Pain complaints are associated with quick returns and insomnia among Norwegian nurses, but do not differ between shift workers and day only workers

Psychometric Evaluation of the Insomnia Severity Index in Nurses

OBJECTIVES

Examine psychometric properties of the Insomnia Severity Index (ISI) in a sample of nurses.

METHOD

In a sample of day shift nurses (N = 289), a confirmatory factor analysis (CFA), convergent and discriminant validity analyses, and a test-retest reliability analysis were performed.

RESULTS

CFA showed that a two-factor model provided the best fit. The ISI had moderate to poor convergent validity with sleep diary parameters, and moderate convergent validity with the Sleep Condition Indicator (r = -.66), Pittsburgh Sleep Quality Index (r = .66), and PROMIS Sleep-Related Impairment measure (r = .67). The ISI demonstrated good discriminant validity with the measures Composite Scale of Morningness (r = -.27), Nightmares Disorder Index (r = .25), PTSD Checklist for DSM-5 (sleep items removed; r = .32), and Perceived Stress Scale (r = .43). The ISI had weaker discriminant validity with the PHQ-9 (r = .69) and Generalized Anxiety Disorder Screener (r = .51). The ISI demonstrated a good test-retest reliability (ICCs = .74-.88).

CONCLUSIONS

The ISI is a psychometrically strong measure for the assessment of insomnia severity in day shift nurses. Overlap with psychological symptoms, primarily anxiety and depression, suggests caution while interpreting these constructs.

The association between proportion of night shifts and musculoskeletal pain and headaches in nurses: a cross-sectional study

BACKGROUND AND PURPOSE

Shift work is associated with musculoskeletal pain and headaches, but little is known about how the intensity of shift work exposure is related to musculoskeletal pain and headaches. This study aimed to investigate whether a higher proportion of night shifts is associated with a higher occurrence of musculoskeletal pain and headaches. Furthermore, to investigate whether sleep duration can mediate this potential association.

METHOD

The study included 684 nurses in rotating shift work who responded to a daily questionnaire about working hours, sleep, and pain for 28 consecutive days. The data were treated cross-sectionally.

RESULTS

A negative binomial regression analysis adjusted for age and BMI revealed that working a higher proportion of night shifts is not associated with a higher occurrence of musculoskeletal pain and headaches. On the contrary, those working ≥ 50% night shifts had a significantly lower occurrence of pain in the lower extremities than those who worked < 25% night shifts (IRR 0.69 95% CI 0.51, 0.94). There was no indication of a mediation effect with total sleep time (TST).

CONCLUSION

The results of this study indicate that working a higher proportion of night shifts is not associated with a higher occurrence of musculoskeletal pain and headaches.

Sleep Quality as a Mediator of Burnout, Stress and Multisite Musculoskeletal Pain in Healthcare Workers: A Longitudinal Study

This study aimed to verify whether sleep quality is a mediator of the relationship between burnout, stress and multisite pain in healthcare workers in a longitudinal study with 12 months of follow-up during the COVID-19 pandemic. Online questionnaires were used for data collection. The sociodemographic questionnaire contained personal and occupational data. The short version of the Copenhagen Psychosocial Questionnaire (COPSOQ II-Br) was used to assess burnout and stress. The Pittsburgh Sleep Quality Index (PSQI-Br) assessed sleep quality over one month. The Nordic Musculoskeletal Questionnaire (NMQ) aimed to identify the presence of multisite musculoskeletal pain in the last 12 months and the last 7 days. Mediation analysis was used to verify whether the effect of the predictor variables (burnout and stress) on the dependent variable (number of pain sites in the last 12 months and 7 days) was due to an intervening variable (sleep quality). Stress and burnout were associated with multisite pain in healthcare workers in the last 12 months and the last 7 days. Sleep quality was a significant mediator of this association in the last 12 months, indicating that some of the association between burnout, stress and multisite pain can be explained by poor sleep quality. Thus, a comprehensive approach to long-term multisite pain should consider psychosocial aspects such as burnout, stress and sleep quality.

Relationship between insomnia and rest time between shifts among shift workers: A multicenter cross‐sectional study

Objectives

A rest time of less than 11 h taken by a shift worker between shifts is defined as quick return (QR). QR is shown to decrease sleep time by virtue of decreasing rest time, diminishing sleepiness and exhaustion, and increasing the number of sick days taken by employees. Therefore, in this multicenter retrospective study, the association between QR and the incidence of insomnia was established using the night‐shift questionnaire from the Korean Workers Health Examination‐Common Data Model.

