Excessive daytime sleepiness in general hospital nurses: prevalence, correlates, and its association with adverse events

Excessive daytime sleepiness in nursing technicians: association with sleep quality and memory

OBJECTIVE

to investigate excessive daytime sleepiness prevalence among nursing technicians and the association with sleep quality and memory.

METHODS

a cross-sectional, inferential study, carried out in a hospital unit in the state of Goiás between December 2020 and January 2021. Assessments were carried out using the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Prospective and Retrospective Memory Questionnaire, instruments validated for the Brazilian context. Bivariate and multivariate logistic regression analyzes were performed.

RESULTS

the sample consisted of 189 nursing technicians with a 40.9% excessive daytime sleepiness prevalence. In multivariate models, excessive daytime sleepiness was not associated with sleep quality, however there was a significant association with overall memory failures.

CONCLUSIONS

study results demonstrate a high excessive daytime sleepiness occurrence, an association with overall memory failures and the need for psychosocial interventions for nursing technicians.

Effect of shift work on excessive daytime sleepiness in female nurses: results from the Japan Nurses' Health Study

We investigated the relationship between shift work and excessive daytime sleepiness (EDS) among participants in the Japan Nurses' Health Study (JNHS). Responses of 9,728 female nurses to the 6th follow-up questionnaire were cross-sectionally analyzed. EDS was defined as an Epworth Sleepiness Scale score ≥11. EDS-associated factors were evaluated using Poisson regression analysis after adjustment for multiple confounders. Of the participants (mean age, 52.2 ± 8.0 yr), 28.7% were engaged in shift work, and the overall prevalence of EDS was 24.6%. EDS-associated factors were investigated separately in women aged <40 yr (n=250), 40-59 yr (n=7,467), and ≥60 yr (n=2,011). Current engagement in shift work (prevalence ratio: 1.92 [95% confidence interval: 1.20-3.06], compared with no experience of shift work) and obesity (2.08 [1.11-3.88] for BMI ≥30 and 1.39 [1.02-1.90] for BMI of 25.0-30.0, compared with BMI of 18.5-25.0) showed an independent association with EDS in women aged ≥60 yr. The effect of shift work on EDS in female nurses differed by age, as shift work and obesity contributed to EDS only in older participants. Shift work should be assigned after full consideration of age, sleep, and health status to minimize medical errors.

Nighttime sleep quality & daytime sleepiness across inpatient psychiatric treatment is associated with clinical outcomes

Prior research has demonstrated the strong link between sleep disturbance and mental health outcomes, including the importance of examining nighttime sleep quality and daytime sleepiness as separate constructs in relation to mental health outcomes. As such, the current study examined patients' self-reported nighttime sleep quality and daytime sleepiness trajectories over the course of inpatient treatment and how these trajectories related to treatment outcomes. Participants were 1,500 adults who voluntarily admitted to an inpatient psychiatric hospital. Mental health outcomes measured were emotion regulation problems, anxiety severity, depression severity, nightmare severity, and suicide risk. Group-based trajectory modeling was used to determine nighttime sleep quality and daytime sleepiness trajectory groups. Multivariate analyses of covariance (MANCOVA) were used to determine between group differences on mental health outcomes. Patients fit into distinct groups based on their trajectories of nighttime sleep quality and daytime sleepiness across inpatient psychiatric treatment: Low, Moderate, and High. Individuals with greater nighttime sleep disturbance and greater daytime sleepiness throughout treatment (High group) demonstrated significantly increased suicide risk, higher nightmare severity, more anxiety, more depression, and more emotion regulation difficulties at discharge. Results suggest an important connection exists between nighttime sleep quality and excessive daytime sleepiness and mental health outcomes for inpatient psychiatry.

