is an inevitable part of nursing and is a major reason for disrupted sleep.

DESIGN

Cross-sectional comparative design.

PARTICIPANTS AND SETTINGS

We used cluster sampling to recruit 520 female nurses working fixed day and rotating night shifts in the United Arab Emirates.

METHODS

Morning and evening melatonin were measured from corresponding saliva samples. The Pittsburgh Sleep Quality Index used to evaluate sleep quality and self-assessment of preferred circadian times was used to assess participants' chronotypes. Data were collected between October 2017-December 2018.

RESULTS

Rotating night shift nurses had significantly lower evening melatonin compared with the fixed day shift group. No significant difference was found in sleep quality between the groups, although more participants in the rotating night shift group (N = 110, 42.31%) expressed better sleep quality than those in the fixed day group (N = 90, 36.00). Participants in the rotating night shift group expressed better subjective sleep, longer sleep duration, less disturbed sleep and better daily function (p > .05) than the fixed day group. Rotating night shift participants were more likely to have evening or intermediate chronotypes and more likely to report alignment of shift work to their chronotype compared with fixed day shift participants (p = .001). Longer shift duration, marital status and city location were associated with reduced evening melatonin among nurses on rotating night shifts.

CONCLUSION

Rotating night shift nurses showed evidence of better sleep than those from the fixed day shift. Proper shift assignment, chronotype and alignment with shift work appeared to produce better sleep quality.

IMPACT

Organizational policy must consider a novel model for work schedules that allow adequate off-duty days for sleep recovery among nurses.

Meta-Analysis Comparing Menstrual Regularity and Dysmenorrhea of Women Working Rotating Shifts and Fixed Day Shifts

Background: Rotating shift work can cause abnormalities in their endocrine system. We conducted a meta-analysis to gain a better understanding of the differences between women working rotating shifts and fixed day shifts in menstrual regularity and dysmenorrhea. Methods: We searched for studies containing relevant keywords that were published between 1990 and 2019 in the Cochrane Library, EBSCO (including the Cumulative Index to Nursing and Allied Health Literature [CINAHL]), MEDLINE, and ProQuest. Data analysis was performed using the software package Comprehensive Meta-Analysis (CMA) Version 3.0. Results: A total of 14 studies met our selection criteria. The pooled odds ratio (OR) comparing the menstrual irregularity of women working rotating shifts and fixed day shifts was 1.35 (95% confidence interval [CI]: 1.28-1.42, p < 0.001). The pooled OR of the women aged 30 years or older was 1.35 (95% CI: 1.28-1.42, p < 0.001); and for the women under 30 years old, the pooled OR was 1.66 (95% CI: 1.13-2.44, p = 0.010). The pooled OR comparing the dysmenorrhea occurrence among women working rotating shifts and fixed day shifts was 1.51 (95% CI: 0.87-2.62, p = 0.139). The pooled OR of the women aged 30 years or older was 2.35 (95% CI: 1.63-3.39, p < 0.001); and for the women under 30 years old, the pooled OR was 1.20 (95% CI: 0.61-2.33, p = 0.601). Conclusions: The results indicate that regardless of age, women working rotating shifts were more likely to experience menstrual irregularity than those working fixed day shifts. With regard to dysmenorrhea, among women aged 30 years or older, those working rotating shifts were also more likely to experience dysmenorrhea than those working fixed day shifts.

BMI differences between different genders working fixed day shifts and rotating shifts: a literature review and meta-analysis

The objective of this study was to perform a systematic literature review and meta-analysis to understand the BMI differences between different genders working fixed day shifts and rotating shifts. The Pubmed, Medline, and Embase databases were searched using set keywords, thereby producing 42 studies. Study quality was assessed using appraisal criteria from the Joanna Briggs Institute (JBI), and meta-analysis was performed using Comprehensive Meta-Analysis Software (CMA) version 3. The indices were the means and standard deviations of BMI values from different genders working fixed day shifts and rotating shifts. The participants of the studies included a total of 43,193 individuals working rotating shifts and 185,875 individuals working fixed day shifts. The pooling effect size (SMD, standardized mean difference) presented was 0.19. The 95% confidence interval ranged from 0.10 to 0.281. The meta-regression analysis results showed that women had higher BMI values than men, the difference was statistically significant (p <.001). The heterogeneity test indicated statistically significant differences (p <.05), and the percentage of heterogeneity (I square) was 97.91%, which indicates that a high degree of heterogeneity exists among studies. A subgroup analysis by gender was conducted. For women, the pooling effect size was 0.25, and the 95% confidence interval ranged from 0.20 to 0.30. For men, the pooling effect size was 0.19, and the 95% confidence interval ranged from 0.05 to 0.33. This meta-analysis found that both women and men working rotating shifts have significantly higher BMI values than those working fixed day shifts. Finally, we divided the data into a cross-sectional group and a cohort group based on study design, and a meta-regression analysis conducted after controlling for age and nature of work variables revealed that in the cohort study, women presented higher BMI values than men, and the difference was statistically significant (p =.010). Thus, in terms of long-term effects, these results indicate that working rotating shifts exerts a greater impact on the BMI of women.