Abstract
ObjectiveWe aimed to study fatigue and sleep in registrars working 12-hour rotating shifts in our tertiary neonatal intensive unit.Methods and participantsThis study involved neonatal registrar’s working day (08:00–21:00) and night (20:30–08:30) shifts. Participants maintained a sleep diary, answered a self-reported sleepiness questionnaire assessing subjective sleepiness, and performed a 10-minute psychomotor vigilance task (PVT) at the start and end of each shift. Primary outcomes: (1) Fatigue at the (i) “start vs end” of day and night shifts, (ii) end of the “day vs night” shifts, and (iii) end of “first vs last shift” in block of day and night shifts. (2) Duration and quality of sleep before the “day vs night” shifts. Mean reaction time (RTM), relative coefficient of variation (RTCV), and lapses (reaction time > 500ms) were used as measures of fatigue on PVT. Secondary outcome: Subjective sleepiness (self-reported sleepiness questionnaire) at the ‘start vs end” of day and night shifts.ResultsFifteen registrars completed the study. Acuity was comparable for all shifts. (1) Psychomotor responses were impaired at the end vs start of day shifts [RTM (p = 0.014), lapses (p = 0.001)], end vs start of night shifts [RTM (p = 0.007), RTCV (p = 0.003), lapses (p<0.001)] and end of night vs day shifts [RTM (p = 0.007), RTCV (p = 0.046), lapses (p = 0.001)]. Only lapses were significantly increased at the end of the last (p = 0.013) vs first shift (p = 0.009) in a block of day and night shifts. (2) Duration of sleep before the night (p = 0.019) and consecutive night shifts was decreased significantly (p = 0.034). Subjective sleepiness worsened after day (p = 0.014) and night shifts (p<0.001).ConclusionFatigue worsened after the 12-hour day and night shifts with a greater change after night shifts. Lapses increased after block of day and night shifts. Sleep was decreased before night shifts. Our findings need to be confirmed in larger studies.
Highlights
(1) Psychomotor responses were impaired at the end vs start of day shifts [reaction time (RTM) (p = 0.014), lapses (p = 0.001)], end vs start of night shifts [RTM (p = 0.007), relative coefficient of variation (RTCV) (p = 0.003), lapses (p
Lapses were significantly increased at the end of the last (p = 0.013) vs first shift (p = 0.009) in a block of day and night shifts
Lapses increased after block of day and night shifts
Summary
Shift work is common in the service industry [1,2,3], with nearly one-fourth of health employees working as shift workers in the United States [4]. Fatigue, increased sleepiness, sleep disturbances, and poor cognition are instant effects of shift work [15,16,17]. This can be explained by the circadian misalignment caused by shift work. The natural rhythm promotes arousal in the day and sleepiness in the night which is balanced by two principal forces, the homeostatic sleep pressure and circadian arousal signal [20]. Night shift workers are awake at night when the circadian arousal signal is at the lowest, and homeostatic sleep pressure is at its peak contributing to sleepiness. Health employees working night shifts are prone to make errors while treating patients [16, 25]. There is a higher risk of making errors in night vs day shift and 12-hour vs 8-hour shift [26]
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