The Number of Monthly Night Shift Days and Depression Were Associated with an Increased Risk of Excessive Daytime Sleepiness in Emergency Physicians in South Korea

This study aimed to report the prevalence and identify the factors associated with excessive daytime sleepiness (EDS) among emergency physicians in South Korea. We analyzed the Korean Emergency Physicians Survey data from 15 January to 26 February 2021. EDS was evaluated using the Epworth sleepiness scale, and a score of 11 or more indicated the presence of EDS. We conducted univariable and multivariable logistic regression analyses to verify the associated factors. A total of 1307 participants responded to the survey, and the response rate was 61.3%. Nine hundred fifty-four participants were included in the study. Two hundred ninety-three participants were classified as the EDS group, and six hundred sixty-one were classified as the non-EDS group. The prevalence of EDS was 30.7% (95% confidence interval (CI), 27.8–33.6%). Monthly night-shift days (odds ratio (OR) 1.106, 95% CI 1.028–1.191) and depression (OR 2.635, 95% CI 1.799–3.861) were significantly associated with an increased risk of EDS, and fair sleep quality (OR 0.560, 95% CI 0.318–0.985) was associated with a decreased risk of EDS. Almost one in three emergency physicians in South Korea suffer from daytime sleepiness. The number of monthly night-shift days and depression were associated with an increased risk of EDS.

Nurses’ Work Environment during the COVID-19 Pandemic in a Person-Centred Practice—A Systematic Review

The work environment and especially the psychosocial work environment influence the mental and physical well-being of employees. The aim of this study was to identify and analyse the state of knowledge regarding nurses’ work situation, health, and person-centred work during the COVID-19 pandemic through a systematic review. Methods: Systematic Review, nine included articles. The theoretical swAge model was used as the framework in a deductive content analysis. Results: The result was presented in the nine determinate areas from the swAge model and showed that all nine determinate areas of the swAge model were of importance to both the nurses’ sustainable work situation during the COVID-19 pandemic and to person-centred care. The COVID-19 pandemic has had a negative effect on nurses’ health, both physically but especially psychologically, with high levels of depression, anxiety, and burnout. Nurses experienced a lack of control and support from organizations. They had to work with limited resources and sometimes care for patients beyond their expertise. Conclusion: There is a further need for more studies that address person-centredness from an organisational perspective with the intention to develop strategies and measure activities on how to make the nurses’ work situation more sustainable, and to increase their ability to give more person-centred care.

Unsupervised Machine Learning Identified Distinct Population Clusters Based on Symptoms of Oral Pain, Psychological Distress, and Sleep Problems

Objectives:

The aims of this study were to explore the use of unsupervised machine learning in clustering the population based on reports of oral pain, psychological distress, and sleep problems and to compare demographic and socio-economic characteristics as well as levels of functional domains (work, social, and leisure) between clusters.

Materials and Methods:

In this cross-sectional study, a total of 1613 participants from the National Health and Nutrition Examination Survey in 2017–2018 were analyzed. Five variables, including oral pain, depression, anxiety, sleep apnea, and excessive daytime sleepiness, were selected for cluster analysis using the k-medoids clustering algorithm. The distribution of categorical variables between clusters was assessed using χ² test. One-way analysis of variance and Kruskal–Wallis H test were used to compare numerical variables as appropriate.

Results:

Five distinct clusters were identified: healthy, norm, anxiety, apnea-comorbid, and pain-comorbid. The apnea-comorbid cluster had mean age of 59 years and higher proportion of men. The pain-comorbid cluster had mean age of 56 years and higher proportion of women. Whites constituted a majority of both comorbid clusters. The pain-comorbid cluster demonstrated the least percentage of individuals with college degree, the lowest income, and significant impairment in all functional domains.

Conclusion:

Through the use of unsupervised machine learning, the clusters with comorbidity of oral pain, psychological distress, and sleep problems have emerged. Major characteristics of the comorbid clusters included mean age below 60 years, White, and low levels of education and income. Functional domains were significantly impaired. The comorbid clusters thus call for public health intervention.

Sleepiness and safety at work among night shift NHS nurses

BACKGROUND

Sleepiness associated with night shift working (NSW) is known to adversely affect workers' health and well-being. It has been associated with adverse safety outcomes and is a recognized workplace hazard among healthcare workers.

AIMS

This study was aimed to assess the prevalence of self-reported sleepiness in NSW nurses and midwives. This study also explored the consequences of sleepiness on safety at work and driving.

METHODS

A cross-sectional study of NSW nurses and midwives was conducted at an National Health Service (NHS) hospital trust from 16 March 2020 to 1 June 2020. Data were collected by online questionnaire and included information on demographics, shift work and safety aspects. Sleepiness was assessed with the Epworth Sleepiness Scale (ESS).

