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Hemati N, Satari S, Khazaie H, Salimi Y, Najafi F, Pasdar Y, Darbandi M. The mediating effect of sleep duration on metabolic syndrome severity in adults: a structural equation modeling approach. BMC Endocr Disord 2024; 24:75. [PMID: 38807076 PMCID: PMC11134647 DOI: 10.1186/s12902-024-01611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is associated to sleep duration. It is crucial to identify factors that disrupt sleep regulation. The study aimed to assess the indirect effect of risk factors related to MetS severity through sleep duration by utilizing a structural equation model (SEM). METHODS The study involving 3,935 adults from the baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study. MetS severity scores were the outcome variables. SEM was employed to explore the relationships, utilizing IBM SPSS and AMOS version 23. RESULTS The mean MetS severity score was higher in women compared to men (0.25 vs. 0.16, P = 0.003). In men, socioeconomic status (SES) has a positive direct effect (β = 0.048) and a negative indirect effect (β=-0.006) on MetS severity. Increased physical activity is directly (β=-0.036) and indirectly (β=-0.093) associated with reducing MetS severity. Nap duration is directly linked to an increase (β = 0.072) but has an indirect effect (β=-0.008) in decreasing MetS severity. In women, SES has a direct (β=-0.020) and indirect (β=-0.001) inverse relationship with MetS severity. Increased physical activity is directly (β=-0.048) and indirectly (β=-0.036) associated with decreasing MetS severity in women. Nap duration is directly associated with an increase in MetS severity (β=-0.018) but indirectly contributes to its reduction (β=-0.002). Sleep duration not only directly affects MetS severity but is also influenced by age, SES, physical activity, obesity and nap duration. CONCLUSION Physical activity, SES, and nap duration directly and indirectly effect the MetS severity. Sleep duration was recognized as a mediating variable that supports the indirect effects.
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Affiliation(s)
- Niloufar Hemati
- Internal Medicine Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shabnam Satari
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical sciences, Kermanshah, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Yahya Pasdar
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mitra Darbandi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Alameri RA, Almulla HA, Al Swyan AH, Hammad SS. Sleep quality and fatigue among nurses working in high-acuity clinical settings in Saudi Arabia: a cross-sectional study. BMC Nurs 2024; 23:51. [PMID: 38238714 PMCID: PMC10795399 DOI: 10.1186/s12912-023-01693-z] [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: 10/14/2023] [Accepted: 12/26/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Poor sleep quality is prevalent among nurses worldwide. Around two-thirds of nurses doing shift work are known to experience sleep problems and fatigue. Fatigue and sleep problems are linked to poor performance, impaired alertness, injuries, chronic diseases, compromised healthcare quality, and medical errors, all of which detrimentally impact nurses and threaten patients' safety. This area of research has received insufficient attention in Saudi Arabia; therefore, the purpose of this study was to examine the levels of sleep quality and perceived fatigue and their association among nurses working in acute care settings in comprehensive hospitals in Saudi Arabia. METHODS A descriptive cross-sectional study using the Pittsburgh Sleep Quality Index and Chalder Fatigue Scale. Data was obtained via an online questionnaire that was distributed to nurses using the QuestionPro platform through hospital administrators, social media (WhatsApp), and personal contact. RESULTS A total of 173 nurses completed the online survey. Most participants reported poor sleep quality (n = 127, 73.4%) and severe perceived fatigue (n = 156, 90.2%). Furthermore, the study revealed a significant correlation between the overall sleep disturbance and fatigue global scores (r = 0.57, P < 0.001), indicating that poor sleep quality was significantly associated with higher fatigue levels among the study sample. CONCLUSIONS The current study found a significant association between sleep quality and severe fatigue in nurses working in high acute care settings in Saudi Arabia. It is very clear from the results that nurses are experiencing poor sleep and severe fatigue, which in turn, will negatively impact the nurse's quality of life and patient safety.
