Night Shift Work Research Articles

Does daily energy and macronutrient intake differ between work and non-workdays in shift workers? A mixed methods study

ABSTRACT Shift workers are at increased risk of obesity and metabolic diseases, but their eating patterns on work and non-workdays are understudied. We aimed to examine whether energy intake and macronutrient intake of day and night shift nurses were different during work and non-workdays. We used a mixed-methods approach to study food intake of shift working nurses from two hospitals during day and night shifts. Participants completed baseline questionnaires about eating behaviour, sleep, chronotype, mood and shift work disorder. Participants then completed a 4-d food diary which included a non-workday prior to the first shift, the first and last shift (either day or night) and the following non-workday. After completion of the food diaries, we used semi-structured interviews to explore the qualitative aspects of eating behaviours. Seventy-nine shift-working nurses participated in the study. Daily energy intake was not significantly different on work and non-workdays in day or night shift workers (p > 0.05). Whilst macronutrient consumption was also not different between day and night shift workers (p > 0.05), sugar intake was higher in day compared to night shift workers (p = 0.02) on the non-workday prior to the first workday. In qualitative interviews, participants reported their eating to be different on day and night shifts as well as work and non-workdays. Eating behaviour in day and night shift workers was highly influenced by food availability, convenience, peers, and family members. Nurses qualitatively report that night and day shifts result in them eating differently despite no statistically discernible difference in energy intake.

Implications for nursing practice on the association between sleep and health outcomes

Between January and December of 2020, a prospective, cross-sectional, observational research was done with 264 nursing staff members, selected among 989 individuals at “Botucatu General Hospital” and stratified by professional type. Sleep quality (SQ) was measured using the Pittsburg Sleep Quality Index (PSQI), while sleep and health were measured using the WHOSAH. A conventional questionnaire was used to obtain expressed characteristics. Means and standard deviations for constant variables and percentages for categorical ones were provided. The correlation coefficient of Spearman's was used to analyze the strength of relationships. A statistical regression analysis, with age adjustment, was used to assess the link between night shift employment and gender in terms of sleep disruption. P 0,05 was considered significant. When considering age, the association between night shift work and a considerable decline in sleep quality for at least one measure remained substantial. Sleep problems were more common among women. A strong relationship existed between how well you slept and lived. There is a correlation between how well nurses sleep and how satisfied they are with their lives, both of which are influenced by the nature of the nursing profession

Assessment of sleep quality and its factors among clinicians working in critical care units and operation theaters at North West Ethiopia, 2022: a multicenter cross-sectional study.

The objective of this study was conducted for the purpose of assessing the quality of sleep and associated factors among clinicians working in the critical care unit and operation theater. A cross-sectional study was conducted from 15 May to 15 June 2022. Data were collected using a self-administered questionnaire from 421 clinicians selected by simple random sampling techniques. Sleep quality was measured by the Pittsburg sleep quality index. The data were entered into Epi-data and exported to SPSS. Frequency and percentage were used for the descriptive analysis. Binary and multivariate logistic regression analysis were used to identify factors associated with poor quality of sleep. The strength of the association was measured with an OR within the 95% CI and P-value of <0.05. About half 220 (52.3%) of the study participants age between 25 and 30 year old and the majority 321 (76.2%) of them were males. The prevalence of poor sleeps quality was 81.5% (95% CI: 77.9-85.5). Working night shift (AOR: 3.37, 95% CI: 1.754-6.484), having depressive symptoms (AOR: 3.25, 95% CI: 1.485-7.147) and having no regular exercises (AOR: 0.299, 95% CI: 0.166-0.537) were predisposing factors for poor sleep quality. The prevalence of poor sleep quality among clinicians working in the ICU and operation room was high. Clinicians who had no regular exercise, who worked in night shift, and who had depressive symptoms were associated with poor quality of sleep. Clinicians should have an awareness on the symptoms of depression, implement sleep hygiene education programs and promoting regular exercise. The authors recommend healthcare policy makers for improving working schedules.

Work-related stress and stress management practice among Chinese hospital staff working night shifts: A mixed-methods study.

Work-related stress and stress management practice among Chinese hospital staff working night shifts: A mixed-methods study.

Exploration of the individual, social and environmental factors influencing dietary behaviour in shift workers with type 2 diabetes working in UK healthcare-The Shift-Diabetes Study: A qualitative study using the theoretical domains framework.