RESULTS

Data collection coincided with the first coronavirus pandemic peak in England. Out of 1985 eligible NSW nurses and midwives, 229 participated in the study, with a response rate of 12%. The prevalence of sleepiness was 28%. Following a night shift, 49% of nurses reported nodding off at the wheel and 44% reported a near-miss car accident in past 12 months. An abnormal ESS score was significantly associated with near-miss car accidents (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.31-5.77) and with low confidence in undertaking complex tasks at night (OR 2.64, 95% CI 1.20-5.84).

CONCLUSIONS

More than a quarter of NSW nurses and midwives reported excessive daytime sleepiness although, due to the low response rate, this may not be representative. Adverse driving events were common. Elevated ESS scores correlated well with safety issues relating to work and driving.

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study

BACKGROUND

Healthcare systems have widely adopted consecutive 12 h day and night shifts for nurses, but the effects of these shifts on cognition, sleepiness, and nursing performance remains understudied.

OBJECTIVE

To determine the extent of changes in cognition and sleepiness in nurses working three consecutive 12 h shifts, quantify the respective impacts of these changes on different aspects of nursing performance, and investigate individual differences in all measures.

DESIGN

A quasi-experimental, between-within design collected data from nurses between November 2018 and March 2020. The between-groups component was comprised of day shift nurses vs. night shift nurses, while the within-groups component was comprised of two separate test sessions for each nurse: one immediately following a third consecutive shift (fatigued) and one after three consecutive days off work (rested).

SETTING

Participants were tested in a northwestern US university's nursing simulation laboratory.

PARTICIPANTS

A volunteer sample of 94 registered nurses involved in direct patient care working 12 h shifts were recruited from two local hospitals.

METHODS

Simulated nursing performance was measured in seven separate domains and an aggregate score from the Creighton Competence and Evaluation Inventory, covering both lower- and higher-level constructs like procedural skills, assessment, decision-making, etc. Cognition and sleepiness were assessed through measures of sustained attention, predicted cognitive effectiveness, and subjective sleepiness.

RESULTS

In our 94 nurses, individual differences in all our measures varied from trivial to extensive. For six domains of performance and the aggregate score there were no significant differences in means across groups or conditions. For the seventh, Communication skills were lower for night nurses than day nurses, but this effect was small. After three consecutive shifts, sustained attention and predicted cognitive effectiveness decreased, and subjective sleepiness increased. Predicted cognitive effectiveness was particularly low for fatigued night nurses relative to other conditions and was positively correlated with Communication while controlling for other predictors.

CONCLUSIONS AND RELEVANCE

Nurses maintained their levels of performance for all domains after three consecutive shifts. Individual differences in predicted cognitive effectiveness could account for variation in performance by shift type for Communication skills but for no other domain of performance. Communication skills and predicted cognitive effectiveness may interest researchers in the development of fatigue-mitigation strategies for night nurses, but our findings also suggest that more sensitive measures of performance may be necessary to capture other meaningful effects of long, consecutive shifts-if any-on patient care. Tweetable abstract: The effects of three consecutive 12 h shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: A quasi-experimental study.

[Sleep disorders and psycho-affective problems in paramedical personnel working an atypical schedule]

INTRODUCTION

Shift work can cause health problems and sleep disorders and therefore affect mental health. These psycho-affective disorders can, in return, worsen sleep disorders and thus establish a vicious circle. The aims of our study were to assess the frequency of sleep and psycho-affective disorders among paramedical personnel doing shift work and to screen them for obstructive sleep apnoea-hypopnoea syndrome (OSA).

METHODS

It was a cross-sectional study carried out among paramedical staff at the University Hospital Center Mongi Slim La Marsa in Tunis. Three questionnaires translated into Arabic (the Berlin questionnaire, the Spiegel questionnaire and the Hospital Anxiety and Depression Scale [HAD]) were presented by the same investigator during the survey.

RESULTS

One hundred and fifty-eight paramedics were interviewed (46.2% were nurses, 23.4% were blue-collar workers, 19% were senior technicians and 11.4% were health care aides, midwives and physiotherapists). The average duration of shift work was 10.27 years, the average age was 36.48 years and there was a female prevalence of 70.9%. Sleep disorders were detected in 40.5% of the cases, OSA in 24%, anxiety in 53.2% and depression in 17.1%.

