The Association Between the Number of Consecutive Night Shifts and Insomnia Among Shift Workers: A Multi-Center Study

Objectives: There is a need to determine the optimal limit of consecutive night shift work to reduce insomnia caused by the accumulation of sleep problems among night shift workers. This study aimed to investigate the prevalence of insomnia caused by consecutive night shifts and evaluate the night shift duration that worsens insomnia the most, using a large amount of medical examination data.Methods: Night shift profiles and baseline demographics data of three hospitals were collected from January 2015 to December 2017. For subjects who had been examined more than once at the same institution, information corresponding to the most recent date was used. Multivariate logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Pooled ORs were calculated by using the results of the three institutions.Results: Of the 33,669 participants, 31.3% were female. The average age was 41.1 ± 11.1 years and the prevalence of insomnia was 38.7% (n = 13,025). After adjusting for potential confounders and compared to workers who reported not working in consecutive night shifts, odds of insomnia were greatest among workers reporting working three consecutive nights (OR 2.65, 95% CI 1.97–3.56) followed by those working two nights (OR 1.81, 95% CI 1.45–2.26), five nights (OR 1.78, 95% CI 1.56–2.03), and four nights (OR 1.68, 95% CI 1.55–1.82).Conclusion: Our study demonstrates a significant relationship between consecutive night shift and insomnia with multicenter examination data, using common data model. This study could be a basis for establishing policies and guidelines that improve night shift workers' health.

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.

Chronotype-specific Sleep in Two Versus Four Consecutive Shifts

The study aimed to explore chronotype-specific effects of two versus four consecutive morning or night shifts on sleep-wake behavior. Sleep debt and social jetlag (a behavioral proxy of circadian misalignment) were estimated from sleep diary data collected for 5 weeks in a within-subject field study of 30 rotating night shift workers (29.9 ± 7.3 years, 60% female). Mixed models were used to examine whether effects of shift sequence length on sleep are dependent on chronotype, testing the interaction between sequence length (two vs. four) and chronotype (determined from sleep diaries). Analyses of two versus four morning shifts showed no significant interaction effects with chronotype. In contrast, increasing the number of night shifts from two to four increased sleep debt in early chronotypes, but decreased sleep debt in late types, with no change in intermediate ones. In early types, the higher sleep debt was due to accumulated sleep loss over four night shifts. In late types, sleep duration did not increase over the course of four night shifts, so that adaptation is unlikely to explain the observed lower sleep debt. Late types instead had increased sleep debt after two night shifts, which was carried over from two preceding morning shifts in this schedule. Including naps did not change the findings. Social jetlag was unaffected by the number of consecutive night shifts. Our results suggest that consecutive night shifts should be limited in early types. For other chronotypes, working four night shifts might be a beneficial alternative to working two morning and two night shifts. Studies should record shift sequences in rotating schedules.

Pain complaints after consecutive nights and quick returns in Norwegian nurses working three-shift rotation: an observational study

ObjectivesTo determine whether nurses working consecutive night shifts, or short transitions between shifts (quick returns (QRs)), yielded higher risk for pain complaints when compared with regular morning shifts. Sleep duration was tested as a potential mediator.DesignObservational diary study.SettingRandom hospitals.ParticipantsNurses with three-shift rotation (morning, evening and night), n=679, 22–63 years old.Outcomes measuresDaily ratings of working hours, sleep and subjective pain complaints in six anatomical regions (head, neck/shoulder/upper back, upper extremity, low back, lower extremity and abdomen) for 28 days. In addition, we assessed demographics, habitual sleep and pain complaints, work and lifestyle factors. It was tested (1) whether the risk for pain complaints was higher after workday 3 versus after workday 2, and whether the difference was larger for consecutive night shifts versus consecutive morning shifts, and (2) whether the risk for pain complaints was higher after QRs versus after two morning shifts. Risk for pain complaints refers to combined increased risk for any pain and risk for increased intensity.ResultsAdjusted analyses showed no shift type by workday interaction for pain complaints in the neck/shoulder/upper back, upper extremities, low back, lower extremities or abdomen. For headache, a strong trend indicated that the risk was higher on workday 3 compared with workday 2 for night shifts (OR 1.13, 95% CI 0.99 to 1.28). The risk was lowered if sleep duration was taken into account (OR 0.37, 95% CI 0.17 to 0.81). No conclusive support was found for the risk for pain complaints being higher after QRs, compared with after morning shifts.ConclusionsFor five of six pain complaints, the hypotheses were not supported by the current data. For headache, we found potential support for a sleep-relieving effect on headache after working several nights in a row. Pain complaints were not instigated or exacerbated by an evening-to-morning transition between shifts.