To identify factors influencing dietary behaviour in shift workers with type 2 diabetes (T2D) working in UK healthcare settings. Semi-structured qualitative interviews based on the theoretical domains framework (TDF) were conducted with a convenience sample (n = 15) of shift workers (32-59 years) diagnosed with T2D who worked night shifts as part of a mixed shift schedule. The TDF was applied to analyse transcripts using a combined deductive framework and inductive thematic analysis approach. Identified influences were mapped to the behaviour change technique taxonomy to identify potential strategies to change dietary behaviour in this context. Key barriers to healthy dietary behaviours were access and cost of food available during night work (TDF domain: Environment Context and Resources). Factors identified as both enablers and barriers included: availability of staff facilities and time to take a break, (Environment Context and Resources), the physical impact of night work (Beliefs About Consequences), eating in response to stress or tiredness (Emotion), advance planning of meals/food and taking own food to work (Behavioural Regulation). Potential techniques to address these influences and improve dietary behaviour in this context include: meal planning templates, self-monitoring and biofeedback, and increasing accessibility and availability of healthier food choices during night shifts. The dietary behaviour of shift workers with T2D is influenced by interacting individual, socio-cultural and environmental factors. Intervention should focus on environmental restructuring and strategies that enable monitoring and meal planning.

Impact of Shift Work on Excessive Daytime Sleepiness among Healthcare Shift Workers

Background: The circadian rhythm can disturb caused by the shift work system, that effect leading to daily sleepiness, and a higher risk of serious health problems. Many healthcare workers are shift workers. Being drowsy condition when one is not expected to be drowsy is called Excessive daytime sleepiness (EDS). EDS is associated with poor sleep hygiene, workspace errors, a lack of productivity, and lack of concentration which are significant safety concerns and a higher risk of occupational accidents among nightshift workers. This study aims to review the original studies on the association of shift work with excessive daytime sleepiness among healthcare shift workers. Methods: This article is a literature review consisting of journal articles. Articles were searched in the following databases PubMed, Scientific Scholar, Google Scholar, and EBSCO. The search terms used were ‘shift work’. ‘Excessive daytime sleepiness’ and Limitations included ‘English language’, ‘published between 2013-2023’, and ‘shift workers’.Results: Based on eleven articles that were analyzed, shift work and excessive daytime sleepiness are directly related to each other among shift workers. There are factors that cause EDS including lack of sleep duration and sleep quality, as well as several comorbidities, and the impact of EDS.

Appraising the Cognitive Alertness of Night Shift Workers: Case of Bottling Company Operators in Central Northern Nigeria

Night shift, a common work schedule in 24-hour production companies has been posing some after-effects on workers’ health, ranging from physical to psychological, and lack of response to these effects could result in cognitive deficiencies for workers and increased downtime for organisations. The objective of this study is to evaluate the effect of the night shift on the response time of workers to digital visual stimuli as compared to the day shift. Twenty-two shift operators from a bottling line between the ages of 25 and 35 years were subjected to psychomotor vigilance test (PVT) using an android PVT application (Versor-PVT Version 1.03) to assess their response times to visual stimuli and analysed using the SPSS software to determine the data distribution, skewness, and kurtosis. Based on the determined data distribution, Wilcoxon signed rank test (WSRT) was utilised to determine the level of significance of the differences between the two of them. The recorded minimum and maximum average response times for post-day and post-night shifts respectively were: 609.94 ms and 733.64 ms; 644.56 ms and 944.17 ms. Results clearly showed that night shift has significant negative impact on the response time of tested operators, such as delayed ability to respond to situations, including fault rectification, thus causing safety concern, and reducing productivity. In conclusion, additional cost is imminently incurred on the part of the organisation in settling medical bills and compensations. The WSRT analysis indicated that there is 95% probability of generating similar results on repeating the experiment under same conditions.

Poorer neurocognitive function of retired night shift workers: a risk assessment.

Poorer neurocognitive function of retired night shift workers: a risk assessment.

Physical workplace violence in the health sector in Saudi Arabia.

Physical workplace violence (WPV) occurs worldwide, causing psychological and physical injuries. However, reports from Saudi Arabia investigating which specialty is the most exposed are scarce. This study aimed to determine the prevalence and circumstances related to physical WPV among all healthcare providers in Saudi Arabia in 12 months, as well as the consequences for both attackers and targets of physical WPV. This cross-sectional study included all healthcare providers registered with the Saudi Commission for Health Specialties who had worked for more than 1 year in the health sector in Saudi Arabia until May 2019. Researchers distributed the questionnaire to the participants via email. Descriptive statistics were used to describe the basic features of the data. Correlations between the categorically measured variables were explored using a chi-square test of independence. Overall, 7398 healthcare workers (HCWs) voluntarily participated in the study, 51.3% being men and 48.7% being women. The mean age was 40 ± 8.62 years), and most participants were of non-Saudi origin. Overall, 9.3% HCWs had encountered physical violence. Male HCWs, pharmacists, nurses, and HCWs of non-Saudi origin were significantly more exposed to physical violence. Furthermore, those with direct physical contact with patients and those working with male patients only were more exposed to physical violence. Physical WPV is an important issue faced by HCWs, particularly those who work night shifts or have direct contact with patients. Results showed that more support, specific strategies and policies to reduce violence occurrence, and protection for healthcare providers are required.