CONCLUSION

Sleep and psycho-affective disorders are frequent among paramedical personnel undertaking shift work in hospitals. Screening consultations in occupational medicine are necessary in order to detect these disorders at an early stage.

The Epworth Sleepiness Scale in Service Members with Sleep Disorders

INTRODUCTION

Excessive daytime sleepiness affects an estimated 20% of the general population. While the prevalence of sleepiness in the military is largely unknown, it is well established that short sleep duration is endemic. The reasons for this include: the demanding nature of their duties, shift work and 24-hour duty periods, deployments and exigencies of military service as well as sleep disorders. The Epworth Sleepiness Scale (ESS) is the most widely used sleep questionnaire and provides a self-assessment of daytime sleepiness. To date the clinical utility of this questionnaire in differentiating sleep disorders in military patients with sleep disorders has never been evaluated.

MATERIALS AND METHODS

The primary aim of this manuscript was to assess if Epworth Sleepiness Scale (ESS) scores differed between military personnel with insomnia, obstructive sleep apnea (OSA), comorbid insomnia/obstructive sleep apnea (COMISA), and a group with neither insomnia nor obstructive sleep apnea (NISA). This study assessed the clinical utility of the ESS in differentiating sleep disorders amongst a sample (N = 488) of U.S. military personnel with insomnia (n = 92), OSA (n = 142), COMISA (n = 221), and a NISA group (n = 33) which served as the control population.

RESULTS

In the present sample, 68.4% of service members reported excessive daytime sleepiness (EDS) with an ESS > 10. ESS scores differed between military personnel with COMISA (13.5 ± 4.83) and those with OSA only (11.5 ± 4.08; p < 0.001) and the NISA group (9.46 ± 4.84; p < 0.001). Also, ESS scores differed between patients with insomnia only (13.0 ± 4.84) and the NISA group (p < 0.01).

CONCLUSIONS

Overall, the ESS had poor ability to differentiate sleep disorders. In military personnel, the ESS appears elevated in the most common sleep disorders, likely due to their insufficient sleep, and does not help to differentiate OSA from insomnia. Further studies are required to validate this questionnaire and determine an appropriate threshold value for abnormal sleepiness in the military population.

"It is really so exhausting": Exploring intensive care nurses' perceptions of 24-hour long shifts

AIM AND OBJECTIVES

To explore the perceptions and experiences of Cambodian ICU registered nurses regarding their working 24-hr shifts.

BACKGROUND

In Europe and the USA, nurses are moving to a 12-hr shift, and numerous studies have revealed the positive and negative effects of these. However, lesser known is the impact of 24-hr nursing shifts on care quality, and health and safety. In Cambodia, 100% of nurses are rostered for these in their shift patterns, but until this study no research had been conducted on such shifts.

DESIGN

A qualitative descriptive study.

METHOD

Three focus group discussions were conducted with 30 registered nurses in July 2019, ten in each group, from three intensive care units of three hospitals in Cambodia. Data saturation was obtained. Data were analysed using content analysis, and the COREQ was applied for reporting this study.

FINDINGS

The ICU nurses' perspectives revealed significant and unacceptable effects of working shifts of ~25-hr length, taking into account staff handover. Two major themes arose: It is so exhausting and Compromised hospital care. Alarmingly, participants worked on average 72 hr per week, were exhausted, and nursed between 6 and 10 critically ill patients per shift.

CONCLUSION

To our knowledge this is the first study on nurses working 24-hr shifts, revealing unacceptable, high risks for the health and safety of nurses and patients, with nursing activities left undone, and a lack of quality care.

RELEVANCE TO CLINICAL PRACTICE

Improving nurse and patient health and safety, and quality of care requires hospital leaders to work with government and nursing organisations to develop better shift strategies. Resources need to be provided so that: nurses can work a maximum 12-hr shifts; the ratio of nurses to patients is improved; and nurses can have decent break times. This has major implications, for not only practice, but also management, administration, budgets and education.

Association between depressive symptoms and poor sleep quality among Han and Manchu ethnicities in a large, rural, Chinese population

Objectives

To estimate the relationship between sleep quality and depression, among Han and Manchu ethnicities, in a rural Chinese population.