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Affiliation(s)
- Rana Ali Alameri
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, King Faisal University, King Faisal Rd, Dammam, 34212, Saudi Arabia.
| | - Hebah A Almulla
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, King Faisal University, King Faisal Rd, Dammam, 34212, Saudi Arabia
| | - Afnan Hamad Al Swyan
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, King Faisal University, King Faisal Rd, Dammam, 34212, Saudi Arabia
| | - Sama S Hammad
- Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University, King Faisal University, King Faisal Rd, Dammam, 34212, Saudi Arabia
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Abate H, Letta S, Worku T, Tesfaye D, Amare E, Mechal A. Shiftwork sleep disorder and associated factors among nurses working at public hospitals in Harari Regional state and Dire Dawa Administration, Eastern Ethiopia: a cross-sectional study. BMC Nurs 2023; 22:118. [PMID: 37055815 PMCID: PMC10100203 DOI: 10.1186/s12912-023-01257-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/20/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Shiftwork sleep disorder is one of the most common health-related effects of Shiftwork, particularly among healthcare workers. It is a chronic condition that is directly related to a person's work schedule. In Ethiopia, although a mental health strategy is in place, little attention is given to studies that focus on shiftwork sleep disorders among nurses. This study aimed to determine the magnitude of shiftwork sleep disorder and associated factors among nurses working at public hospitals in Harari Regional State and the Dire Dawa Administration. METHODS Institutional based cross-sectional study was conducted from June 1-30, 2021 among 392 nurses selected by a simple random sampling technique. A structured interviewer-guided self-administered questionnaire was used for data collection. The International Classification of Sleep Disorders 3rd edition (ICSD-3), Bargen Insomnia Scale (BIS) and Epworth Sleepiness Scale were used to assess shift-work sleep disorder. The data were entered into EpiData and exported to SPSS for analysis. Bivariable logistic regression was used to see the association between the outcome and the explanatory variables. Bivariate and Multivariate analyses were performed, and AOR with 95% CI was used to measure the strength of the association. Those variables with a p-values of < 0.05 were considered as statistically significant. RESULTS In this study, the magnitude of shiftwork sleep disorder among nurses was 30.4% (95% CI: 25.4-34.5). Being female (AOR = 2.4, 95% CI: 1.3, 4.2), working an average number of nights > 11 per month in the last 12 months (AOR = 2.5, 95% CI: 1.3, 3.8), and khat use in the last 12 months (AOR = 4.9, 95% CI: 2.9, 8.7) were significantly associated with the shiftwork sleep disorder. CONCLUSIONS The study revealed that about one-third of the nurses had a shiftwork sleep disorder implying a high burden of the problem among nurses in the study setting, which endangers nurses, patients, and the healthcare system. Being female, working an average number of nights > 11 per month in the last 12 months, and khat use showed statistically significantly associated with the shiftwork sleep disorder. Early detection of shiftwork sleep disorder, having a policy on khat use and considering rest/recovery while scheduling work time should be addressed to prevent shiftwork sleep disorder.
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Affiliation(s)
- Henok Abate
- School of Nursing and Midwifery, College of Health Science and Medicine, Jigjiga University, Jigjiga, Ethiopia
| | - Shiferaw Letta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Eldana Amare
- Comprehensive Nursing Department, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Ayalnesh Mechal
- Comprehensive Nursing Department, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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4
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Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Dakanalis A, Vasios GK, Voulgaridou G, Pavlidou E, Mantzorou M, Giaginis C. Evaluating the Relationship between Circadian Rhythms and Sleep, Metabolic and Cardiovascular Disorders: Current Clinical Evidence in Human Studies. Metabolites 2023; 13:370. [PMID: 36984810 PMCID: PMC10057970 DOI: 10.3390/metabo13030370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Circadian rhythms are generated by the circadian clock, a self-sustained internal timing system that exhibits 24-h rhythms in the body. Many metabolic, cellular, behavioral and physiological processes are regulated by the circadian clock in coordination with environmental cues. The present study is a comprehensive review of the currently existing evidence concerning the relationship between circadian rhythms and sleep, metabolic, and cardiovascular disorders. We thoroughly searched the online databases PubMed, Scopus, and Web of Science to find the existing clinical studies from the last twenty-three years (2000-2023). Circadian misalignment was found to be associated with an increase in the risk of metabolic disorders, cardiovascular diseases, and obesity, as well as inadequate sleep quality. In this review article, all the included studies had a strength protocol design and all of them were conducted on humans. However, the most common limitations of them were the small sample size and the short time of the intervention. In conclusion, managing the factors that disrupt the optimal function of central and peripheral clocks can help to reduce the risk of metabolic and cardiovascular diseases, improving also sleep quality. Future studies should further explore the underlying mechanisms of the interconnections between circadian clocks and sleep, metabolic, and cardiovascular disorders. This may provide new opportunities for advance chronotherapy approach.
