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Devine JK, Cooper N, Choynowski J, Hursh SR. Sleep Behavior in Royal Australian Navy Shift Workers by Shift and Exposure to the SleepTank App. Mil Med 2024; 189:743-750. [PMID: 39160894 DOI: 10.1093/milmed/usae253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/10/2024] [Accepted: 05/30/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Rotating shiftwork schedules are known to disrupt sleep in a manner that can negatively impact safety. Consumer sleep technologies (CSTs) may be a useful tool for sleep tracking, but the standard feedback provided by CSTs may not be salient to shift-working populations. SleepTank is an app that uses the total sleep time data scored by a CST to compute a percentage that equates hours of sleep to the fuel in a car and warns the user to sleep when the "tank" is low. Royal Australian Navy aircraft maintenance workers operating on a novel rotational shift schedule were given Fitbit Versa 2s to assess sleep timing, duration, and efficiency across a 10-week period. Half of the participants had access to just the Fitbit app while the other half had access to Fitbit and the SleepTank app. The goal of this study was to evaluate differences in sleep behavior between shifts using an off-the-shelf CST and to investigate the potential of the SleepTank app to increase sleep duration during the 10-week rotational shift work schedule. MATERIALS AND METHODS Royal Australian Navy volunteers agreed to wear a Fitbit Versa 2 with the SleepTank app (SleepTank condition), or without the SleepTank app (Controls), for up to 10 weeks from May to July 2023 during the trial of a novel shift rotation schedule. Participants from across 6 units worked a combination of early (6:00 AM to 2:00 PM), day (7:30 AM to 4:30 PM), late (4:00 PM to 12:00 AM), and night shifts (12:00 AM to 6:00 AM) or stable day shifts (6:00 AM to 4:00 PM). Differences in sleep behavior (time in bed, total sleep time, bedtime, wake time, sleep efficiency [SE]) between conditions and shift types were tested using Analysis of Variance. This study was approved by the Australian Departments of Defence and Veterans' Affairs Human Research Ethics Committee. RESULTS Thirty-four participants completed the full study (n = 17 Controls; n = 17 SleepTank). There was a significant effect of shift type on 24-hour time in bed (TIB24; F(4,9) = 8.15, P < .001, η2 = 0.15) and total sleep time (TST24; F(4,9) = 8.54, P < .001, η2 = 0.18); both were shorter in early shifts and night shifts compared to other shift types. TIB24 and TST24 were not significantly different between conditions, but there was a trend for greater SE in the SleepTank condition relative to Controls (F(1,9) = 2.99, P = .08, η2 = 0.11). CONCLUSIONS Sleep data collected by Fitbit Versa 2s indicated shorter sleep duration (TIB24, TST24) for Royal Australian Navy workers during early and late shifts relative to stable day shifts. Access to the SleepTank app did not greatly influence measures of sleep duration but may be protective against fatigue by affecting SE. Further research is needed to evaluate the utility of the SleepTank app as a means of improving sleep hygiene in real-world, shift-working environments.