0777 Variations in Vigilance and Sleep Among Underground Mine Workers During 14 Consecutive Night Shifts

Introduction Adverse effects of night shift work are well known but there is scarce data on how vigilance and sleep vary across a large number of consecutive night shifts. Methods In summer, 38 underground miners (mean age (SD): 36.8 (13.9) years) wore an actigraph, filled out the Morningness-Eveningness questionnaire, and completed a Visual Analog Scale capturing subjective vigilance (very sleepy to very alert) 4 times per shift (19:00, 22:00, 02:00, and 05:30) for 14 consecutive night shifts. Mixed effects linear regression models were used to account for repeated measures. Results Mean vigilance level is lower at 22:00, 02:00 and 05:30 than at the beginning of the shift at 19:00 (p<0.001). Also, a more pronounced decrease in vigilance during the night was observed among older workers compared to younger workers (p<0.05). Moreover, workers with greater eveningness have higher vigilance at the beginning of the first night shift at 19:00 (p<0.001), but their decline in vigilance level during the night is faster than that observed in workers with greater morningness (p<0.01). Interestingly, the mean vigilance decline observed at 02:00 and 05:30 (compared to 19:00) is slowed down for each additional night shift (p<0.001). Furthermore, mean sleep efficiency is negatively associated with morningness and gradually decreases across consecutive night shifts (p<0.05). In addition, mean sleep duration is shorter in older workers and is positively associated with morningness (p<0.05). Conclusion Results show a progressive improvement in vigilance of mine workers assigned to a large number of consecutive 12-hour night shifts from 2 am onwards. This may probably be ascribed to an adjustment in homeostatic sleep propensity consecutive to the partial sleep deprivation associated with time spent traveling to the remote site before the first shift. However, circadian adjustment is unlikely considering the strong morning light exposure experienced daily after the night shift. Support College and Community Innovation Program of the Natural Sciences and Engineering Research Council of Canada (NSERC) (CUI2I 472201-14)

Role of nocturnal light intensity on adaptation to three consecutive night shifts: a counterbalanced crossover study

ObjectivesTo investigate how a standard ceiling mounted light-emitting diode (LED)-based bright light intervention affected alertness and neurobehavioural performance during three consecutive simulated night shifts, and timing of circadian rhythm after the shifts.MethodsTwenty seven participants (20 females, 21.4±2.1 years; mean±SD) worked three consecutive night shifts (23:00–07:00) under a full-spectrum (4000 K) bright light (900 lx) and a standard light (90 lx) condition in a counterbalanced crossover design (separated by 4 weeks). Subjective alertness (Karolinska Sleepiness Scale) and neurobehavioural performance (Psychomotor Vigilance Task and Digit Symbol Substitution Test) were assessed five times during each shift. Salivary dim-light melatonin onset (DLMO) was assessed before and after the shifts. The simulated night shifts were conducted in a laboratory while the participants slept at home.ResultsSubjective alertness and neurobehavioural performance deteriorated during the night shifts in both light conditions. However, bright light significantly reduced alertness and performance decrements as compared with standard light. For a subset of the participants, DLMO was delayed by a mean of 3:17±0:23 (mean±SEM) hours after three night shifts in bright light and by 2:06±0:15 hours in standard light, indicating that bright light causes larger phase delay.ConclusionBright light improved performance and alertness during simulated night shifts and improved adaptation to night work. Bright light administered by ceiling mounted LED luminaires has the potential to improve adaptation to night work and reduce the risk of accidents and injuries among night workers.Trial registration numberNCT03203538.