Self-rated health and its related influencing factors among emergency department physicians: a national cross-sectional study.

Protecting and improving the personal health of healthcare workers is critical to improving the efficiency and quality of care. To effectively meet the needs of the emergency service system, emergency physicians need to be in a good state of health. However, due to the special characteristics of work in the emergency department, emergency physicians have to face various psychosocial pressures, which may bring them physical and mental distress. Therefore, this study aims to explore the emergency physicians' self-rated health status and its related factors, to provide an empirical study for the improvement of emergency physicians' self-rated health status. A cross-sectional survey of emergency physicians was conducted in China between July and August 2018. The questionnaires contained items on demographic characteristics, behavioral lifestyle and job-related factors, as well as self-rated health. The generalized ordinal logistic model was used to identify related factors of emergency physicians' self-rated health status. Only 14.4% of Chinese emergency physicians considered themselves in good health status. Results showed that emergency physicians who never exercised (β = 0.76, p < 0.001) and exercised <2 times per week (β = 0.34, p < 0.001) were more likely to report poor health status. In addition, emergency physicians with good sleep quality (β = -3.84, p < 0.001), fewer night work shifts (β = -0.47, p < 0.001), less frequency of visiting patients (β = -0.33, p < 0.001), never suffered the workplace violence (β = -0.47, p < 0.001) and never perceived effort-reward imbalance (β = -0.68, p < 0.001) were more likely to report good self-rated health. Chinese emergency physicians' self-rated health status was not optimistic. Self-rated health is associated with multiple domains of work-related factors and personal lifestyle. Feasible measures should be taken to improve the working environment of emergency physicians, develop acceptable shift schedules for employees, monitor and maintain the health status of emergency department physicians.

Night and shift work patterns and incidence of type 2 diabetes and hypertension in a prospective cohort study of healthcare employees.

This study aimed to evaluate effects of night and shift work patterns on type 2 diabetes (T2D) and hypertension in a longitudinal study, with detailed information on working hours. The cohort comprised about 28 000 nurses and nursing assistants employed for more than one year 2008-2016 in Stockholm, Sweden. The employee register held detailed individual information on daily working hours. Information on diagnoses came from national and regional registers. Hazard ratios (HR) and confidence intervals (CI) were estimated by discrete-time proportional hazard models, adjusting for sex, age, country of birth, and profession. During follow-up in 2013-2017, we identified 232 cases of T2D and 875 of hypertension. We observed an increased risk of T2D, but not hypertension, among employees who worked only night shifts the previous year (HR 1.59, 95% CI 1.02-2.43) and those with intensive shift work (>120 afternoon and/or night shifts the previous year: HR 1.67, 95% CI 1.11-2.48) compared to only day work. There was a non-significantly increased risk of T2D related to mixed day and afternoon shifts (HR 1.34, 95% CI 0.97-1.88). We observed tendencies in increased risk of T2D related to frequent spells of ≥3 consecutive night shifts and with number of years with exclusive (but not mixed) night work. Permanent night work and frequent afternoon and/or night shifts were associated with an increased risk of T2D the following year, but not hypertension. The T2D risk was, to some extent, affected by frequent spells of several night shifts in a row and by cumulative years with permanent night work.

Heart rate and heart rate variability following sleep deprivation in retired night shift workers and retired day workers.