Methods

A sample of 8,888 adults was selected using a multistage cluster and random sampling method. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were assessed via the Center for Epidemiological Survey, Depression Scale (CES-D). Logistic regression was conducted to assess associations between sleep quality and depression.

Results

The prevalence of poor sleep quality and depression in the Manchus (20.74% and 22.65%) was significantly lower than that in the Hans (29.57% and 26.25%), respectively. Depressive participants had higher odds ratios of global and all sub PSQI elements than non-depressive participants, both among the Hans and the Manchus. Additive interactions were identified between depressive symptoms and ethnicity with global and four sub-PSQI elements, including subjective sleep quality, sleep disturbance, use of sleep medication and daytime dysfunction.

Conclusions

The findings revealed that the prevalence of poor sleep quality and depression among the Hans was greater than among the Manchus. Depression was associated with higher odds of poor sleep quality.

Factors associated with fatigue in patients with insomnia

Although fatigue is common in insomnia, the clinical associates of fatigue in patients with insomnia are largely unknown. We aimed to investigate the clinical associates of fatigue in patients with insomnia. Patients visiting the Stanford Sleep Medicine Center completed the Insomnia Severity Index (ISI), Insomnia Symptom Questionnaire (ISQ), the Fatigue Severity Scale (FSS), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). Among 6367 patients, 2024 were diagnosed with insomnia (age 43.06 ± 15.19 years; 1110 women and 914 men) according to the ISI and the ISQ. Insomnia patients with severe fatigue (n = 1306) showed higher insomnia symptoms, daytime sleepiness, depression and longer habitual sleep duration than those without severe fatigue (n = 718). Higher insomnia symptoms, daytime sleepiness and depressive symptoms, and longer habitual sleep duration, independently predicted higher fatigue scores. Among insomnia patients with daytime sleepiness (ESS≥10), only habitual sleep duration and depression predicted fatigue scores. The interaction between insomnia severity and daytime sleepiness significantly predicted the severity of fatigue. Depression was a significant mediator between insomnia and fatigue. For 598 insomnia patients undergoing overnight polysomnography (PSG), no significant correlations were found between fatigue and any PSG parameters. The current study suggests that managing insomnia or depression may reduce the fatigue of insomnia patients, whereas arbitrary efforts to prolong sleep duration may worsen their fatigue.

Risk Assessment for Self Reported Obstructive Sleep Apnea and Excessive Daytime Sleepiness in a Greek Nursing Staff Population

Background and objectives: The risk assessment of Obstructive Sleep Apnea (OSA) and Excessive Daytime Sleepiness (EDS) in specific occupational populations is important due to its association with morbidity. The aim of the present study was to identify the risk of OSA development and EDS in a Greek nursing staff population. Materials and Methods: In this cross-sectional study a total of 444 nurses, 56 males (age = 42.91 ± 5.76 years/BMI = 27.17 ± 4.32) and 388 females (age = 41.41 ± 5.92 years/BMI = 25.08 ± 4.43) working in a Greek secondary and tertiary hospital participated during the period from 18 January 2015 to 10 February 2015. The participants completed the Berlin Questionnaire (BQ), concerning the risk for OSA and the Epworth Sleepiness Scale (ESS), concerning the EDS. The work and lifestyle habits of the participants were correlated with the results of the questionnaires. Results: According to the BQ results 20.5% (n = 91) of the nursing staff was at high risk for OSA. Increased daytime sleepiness affected 27.7% (n = 123) of the nurses according to ESS results. Nurses at risk for Obstructive Sleep Apnea Syndrome (OSAS), positive for both BQ and ESS, were 7.66% (n = 34). Out of the nurses that participated 77% (n = 342) were working in shifts status and had significant meal instability (breakfast p < 0.0001, lunch p < 0.0001, dinner p = 0.0008). Conclusions: The population at high risk for OSA and EDS in the nursing staff was found to be 20% and 28% respectively. High risk for OSAS was detected in 7.66% of the participants. The high risk for OSA and EDS was the same irrespective of working in shift status. In specific, nursing population age was an independent predictor for high risk for OSA and skipping lunch an independent predictor of daytime sleepiness.