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Affiliation(s)
- Jaime K Devine
- Operational Fatigue and Performance, Institutes for Behavior Resources, Baltimore, MD 21218, USA
| | - Nadine Cooper
- Human Factors, Royal Australian Navy Headquarters Fleet Air Arm HQFAA Albatross, Nowra Hill, NSW 2540, Australia
| | - Jake Choynowski
- Operational Fatigue and Performance, Institutes for Behavior Resources, Baltimore, MD 21218, USA
| | - Steven R Hursh
- Operational Fatigue and Performance, Institutes for Behavior Resources, Baltimore, MD 21218, USA
- Psychiatry and Behavioral Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Shattuck NL, Matsangas P. Recipe for fatigue: sleep, work patterns, and well-being of galley workers on surface ships of the US Navy. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae050. [PMID: 39135849 PMCID: PMC11317623 DOI: 10.1093/sleepadvances/zpae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/05/2024] [Indexed: 08/15/2024]
Abstract
Study Objectives The purpose of the study was to compare the fatigue levels, work/rest patterns, health-related behaviors, and well-being of galley workers with other sailors on US Navy ships while underway. Methods Analysis was based on a retrospective comparison of data from 3 fit-for-duty groups of sailors: 67 galley workers, 192 non-watchstanders, and 466 watchstanders. Participants completed questionnaires (Epworth Sleepiness Scale [ESS], Insomnia Severity Index [ISI], Pittsburgh Sleep Quality Index [PSQI], and Profile of Mood States [POMS]) and activity logs, and wore actigraphs. Results Galley workers slept MD = 6.57 (IQR = 1.42) h/d and worked MD = 12.8 (IQR = 2.42) h/d. Approximately 84% of the galley workers were classified as poor sleepers, ~57% reported having excessive daytime sleepiness (EDS), and ~38% reported elevated insomnia symptoms. Compared to non-watchstanders, galley workers had worse scores on POMS (total mood disturbance, tension-anxiety, depression, anger-hostility, fatigue, and confusion-bewilderment), ESS, ISI, and PSQI. Compared to non-watchstanders, galley workers had a higher risk for symptoms of EDS (75%), symptoms of clinically relevant insomnia (126%), and for being classified as poor sleepers (27%). Galley workers slept less and worked on average 2 h/d more than non-watchstanders. Compared to watchstanders, galley workers had worse ESS, ISI, and anger-hostility scores. More watchstanders napped compared to galley workers. Conclusions Although they are considered day workers, the sleep patterns, fatigue levels, and mood of galley workers are comparable to, or worse than, watchstanders or other non-watchstanders. To ameliorate the effects of long work hours on sailor well-being, ship leadership should consider adopting strategies to improve galley workers' well-being.
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Boivin DB, Boudreau P. Interindividual variability in coherence between self-reported alertness and performance in shift workers. Sleep Health 2024; 10:S63-S66. [PMID: 37914633 DOI: 10.1016/j.sleh.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Evidence indicates that self-reported measures of alertness do not always reflect performance impairments. The present study aims to explore whether subjective and objective measures of vigilance vary in the same direction in individuals working nights. METHODS A total of 76 police officers participated to a month-long observational study. They worked either a 2 or 3-shift system during which they self-reported alertness and completed a psychomotor vigilance task several times a day. RESULTS A reduction in alertness and reaction speed was observed with time awake. At the group level, changes in alertness and reaction speed with time awake were positively correlated during night shifts only. In 63.6% of the officers, changes were coherent between both variables. The other officers reported that their alertness dropped (25.5%) or improved (10.9%) whereas their performance changed in the opposite direction. CONCLUSION Significant interindividual variability exists in self-appraisal vigilance impairment due to night shift work.
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Affiliation(s)
- Diane B Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Quebec, Canada.
| | - Philippe Boudreau
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Quebec, Canada.
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Redfern N, Bilotta F. Fatigue in anesthesia workers. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744462. [PMID: 37690608 PMCID: PMC10877323 DOI: 10.1016/j.bjane.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Nancy Redfern
- Newcastle upon Tyne Hospitals, Department of Anaesthesia, Newcastle upon Tyne, UK.
| | - Federico Bilotta
- "Sapienza" University of Rome, Department of Anesthesiology and Critical Care, Rome, Italy
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Shechter A, Firew T, Miranda M, Fray N, Norful AA, Gonzalez A, Chang BP. Sleep Disturbance and Burnout in Emergency Department Health Care Workers. JAMA Netw Open 2023; 6:e2341910. [PMID: 37921770 PMCID: PMC10625040 DOI: 10.1001/jamanetworkopen.2023.41910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
This cross-sectional study examines the association of sleep disturbances with burnout among emergency medicine health care workers.