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Affiliation(s)
- Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Sousana K. Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Dimitrios Papandreou
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Maria Spanoudaki
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
- Clinical Dietetics & Nutrition Department of 424 General Military Hospital, New Efkarpia Ring Road, 56429 Thessaloniki, Greece
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 38, 20900 Monza, Italy
| | - Georgios K. Vasios
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Gavriela Voulgaridou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Eleni Pavlidou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Maria Mantzorou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Lemnos, Greece
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5
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Liu P, Wei D, Nie L, Fan K, Xu Q, Wang L, Wang J, Song Y, Wang M, Liu X, Hou J, Yu S, Li L, Wang C, Huo W, Fan C, Mao Z. The correlation between testosterone and stroke and the mediating role of blood pressure: The Henan rural cohort study. J Stroke Cerebrovasc Dis 2022; 31:106669. [PMID: 35985144 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106669] [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: 04/22/2022] [Revised: 06/27/2022] [Accepted: 07/17/2022] [Indexed: 10/15/2022] Open
Abstract
AIMS We aimed to investigate the association of serum testosterone with stroke and calculate the proportion explained by blood pressure on this association. MATERIALS AND METHODS A total of 6175 subjects were included in this study. Serum testosterone was quantified by liquid chromatography-tandem mass spectrometry. The logistic regression model was used to evaluate the association between serum testosterone and stroke. Linear regression analysis was used to assess the associations of serum testosterone with blood pressure. In addition, mediation analysis was performed to identify the mediation effects of blood pressure on the association of serum testosterone with stroke. Sex-stratified analysis was employed throughout the research. RESULTS After adjusting for multiple variables, serum testosterone levels were negatively associated with stroke in males (per 1 unit natural log-transformed, odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.69-0.94; Tertile 3 vs Tertile 1, OR = 0.65, 95% CI:0.44-0.96). Furthermore, blood pressure played a partial mediating role in the relationship between testosterone and stroke in males. The indirect effect/total effect of systolic blood pressure, diastolic blood pressure and mean arterial pressure were 7.37%, 9.54% and 9.22%, respectively. Notably, the relationship between testosterone and stroke and the role of blood pressure in regulating them was not observed in females. CONCLUSION This study describes that in rural Chinese males, testosterone can reduce the risk of stroke by affecting blood pressure. To some extent, we provide a new epidemiological evidence for the relationship between testosterone and stroke.