Shift workers experience poor sleep and dysregulated cardiac autonomic function during sleep. However, it is unknown if this dysregulation persists into retirement, potentially accelerating the age-associated risk for adverse cardiovascular outcomes. Using sleep deprivation as a physiological challenge to cardiovascular autonomic function, we compared heart rate (HR) and high-frequency heart rate variability (HF-HRV) during baseline and recovery sleep following sleep deprivation between retired night shift and day workers. Participants were retired night shift (N = 33) and day workers (N = 37) equated on age (mean [standard deviation] = 68.0 [5.6] years), sex (47% female), race/ethnicity (86% White), and body mass index. Participants completed a 60-h lab protocol including one night of baseline polysomnography-monitored sleep, followed by 36 h of sleep deprivation and one night of recovery sleep. Continuously recorded HR was used to calculate HF-HRV. Linear mixed models compared HR and HF-HRV during non-rapid eye movement (NREM) and REM sleep between groups during baseline and recovery nights. Groups did not differ on HR or HF-HRV during NREM or REM sleep (ps > .05) and did not show differential responses to sleep deprivation. In the full sample, HR increased and HF-HRV decreased from baseline to recovery during NREM (ps < .05) and REM (ps < .01). Both groups exhibited cardiovascular autonomic changes during recovery sleep following 36 h of sleep deprivation. Sleep deprivation appears to induce cardiovascular autonomic changes that persist into recovery sleep in older adults, regardless of shift work history.

Association between night shift work and NAFLD: a prospective analysis of 281,280 UK Biobank participants

ContextThis study aimed to investigate the association between night shift work and the risk of nonalcoholic fatty liver disease (NAFLD).MethodsWe conducted a prospective analysis of 281,280 UK Biobank participants. Cox proportional hazards models were used to estimate the association of night shift work with incident NAFLD. Polygenic risk score analyses were performed to assess whether a genetic predisposition to NAFLD modified the association.ResultsDuring a median follow-up of 12.1 years (3,373,964 person-years), 2,555 incident NAFLD cases were identified. Compared with workers who never/rarely worked night shifts, those who worked some night shifts or usual/permanent night shifts were 1.12 (95% CI: 0.96–1.31) and 1.27 (95% CI: 1.08–1.48) times more likely to develop NAFLD, respectively. Among the 75,059 participants who had reports on lifetime experience of night shift work, those with a longer duration, a higher frequency, more consecutive night shifts and a longer length per shift all showed higher risks of incident NAFLD. Further analyses showed that the association between night shift work and incident NAFLD was not modified by a genetic predisposition to NAFLD.ConclusionsNight shift work was associated with increased risks of incident NAFLD.

P15-004-23 Shifting Weight in Night Shift Workers: Results From a 24 Week, Parallel, Multi-Site, Randomised Controlled Trial (SWIFt)

P15-004-23 Shifting Weight in Night Shift Workers: Results From a 24 Week, Parallel, Multi-Site, Randomised Controlled Trial (SWIFt)

The Correlation Between Night Shift Work Schedules, Sleep Quality, and Depression Symptoms.

Poor sleep and depressive symptoms are two negative effects of night shift work on physical and mental health. This study evaluated the correlation between sleep quality and depression symptoms among nurses in Saudi Arabia. Specifically, we assessed depressive symptoms and sleep quality observed among nurses who worked night shifts and compared the outcomes with those who worked exclusively day shifts in hospital settings. A total of 191 participants (55.5% men, 44.5% women) participated. The response rate was 63.6%. The hospital anxiety and depression scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression score and sleep quality, respectively. Nurses whoworkednight shifts had substantially higher PSQI ratings (p<0.05) than those whoworked day shifts. In addition, there was a clear relationship between the HADS and PSQI scores. According to the binary logistic regression, longer working hours and inadequate sleep were both independently linked to depressive symptoms among nurses. Poor sleep quality brought on by night shifts may explain why Saudi nurses who work night shifts experience higher rates of depression than those who work day shifts only.

Artificial light at night and night-shift work: Emerging threats for human health

Artificial light at night and night-shift work: Emerging threats for human health

BC05 Technological and clinical demonstration of a skin ageing analysis prototype