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Affiliation(s)
- Ari Shechter
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Tsion Firew
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
| | - Maody Miranda
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
| | - Nakesha Fray
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Alvis Gonzalez
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Bernard P. Chang
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York
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Johnson T, Gurubhagavatula I. Assessment of Vigilance and Fatigue. Sleep Med Clin 2023; 18:349-359. [PMID: 37532374 DOI: 10.1016/j.jsmc.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
This article summarizes the definitions of vigilance, fatigue, and sleepiness, as well as tools used in their assessment. Consideration is given to the strengths and limitations of the different subjective and objective tools. Future directions for research are also discussed, as well as the public health importance of continued investigation in this subject.
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Affiliation(s)
- Tyler Johnson
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, 3624 Market Street, Suite 205, Philadelphia, PA 19104, USA.
| | - Indira Gurubhagavatula
- Division of Sleep Medicine, Perelman School of Medicine, University of Pennsylvania, 3624 Market Street, Suite 205, Philadelphia, PA 19104, USA; Crescenz VA Medical Center, Philadelphia, PA, USA.
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Steffey MA, Risselada M, Scharf VF, Buote NJ, Zamprogno H, Winter AL, Griffon D. A narrative review of the impact of work hours and insufficient rest on job performance. Vet Surg 2023; 52:491-504. [PMID: 36802073 DOI: 10.1111/vsu.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 12/13/2022] [Accepted: 01/25/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. STUDY DESIGN Narrative review. METHODS Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. RESULTS Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. CONCLUSION Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. CLINICAL SIGNIFICANCE (OR IMPACT) A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.
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Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Marije Risselada
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Valery F Scharf
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Nicole J Buote
- Department of Clinical Science, Cornell University College of Veterinary Medicine, Ithaca, New York, USA
| | | | | | - Dominique Griffon
- Western University of Health Sciences, College of Veterinary Medicine, Pomona, California, USA
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Gusman E, Standlee J, Reid KJ, Wolfe LF. Work-Related Sleep Disorders: Causes and Impacts. Semin Respir Crit Care Med 2023; 44:385-395. [PMID: 37072022 DOI: 10.1055/s-0043-1767787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Insufficient sleep syndrome, shift work disorder, and obstructive sleep apnea (OSA) not only significantly impact the health of affected individuals, but also pose a threat to public safety. This article describes the clinical manifestations and impact of these sleep disorders, particularly as they pertain to workers' health and those with safety-sensitive positions. Sleep deprivation, circadian rhythm disruptions, and excessive daytime sleepiness-hallmarks of insufficient sleep, shift work disorder, and OSA, respectively-all lead to a series of cognitive deficits and impaired concentration that affect workers in a wide variety of fields. We describe the health consequences of these disorders along with treatment strategies, with a focus on current regulatory standards and the under-recognition of OSA in commercial drivers. Given its large scale, there is a need for improved guidelines and regulations for the screening, diagnosis, treatment, and long-term follow-up of OSA in commercial motor vehicle drivers. Increased recognition of the ways in which these sleep disorders impact workers will pave the way for significant improvements in occupational health and safety.
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Affiliation(s)
- Elen Gusman
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
| | - Jordan Standlee
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - Kathryn J Reid
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
| | - Lisa F Wolfe
- Department of Pulmonary and Critical Care Medicine, Northwestern Medicine, Chicago, Illinois
- Department of Neurology, Division of Sleep Medicine, Northwestern Medicine, Chicago, Illinois
- Center for Circadian and Sleep Medicine, Northwestern Medicine, Chicago, Illinois
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Stenson AR, Whitney P, Hinson JM, Hansen DA, Lawrence-Sidebottom D, Skeiky L, Riedy SM, Kurinec CA, Van Dongen HPA. Effects of total sleep deprivation on components of top-down attentional control using a flexible attentional control task. J Sleep Res 2023; 32:e13744. [PMID: 36205178 DOI: 10.1111/jsr.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/28/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
Sleep deprivation consistently decreases vigilant attention, which can lead to difficulty in performing a variety of cognitive tasks. However, sleep-deprived individuals may be able to compensate for degraded vigilant attention by means of top-down attentional control. We employed a novel task to measure the degree to which individuals overcome impairments in vigilant attention by using top-down attentional control, the Flexible Attentional Control Task (FACT). The FACT is a two-choice task that has trials with valid, invalid, and neutral cues, along with an unexpected switch in the probability of cue validity about halfway in the task. The task provides indices that isolate performance components reflecting vigilant attention and top-down attentional control. Twelve healthy young adults completed an in-laboratory study. After a baseline day, the subjects underwent 39 hours of total sleep deprivation (TSD), followed by a recovery day. The FACT was administered at 03:00, 11:00, and 19:00 during sleep deprivation (TSD condition) and at 11:00 and 19:00 after baseline sleep and at 11:00 after recovery sleep (rested condition). When rested, the subjects demonstrated both facilitation and interference effects on cued trials. While sleep deprived, the subjects showed vigilant attention deficits on neutral cue trials, and an impaired ability to reduce these deficits by using predictive contextual cues. Our results indicate that the FACT can dissociate vigilant attention from top-down attentional control. Furthermore, they show that during sleep deprivation, contextual cues help individuals to compensate partially for impairments in vigilant attention, but the effectiveness of top-down attentional control is diminished.