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Affiliation(s)
- Pengling Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Dandan Wei
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Luting Nie
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Keliang Fan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Qingqing Xu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Lulu Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Juan Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yu Song
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Mian Wang
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Songcheng Yu
- Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Linlin Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Occupational and Environmental Health Sciences, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Caini Fan
- Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou University People's Hospital,Henan University People's Hospital, Zhengzhou 450003, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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6
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Ahmadi SA, Tranmer JE, Ritonja JA, Flaten L, Topouza DG, Duan QL, Durocher F, Aronson KJ, Bhatti P. DNA methylation of circadian genes and markers of cardiometabolic risk in female hospital workers: An exploratory study. Chronobiol Int 2022; 39:735-746. [PMID: 35109725 DOI: 10.1080/07420528.2022.2032729] [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: 11/03/2022]
Abstract
Night shift work has been linked to increased risk of cardiovascular disease (CVD); however, the underlying mechanisms remain unclear. A compelling yet understudied mechanism involves differential DNA methylation of circadian genes. To investigate the relevance of this mechanism, we conducted an exploratory cross-sectional study of 74 female hospital personnel (38 day workers, 36 night shift workers). Sociodemographic, lifestyle, and health characteristics as well as shift work status and history were determined through self-report. Fasting blood samples were collected to measure markers of cardiometabolic risk and DNA was extracted to measure DNA methylation of 1150 cytosine-guanine (CpG) sites across 22 circadian genes. Associations between methylation levels at individual CpG sites (β-values) and markers of cardiometabolic risk were analyzed while considering effect modification by shift work status. The false discovery rate was applied to account for multiple comparisons (q ≤ 0.20). Two CpG sites [cg06758649 (CRY1) and cg06899802 (CSNK1A1)] were differentially associated with waist circumference and body mass index by shift work status, and eight CpG sites [cg26103512 (CSNK1D), cg03941313 (CSNK1E), cg18217763 (CSNK1E), cg16682686 (DEC1), cg12061096 (RORA), cg10133825 (RORA), cg19652148 (RORA), and cg22904654 (RORA)] were differentially associated with LDL cholesterol concentration by shift work status (all q ≤ 0.20). Our findings suggest that the relationship between DNA methylation of circadian genes and cardiometabolic risk differs by day and night shift worker status, which may contribute to mechanisms of increased risk of CVD observed among night shift workers.
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Affiliation(s)
- Salman A Ahmadi
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Joan E Tranmer
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,School of Nursing, Queen's University, Kingston, ON, Canada
| | - Jennifer A Ritonja
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Lisa Flaten
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Danai G Topouza
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Qing Ling Duan
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.,School of Computing, Queen's University, Kingston, ON, Canada
| | - Francine Durocher
- Chu de Québec-Université Laval Research Center (Endocrinology and Nephrology Division), Université Laval Cancer Research Center and Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Kristan J Aronson
- Department of Public Health Sciences, Queen's University, Kingston, ON, Canada.,Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, BC, Canada
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7
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Golding H, Ritonja JA, Day AG, Aronson KJ, Tranmer J. Modeling the relationship between shift work and cardiometabolic risk through circadian disruption, sleep and stress pathways. Chronobiol Int 2022; 39:704-713. [PMID: 35100920 DOI: 10.1080/07420528.2022.2032124] [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: 11/03/2022]
Abstract
The purpose of this study is to elucidate the multiple pathways linking shift work exposure to cardiometabolic risk (CMR) through the intermediates of circadian disruption, sleep disturbances, and stress. A cross-sectional study was conducted at Kingston Health Sciences Center that included female hospital workers, 160 who worked a day-only schedule and 168 who worked rotating days and nights. Participants completed questionnaires, a clinical exam, and wore accelerometers to collect sleep data for 8 days. Participants also collected urine samples at each void during a 24-h collection period, on the day shift for day-only workers and the night shift for rotating shift workers, for cortisol and melatonin measures. We adapted and tested a conceptual model proposed by Knutsson and Boggild for circadian disruption, sleep, and stress mechanistic pathways linking shift work to CMR using structural equation modeling techniques. Status as a rotating shift worker was associated with increased circadian disruption of cortisol and melatonin production compared to day-only workers (P < .001). Increased circadian disruption was associated with an increased CMR (P = .01). Rotating shift work was associated with sleep disturbances (P = .002) and increased job stress (P < .001), but neither was associated with CMR. We conclude that rotating shift work is associated indirectly with increased CMR. This association is mediated by circadian disruption as indicated by attenuated melatonin and cortisol, and flatter cortisol curves.