Abstract The skin undergoes intrinsic and extrinsic ageing, with extrinsic ageing caused by environmental factors including inadequate sleep. Preliminary studies have suggested a link between sleep quality and skin ageing. Noninvasive devices have been developed that are able to measure and quantify markers of skin ageing, such as collagen levels and wrinkle formation. A handheld optical coherence tomography (OCT) test, sourced from Industrial Technology Research Institute, is one such device that allows for the measurement of dermal collagen levels. We describe a pilot study to assess the feasibility of combining several methods to quantify skin ageing in those with and without sleep disturbance, to understand which specific markers of skin ageing are affected by poor sleep. Questionnaires were distributed to 10 female workers and completed by each participant to understand their sleep and sun protection habits. There were two groups: women working fixed day shifts (aged 41–53 years) or fixed night shifts (aged 22–63 years). Skin swabs, VISIA® and OCT were used to measure markers of skin ageing of both cheeks: DNA amplification, wrinkles (percentile) and collagen (percentage), respectively. The entire testing could be completed by each participant within 15 minutes. The results were then compared between the different groups. The testing was well tolerated in this small sample. There was a statistically significant difference between day and night workers in their percentile of wrinkles using the VISIA (left cheek: P = 0.039; right cheek: P = 0.015), with night workers showing fewer signs of wrinkle formation. No statistically significant difference in DNA amplification was observed between day and night workers using skin swabs (left cheek: P = 0.27; right cheek: P = 0.32). Using OCT, no statistically significant difference was observed in collagen percentage between day and night workers (left cheek: P = 0.73; right cheek: P = 0.98). Skin swabs, OCT and VISIA were well tolerated, with no adverse events seen. The VISIA showed a significant difference in markers of skin ageing between day and night workers. Night shift workers may have shown fewer signs of wrinkle formation due to confounding factors such as age and smoking. No significant difference was observed with skin swabs and OCT, which may be related to the small sample size. The skin swabs, VISIA and OCT together can be quickly used to test the impact of sleep or any other extrinsic factor on skin ageing. This study has provided useful pilot data that can be scaled for future, larger studies.

Impact of Simulated Rotating Shift Work on Mammary Tumor Development in the p53R270H©/+WAPCre Mouse Model for Breast Cancer.

Epidemiological studies associate night shift work with increased breast cancer risk. However, the underlying mechanisms are not clearly understood. To better understand these mechanisms, animal models that mimic the human situation of different aspects of shift work are needed. In this study, we used "timed sleep restriction" (TSR) cages to simulate clockwise and counterclockwise rotating shift work schedules and investigated predicted sleep patterns and mammary tumor development in breast tumor-prone female p53R270H©/+WAPCre mice. We show that TSR cages are effective in disturbing normal activity and estimated sleep patterns. Although circadian rhythms were not shifted, we observed effects of the rotating schedules on sleep timing and sleep duration. Sleep loss during a simulated shift was partly compensated after the shift and also partly during the free days. No effects were observed on body weight gain and latency time of breast cancer development. In summary, our study shows that the TSR cages can be used to model shift work in mice and affect patterns of activity and sleep. The effect of disturbing sleep patterns on carcinogenesis needs to be further investigated.

Effect of Short versus Long Duration Naps on Blood Pressure during Simulated Night Shift Work: A Randomized Crossover Trial

Objective Blunting of the sleep-related dip in blood pressure (BP) has been linked to numerous cardiovascular outcomes including myocardial infarction. Blunting of BP dipping occurs during night shift work and previous research suggest that a 60-min or longer on-shift nap is needed to restore normal/healthy BP dipping. We sought to determine the effect of different durations of napping on BP during and following simulated night shifts. We hypothesized that the greatest benefit in terms of restoration of normal BP dipping during night shift work would be observed during a longer duration nap versus a shorter nap opportunity. Methods We used a randomized crossover laboratory-based study design. Participants consented to complete three separate 72-hr conditions that included a 12-hr simulated night shift. Nap conditions included a 30-min and 2-hr nap compared to a no-nap condition. Ambulatory BP monitoring was assessed hourly and every 10-30 mins during in-lab naps. Blunted BP dipping during in-lab naps was the primary outcome. Goal enrollment of 25 (35 with attrition) provided 80% power to detect a mean difference of 5 mmHg in BP between nap conditions. Results Of the 58 screened, 28 were consented, and 26 completed all three 72-hr conditions. More than half (53.6%) were female. Mean age was 24.4 years (SD7.2). Most (85.7%) were certified as emergency medical technicians or paramedics. The mean percentage dip in systolic BP (SBP) and diastolic BP (DBP) did not differ between the 30-min and 2-hr nap conditions (p > 0.05), yet a greater proportion of participants experienced a 10-20% dip in SBP or DBP during the 2-hr nap versus the 30-min nap (p < 0.05). For every additional minute of total sleep during the 30-min nap, the percentage of SBP dip improved by 0.60%, and the percentage of DBP dip improved by 0.68% (p < 0.05). These improvements approximate to a 6% per minute relative advancement toward normal/healthy BP dipping. Conclusions Restoration of a normal/healthy dip in BP is achievable during short and long duration nap opportunities during simulated night shift work. Our findings support the hypothesis that BP dipping is more common during longer 2-hr versus shorter 30-min naps. Trial registration ClinicalTrials.gov, NCT04469803. Registered on 9 July 2020.

Effectiveness of sleep interventions for rotating night shift workers: a systematic review and meta-analysis.

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. 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. 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). 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.