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Affiliation(s)
- Anthony R Stenson
- Department of Psychology, Washington State University, Pullman, Washington, USA
| | - Paul Whitney
- Department of Psychology, Washington State University, Pullman, Washington, USA.,Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - John M Hinson
- Department of Psychology, Washington State University, Pullman, Washington, USA.,Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Devon A Hansen
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | | | - Lillian Skeiky
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
| | - Samantha M Riedy
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Courtney A Kurinec
- Department of Psychology, Washington State University, Pullman, Washington, USA.,Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
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Sutherland C, Smallwood A, Wootten T, Redfern N. Fatigue and its impact on performance and health. Br J Hosp Med (Lond) 2023; 84:1-8. [PMID: 36848155 DOI: 10.12968/hmed.2022.0548] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
An increasing body of evidence suggests that fatigue among healthcare staff is widespread, owing to a combination of high work intensity, long daytime hours and night-shift working. This has been linked to poorer outcomes for patients and longer inpatient stays, and to increased risks of work-related accidents, errors and injuries for practitioners. These include needlestick injuries and motor vehicle accidents, and other impacts on practitioner health, ranging from cancer, mental health problems, metabolic disorders to coronary disease. Other 24-hour safety-critical industries have fatigue policies that acknowledge the risks of staff fatigue and provide a system to manage it and mitigate harm, but these are still lacking within healthcare. This review explains the basic physiology behind fatigue and outlines its impacts on healthcare practitioners' clinical practice and wellbeing. It proposes methods to minimise these effects for individuals, organisations and the wider UK health service.
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Affiliation(s)
- Ceri Sutherland
- Sleep Service, James Cook University NHS Foundation Trust, Middlesbrough, UK
| | - Aidan Smallwood
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tom Wootten
- Department of Intensive Care, Hawke's Bay Fallen Soldier's Memorial Hospital, Hastings, New Zealand
| | - Nancy Redfern
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Chinoy ED, Cuellar JA, Jameson JT, Markwald RR. Daytime Sleep-Tracking Performance of Four Commercial Wearable Devices During Unrestricted Home Sleep. Nat Sci Sleep 2023; 15:151-164. [PMID: 37032817 PMCID: PMC10075216 DOI: 10.2147/nss.s395732] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose Previous studies have found that many commercial wearable devices can accurately track sleep-wake patterns in laboratory or home settings. However, nearly all previous studies tested devices under conditions with fixed time in bed (TIB) and during nighttime sleep episodes only. Despite its relevance to shift workers and others with irregular sleep schedules, it is largely unknown how devices track daytime sleep. Therefore, we tested the sleep-tracking performance of four commercial wearable devices during unrestricted home daytime sleep. Participants and Methods Participants were 16 healthy young adults (6 men, 10 women; 26.6 ± 4.6 years, mean ± SD) with habitual daytime sleep schedules. Participants slept at home for 1 week under unrestricted conditions (ie, self-selecting TIB) using a set of four commercial wearable devices and completed reference sleep logs. Wearables included the Fatigue Science ReadiBand, Fitbit Inspire HR, Oura Ring, and Polar Vantage V Titan. Daytime sleep episode TIB biases and frequencies of missed and false-positive daytime sleep episodes were examined. Results TIB bias was low in general for all devices on most daytime sleep episodes, but some exhibited large biases (eg, >1 h). Total missed daytime sleep episodes were as follows: Fatigue Science: 3.6%; Fitbit: 4.8%; Oura: 6.0%; Polar: 37.3%. Missed episodes occurred most often when TIB was short (eg, naps <4 h). Conclusion When daytime sleep episodes were recorded, the devices generally exhibited similar performance for tracking TIB (ie, most episodes had low bias). However, the devices failed to detect some daytime episodes, which occurred most often when TIB was short, but varied across devices (especially Polar, which missed over one-third of episodes). Findings suggest that accurate daytime sleep tracking is largely achievable with commercial wearable devices. However, performance differences for missed recordings suggest that some devices vary in reliability (especially for naps), but improvements could likely be made with changes to algorithm sensitivities.
