The Effect of Shift Work on the Prevalence and Clinical Impact of Functional Bowel Disorders in Nurses

Abstract

Purpose: The gastrointestinal (GI) tract undergoes circadian fluctuations in a variety of physiologic parameters. There is evidence that disruption of the sleep cycle can impact upon normal gastrointestinal functions. The aim of this study was to determine the effect of shift work on the prevalence and clinical impact of functional gastrointestinal disorders (IBS, functional constipation and diarrhea) in nurses. Methods: Nurses engaged in direct patient care who were employed at a large University Health System within the U.S. were invited to anonymously complete a set of online validated surveys (Rome 3, IBS-QOL, modified sleep 50 questionnaire). Based upon their work schedules, respondents were classified as: permanent day-shift workers, permanent night-shift workers and those rotating between day and night shifts. Participants with self-reported organic GI diseases, previous major GI surgery, or who were pregnant were excluded. Results: Complete data were available for 399 nurses (214 day shift, 110 night shift, and 75 rotating shifts). The main study results can be found in the table. More than 85% of respondents were female. Night shift and rotating nurses were younger than day shift nurses (P < 0.0001). There were no significant differences in BMI between groups. Rotating shift nurses had a significantly higher prevalence of IBS compared to day shift nurses (P= 0.009). Multivariable logistic regression correcting for age & gender (OR = 2.0, 1.12–3.45) as well as sleep quality (OR = 2.14, 1.14–4.03) proved this association to be robust. The prevalence of IBS subtypes (IBS-C, IBS-D, IBS-M) was similar between groups with the exception of IBS-D which was more common in night vs. day shifts nurses (11.3% vs. 5.2%, P= 0.03). There were no significant between group differences in the mean total IBS-QOL scores. The prevalence of functional constipation and diarrhea was similar between the groups. Conclusion: When evaluating patients with IBS, it may be important to consider work schedule. These results support the hypothesis that circadian rhythm and sleep disturbances may play a role in GI symptoms & IBS.Table