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Affiliation(s)
- Haley Golding
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jennifer A Ritonja
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Kristan J Aronson
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Joan Tranmer
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,School of Nursing, Queen's University, Kingston, Ontario, Canada
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8
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Boivin DB, Boudreau P, Kosmadopoulos A. Disturbance of the Circadian System in Shift Work and Its Health Impact. J Biol Rhythms 2021; 37:3-28. [PMID: 34969316 PMCID: PMC8832572 DOI: 10.1177/07487304211064218] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The various non-standard schedules required of shift workers force abrupt changes in the timing of sleep and light-dark exposure. These changes result in disturbances of the endogenous circadian system and its misalignment with the environment. Simulated night-shift experiments and field-based studies with shift workers both indicate that the circadian system is resistant to adaptation from a day- to a night-oriented schedule, as determined by a lack of substantial phase shifts over multiple days in centrally controlled rhythms, such as those of melatonin and cortisol. There is evidence that disruption of the circadian system caused by night-shift work results not only in a misalignment between the circadian system and the external light-dark cycle, but also in a state of internal desynchronization between various levels of the circadian system. This is the case between rhythms controlled by the central circadian pacemaker and clock genes expression in tissues such as peripheral blood mononuclear cells, hair follicle cells, and oral mucosa cells. The disruptive effects of atypical work schedules extend beyond the expression profile of canonical circadian clock genes and affects other transcripts of the human genome. In general, after several days of living at night, most rhythmic transcripts in the human genome remain adjusted to a day-oriented schedule, with dampened group amplitudes. In contrast to circadian clock genes and rhythmic transcripts, metabolomics studies revealed that most metabolites shift by several hours when working nights, thus leading to their misalignment with the circadian system. Altogether, these circadian and sleep-wake disturbances emphasize the all-encompassing impact of night-shift work, and can contribute to the increased risk of various medical conditions. Here, we review the latest scientific evidence regarding the effects of atypical work schedules on the circadian system, sleep and alertness of shift-working populations, and discuss their potential clinical impacts.
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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, Montreal, QC, Canada
| | - Philippe Boudreau
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Anastasi Kosmadopoulos
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
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9
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Shin S, Kim SH, Jeon B. Objective Assessment of Sleep Patterns among Night-Shift Workers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413236. [PMID: 34948844 PMCID: PMC8701940 DOI: 10.3390/ijerph182413236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
In this scoping review of the literature, we identified the types and the parameters of objective measurements to assess sleep patterns among night-shift workers. We conducted a literature search using electronic databases for studies published from 1991 to 2020 and charted and summarized key information. We included 32 studies in the review. Polysomnography was used in 6 studies and wearable sleep detection devices were utilized in 26 studies. The duration of sleep assessment using the wearable devices ranged from 1 day to ≥4 weeks, and more than half of the studies collected data for >2 weeks. The majority of the studies used subjective questionnaires, such as the Karolinska Sleepiness Scale, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index, in addition to objective sleep measurements. Total sleep time was the most common parameter, followed by sleep efficiency, sleep onset latency, and time or frequency of being awake. As the utilization of wearable devices to assess the sleep patterns of night-shift workers is expected to increase, further evaluation of device accuracy and precision, optimal data collection period, and key parameters is warranted.
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Affiliation(s)
- Seunghwa Shin
- Department of Nursing, Andong Science College, Kyungpook, Andong 36616, Korea;
| | - Su-Hyun Kim
- College of Nursing, Kyungpook National University, Daegu 41944, Korea;
- Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-420-4928; Fax: +82-53-421-2758
| | - Bomin Jeon
- College of Nursing, Kyungpook National University, Daegu 41944, Korea;
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10