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Affiliation(s)
- Evan D Chinoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Joseph A Cuellar
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Leidos, Inc, San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Correspondence: Rachel R Markwald, Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA, Tel +1 619 767 4494, Email
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Chaput JP, Gariépy G, Pendharkar SR, Ayas NT, Samuels C, Vallières A, Davidson JR, Morin CM, Simonelli G, Bourguinat C, Gruber R, Petit D, Narang I, Viau V, Carrier J. National strategy on the integration of sleep and circadian rhythms into public health research and policies: Report from the Canadian Sleep and Circadian Network. Sleep Health 2022; 8:551-563. [PMID: 35963823 DOI: 10.1016/j.sleh.2022.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/16/2022] [Accepted: 06/09/2022] [Indexed: 10/15/2022]
Abstract
Scientists in sleep and circadian rhythms, public health experts, healthcare providers, partners, and stakeholders convened in 2020 for a 2-day meeting organized by the Canadian Sleep and Circadian Network to develop a national strategy for the integration of sleep and circadian rhythms into public health and policies in Canada. The objective of this paper is to present the national strategy that emerged from this meeting of 60 participants from across Canada. The meeting focused on 4 key target priorities: (1) atypical working schedules, (2) sleep and circadian rhythms of children and adolescents, (3) insomnia, and (4) impact of sleep apnea on health. Following constructive discussions over 2 days, it was decided that the following 4 strategic objectives should be prioritized to accelerate the integration of sleep and circadian rhythms into public health policies in Canada: (1) Increase public health sleep and circadian rhythm research, (2) Increase public health education and knowledge mobilization on sleep, (3) Inform and support public health sleep interventions and policies, and (4) Promote sleep health training. The participants recommended that research and public health efforts should address the needs along the continuum of sleep health. The committee noted that strategies and interventions could differ across contexts, settings, sectors, and jurisdictions. The national strategy also identified high-priority research questions in public health and recommended mechanisms to build research capacity, providing a path forward for the integration of sleep and circadian rhythms into public health research and policies.
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Affiliation(s)
- Jean-Philippe Chaput
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, Ontario, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Geneviève Gariépy
- École de santé publique, Département de médecine sociale et préventive, Université de Montréal, Montreal, Québec, Canada; Institut universitaire de santé mentale de Montréal, Montreal, Québec, Canada
| | - Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Najib T Ayas
- Department of Medicine, Respiratory and Critical Care Division, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles Samuels
- Centre for Sleep and Human Performance, Calgary, Alberta, Canada
| | - Annie Vallières
- École de Psychologie, Université Laval, Quebec City, Québec, Canada
| | - Judith R Davidson
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Charles M Morin
- École de Psychologie, Université Laval, Quebec City, Québec, Canada
| | - Guido Simonelli
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada
| | | | - Reut Gruber
- Attention, Behavior and Sleep Laboratory, Douglas Hospital Research Centre, Montreal, Québec, Canada; Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Dominique Petit
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de-Montréal, Montréal, Québec, Canada; Department of Psychiatry, Université de Montréal, Montreal, Québec, Canada
| | - Indra Narang
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Julie Carrier
- Département de psychologie, Université de Montréal, Montreal, Québec, Canada; Centre d'étude avancée en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada.