Methods

Three hospitals collected the night‐shift profiles and baseline demographic data of 33 669 workers between January 2015 and December 2017. The most recent date of examination was used for participants who had been examined multiple times at the same institution. We used multiple logistic regression to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). The pooled ORs were estimated using combined results from the three institutions.

Results

The proportion of men was higher than that of women in the QR group at each institution. The pooled ORs were computed using combined data from the three institutions. Workers who reported a QR had the highest risk of sleeplessness (OR, 1.21; 95% CI, 1.12–1.31) compared to those workers who reported a slow return, after adjusting for possible confounders.

Conclusions

A substantial correlation was established between QR and insomnia using the CDM approach and data from multiple centers. This study may serve as a foundation for developing guidelines to enhance the health of shift workers and prevent occupational accidents.

Shift work, inflammation and musculoskeletal pain-The HUNT Study

BACKGROUND

Studies have indicated that shift work, in particular night work, is associated with chronic musculoskeletal pain but the mechanisms are unclear. It has been suggested that sleep disturbance, a common complaint among shift and night workers, may induce low-grade inflammation as well as heightened pain sensitivity.

AIMS

Firstly, this study was aimed to examine the cross-sectional associations between shift work, C-reactive protein (CRP) level and chronic musculoskeletal pain, and secondly, to analyse CRP as a mediator between shift work and chronic musculoskeletal pain.

METHODS

The study included 23 223 vocationally active women and men who participated in the HUNT4 Survey of the Trøndelag Health Study (HUNT). Information was collected by questionnaires, interviews, biological samples and clinical examination.

RESULTS

Regression analyses adjusted for sex, age and education revealed significant associations between shift work and odds of any chronic musculoskeletal pain (odd ratio [OR] 1.11, 95% confidence interval [CI] 1.04-1.19), between shift work and CRP level (OR 1.09, 95% CI 1.03-1.16) and between CRP level 3.00-10 mg/L and any chronic musculoskeletal pain (OR 1.38, 95% CI 1.27-1.51). Shift work and CRP were also associated with number of chronic pain sites. Mediation analysis indicated that shift work was indirectly associated with any chronic musculoskeletal pain through CRP (OR 1.03, 95% CI 1.01-1.06).

CONCLUSIONS

The results support the hypothesis that shift work is associated with chronic musculoskeletal pain, and that systemic inflammation may be a biological mechanism linking shift work to chronic pain.

Shift work, low-grade inflammation, and chronic pain: a 7-year prospective study

Objectives

We investigated prospective associations of shift work with chronic pain and C‐reactive protein (CRP), an indicator of inflammation. Furthermore, we elucidated CRP as a possible mediator and/or moderator of effects of shift work on pain.

Methods

Data from a 7 years follow‐up study were analyzed (N = 2323). Shift work and chronic pain of “neck/shoulder”, “arm/hand”, “upper back”, “low back”, “hip/leg/feet”, and “other regions” were measured by questionnaires. “Chronic widespread pain”, “number of chronic pain sites”, and “any chronic pain” were computed. CRP was measured in serum samples. Logistic and Poisson regressions were conducted. Mediation was assessed by casual mediation analyses and moderation by the Relative Excess Risk due to Interaction (RERI).

Results

Shift work was not associated with any chronic pain variable and no mediation was detected. CRP was associated with low back pain, hip/leg pain, and “number of pain sites”, and also with the combination of shift work and CRP of 1–2.99 mg/L (compared to: no shiftwork and CRP < 1). Additionally, shiftwork and CRP 1–2.99 mg/L was associated with risk of “any chronic pain” (OR: 1.76, 95% CI: 1.12, 2.85), which was not associated with CRP alone. Moderation analyses suggested the risks for “any chronic pain” and “number of pain regions” increased when individuals with elevated CRP worked shifts—beyond what the separate effects of CRP and shift would suggest.

Conclusions

We found no evidence of shift work in general affecting CRP or chronic pain. However, shift work and elevated CRP combined may influence chronic pain.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-020-01626-2.

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

OBJECTIVES

To 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.

DESIGN

Observational diary study.

SETTING

Random hospitals.

PARTICIPANTS

Nurses with three-shift rotation (morning, evening and night), n=679, 22-63 years old.

OUTCOMES MEASURES

Daily 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.

RESULTS

Adjusted 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.

CONCLUSIONS

For 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.