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13
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Fietze I, Rosenblum L, Salanitro M, Ibatov AD, Eliseeva MV, Penzel T, Brand D, Westermayer G. The Interplay Between Poor Sleep and Work-Related Health. Front Public Health 2022; 10:866750. [PMID: 35875041 PMCID: PMC9301247 DOI: 10.3389/fpubh.2022.866750] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Sleep disorders can arise from work. Employees who experience work overload are more likely to develop sleep problems. Poor sleep leads to decreased performance, sick leave, and accidents. Therefore, sleep disorders may be linked to workplace hazards as well as decreased occupational health, however, the relationship remains unknown. Methods This relationship was examined using secondary data analysis of aggregated survey data from 97 companies based in Germany between 2003 and 2020 as part of Workplace Health Management project. Two extreme groups with respect to sleep problems were analyzed (N = 4,865 + 9,795). The survey “Diagnosis of corporate health” contained 137 individual questions which recorded all relevant working conditions, aspects of health, and one question relating to insomnia traits. A one-way analysis of variance was used to examine whether and to what extent the potentials, hazards, and health aspects differed between employees depending on their perceived sleep problems. In addition, multiple linear regressions were used to determine whether and to what extent work characteristics affect various health aspects for both good and poor sleepers. Results In total, 49.7% of staff reported moderate difficulty falling and/or remaining asleep. These poor sleepers perceived all health potentials worse than good sleepers, especially on scales such as fair assessment, work climate, and learning at work. Furthermore, poor sleepers perceived health hazards (physical environmental stress, job insecurity, and time pressure) more whilst positive health indicators (joy of work and confidence) were perceived less. Conclusion Overall, the determination of sleep difficulties could be used as a substantial health indicator. Also, these sleep problems are reported more frequently in certain occupations compared to others, which could mean that the perception of sleep health varies between professions. Therefore, it is important to implement specific recommendations for each industry in order to improve working conditions for poor sleepers which in turn, improves their health.
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Affiliation(s)
- Ingo Fietze
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
- The Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
- *Correspondence: Ingo Fietze
| | - Lisa Rosenblum
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurophysics, Philipps-Universität Marburg, Marburg, Germany
| | - Matthew Salanitro
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Alexey Danilovich Ibatov
- The Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Marina Vladimirovna Eliseeva
- The Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Thomas Penzel
- Interdisciplinary Sleep Medicine Center, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Désirée Brand
- BGF Gesellschaft für Betriebliche Gesundheitsförderung mbH, Berlin, Germany
| | - Gerhard Westermayer
- The Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
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The Development, Implementation, and Feasibility of a Circadian, Light, and Sleep Skills Program for Shipboard Military Personnel (CLASS-SM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053093. [PMID: 35270786 PMCID: PMC8910671 DOI: 10.3390/ijerph19053093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7−9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.
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15
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Working around the Clock: Is a Person’s Endogenous Circadian Timing for Optimal Neurobehavioral Functioning Inherently Task-Dependent? Clocks Sleep 2022; 4:23-36. [PMID: 35225951 PMCID: PMC8883919 DOI: 10.3390/clockssleep4010005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/17/2022] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
Neurobehavioral task performance is modulated by the circadian and homeostatic processes of sleep/wake regulation. Biomathematical modeling of the temporal dynamics of these processes and their interaction allows for prospective prediction of performance impairment in shift-workers and provides a basis for fatigue risk management in 24/7 operations. It has been reported, however, that the impact of the circadian rhythm—and in particular its timing—is inherently task-dependent, which would have profound implications for our understanding of the temporal dynamics of neurobehavioral functioning and the accuracy of biomathematical model predictions. We investigated this issue in a laboratory study designed to unambiguously dissociate the influences of the circadian and homeostatic processes on neurobehavioral performance, as measured during a constant routine protocol preceded by three days on either a simulated night shift or a simulated day shift schedule. Neurobehavioral functions were measured every 3 h using three functionally distinct assays: a digit symbol substitution test, a psychomotor vigilance test, and the Karolinska Sleepiness Scale. After dissociating the circadian and homeostatic influences and accounting for inter-individual variability, peak circadian performance occurred in the late biological afternoon (in the “wake maintenance zone”) for all three neurobehavioral assays. Our results are incongruent with the idea of inherent task-dependent differences in the endogenous circadian impact on performance. Rather, our results suggest that neurobehavioral functions are under top-down circadian control, consistent with the way they are accounted for in extant biomathematical models.
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16
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Ropponen A, Koskinen A, Puttonen S, Ervasti J, Kivimäki M, Oksanen T, Härmä M, Karhula K. Working hours, on-call shifts, and risk of occupational injuries among hospital physicians: A case-crossover study. J Occup Health 2022; 64:e12322. [PMID: 35297542 PMCID: PMC9176712 DOI: 10.1002/1348-9585.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate the association of hospital physicians' working hours and on-call shifts with the risk of occupational injuries. METHODS In this nested cohort study of 556 Finnish hospital physicians, we linked electronic records from working-hour and on-call duty payroll data to occupational injury data obtained from the Finnish Workers' Compensation Center for the period 2005-2019. We used a case-crossover design with matched intervals for a 7-day 'case window' immediately prior to occupational injury and a 'control window' 7 days prior to the beginning of the case window, and analyzed their associations using conditional logistic regression models. RESULTS We noted 556 occupational injuries, 281 at the workplace and 275 while commuting. Having three to four long (>12 h) work shifts on the preceding 7 days was associated with a higher probability of an occupational injury (odds ratio [OR] 2.14, 95% confidence interval [CI] 1.11, 4.09), and the OR for three to four on-call shifts was 3.54 (95%CI 2.11, 5.92) in comparison to having none of these work shift types. A higher number of several consecutive working days was associated with a higher probability of injury in a dose-response manner. Moreover, increasing weekly working hours was associated with an increased likelihood of injury (OR 1.03, 95%CI 1.01, 1.04), whereas the number of normal (≤12 h) work shifts reduced this likelihood (OR 0.79, 95%CI 0.64, 0.98). CONCLUSIONS Our findings suggest that accumulated working-hour load, as opposed to single, very long (>24 h) work shifts, may increase the risk of occupational injury among hospital physicians.
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Affiliation(s)
- Annina Ropponen
- Finnish Institute of Occupational HealthHelsinkiFinland
- Division of Insurance MedicineDepartment of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Aki Koskinen
- Finnish Institute of Occupational HealthHelsinkiFinland
| | | | - Jenni Ervasti
- Finnish Institute of Occupational HealthHelsinkiFinland
| | - Mika Kivimäki
- Finnish Institute of Occupational HealthHelsinkiFinland
- ClinicumFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Epidemiology and Public HealthUniversity College LondonLondonUnited Kingdom
| | - Tuula Oksanen
- School of MedicineInstitute of Public Health and Clinical NutritionUniversity of Eastern FinlandKuopioFinland
| | - Mikko Härmä
- Finnish Institute of Occupational HealthHelsinkiFinland
| | - Kati Karhula
- Finnish Institute of Occupational HealthHelsinkiFinland
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17
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Basner M, Smith MG, McCauley P, Van Dongen HPA. Seasonal night-work with extended hours and transmeridian travel: An analysis of global fatigue-related sleigh crash risk. Sleep Health 2021; 8:3-6. [PMID: 34920975 DOI: 10.1016/j.sleh.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Mathias Basner
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Michael G Smith
- Unit for Experimental Psychiatry, Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Peter McCauley
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Hans P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA
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