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Chang WP, Li HB. Influence of shift work on rest-activity rhythms, sleep quality, and fatigue of female nurses. Chronobiol Int 2021; 39:557-568. [PMID: 34906006 DOI: 10.1080/07420528.2021.2005082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Female nurses working rotating shifts must change their daily routines often, which affects their biological circadian rhythms and could cause sleep disorders and fatigue. The objective of this study was to compare the sleep-wake rhythms, sleep quality, and fatigue of female nurses working rotating shifts and fixed day shifts and to analyze the factors that influence their fatigue. Participants comprised a shift worker group of 101 nurses and a day worker group of 76 nurses. Following the collection of basic information of the nurses and their scores in the various constructs of the Pittsburg Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS) questionnaire, each nurse wore an actigraph for seven consecutive days to collect for analysis the sleep-wake rhythm parameter dichotomy index (I < O) and durations of continuous sleep and wake. Multivariable linear regression was then used to determine whether the influence of various variables on fatigue differed between the two groups. Results revealed that the sleep-wake rhythm parameter I < O of the day worker group was significantly higher than that of the shift worker group (t = 5.08, p < .001). The shift worker group exhibited significantly higher PSQI global scores (t = -2.00, p = .047), longer total sleep time (t = 2.07, p = .040), poorer habitual sleep efficiency (t = -3.06, p = .003), and greater use of sleeping medication (t = -2.90, p = .004) than did the day worker group. Multivariable linear regression was performed to analyze the important predictors of the CIS score in the two groups with body mass index, age, work experience, marital status, educational background, department of employment, shift type at the time of recruitment, sleep-wake rhythm parameter I < O, and quality of sleep as independent variables. Results indicated that in the shift worker group, the overall explanatory power (R2) of the multivariable linear regression model was 22.9% (F = 3.01, p = .003), and only the PSQI global score (β = 0.33, p = .003) influenced the CIS score. In the day worker group, the various variables did not influence the CIS score in the multivariable linear regression model. Although the female nurses working rotating shifts spent more time in bed, their sleep-wake rhythms and sleep quality were poorer than those of the day worker group. Furthermore, the sleep quality of female nurses in the shift worker group had a significant impact on their fatigue. In other words, for female nurses who must work rotating shifts, sleep quality determines whether fatigue can be reduced. The shift-working nurses themselves should implement sleep management, such as avoiding disruptions to their sleep-wake rhythm and improving sleep quality, which should be effective strategies to reduce fatigue.
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Affiliation(s)
- Wen-Pei Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Hau-Bin Li
- Institute of Physics, Academia Sinica, Taipei, Taiwan
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11
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Night shift work and the risk of metabolic syndrome: Findings from an 8-year hospital cohort. PLoS One 2021; 16:e0261349. [PMID: 34898652 PMCID: PMC8668137 DOI: 10.1371/journal.pone.0261349] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/30/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Studies concerning the risk of metabolic syndrome associated with night work have shown inconsistent findings, due to imprecise working time data and cross-sectional design. We used register-based daily working time data to examine the risk of incident metabolic syndrome associated with night shift work. Methods Working time data collected between 2010 and 2018 of 5775 Taiwanese hospital workers were used to identify night shift workers and to calculate the number of night shifts. Metabolic syndrome was identified by annual occupational health examination results, which were linked to the working time data. Logistic regression models and generalized estimating equations were used to examine the association between night shift work and metabolic syndrome and the 5 components of metabolic syndrome. Results Night shift work is associated with a higher risk of developing metabolic syndrome (adjusted OR = 1.36, 95% CI = 1.04 to 1.78) and high waist circumference (adjusted OR = 1.27, 95% CI = 1.07 to 1.78) compared to day work. Among night shift workers, increased number of night shifts was associated with high blood pressure (adjusted OR = 1.15, 95% CI = 1.01 to 1.31). Conclusions Night shift work is associated with metabolic risk factors. Long-term effects of circadian rhythm disruption on metabolic disturbances needs to be further studied.
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12
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Serafin LI, Fukowska M, Zyskowska D, Olechowska J, Czarkowska-Pączek B. Impact of stress and coping strategies on insomnia among Polish novice nurses who are employed in their field while continuing their education: a cross-sectional study. BMJ Open 2021; 11:e049787. [PMID: 34857563 PMCID: PMC8640655 DOI: 10.1136/bmjopen-2021-049787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 11/09/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine to what degree particular coping strategies mediate the association between stress and insomnia in novice nurses who are employed while continuing their education and how type of education moderate the relationships between workplace stress, coping strategies and insomnia. METHODS A descriptive cross-sectional study was performed using an online questionnaire, which was completed by 159 novice registered nurses. The questionnaire comprised four components: Athens Insomnia Scale, Perceived Stress at Work (based on Perceived Stress Scale), Brief-Coping Orientation to Problem Experienced (COPE)and metrics with sociodemographic data questions. RESULTS Stress was found to be a significant predictor of insomnia among novice nurses. After adjusting the coping strategy, work stress ceased to be a significant predictor of insomnia. Among the strategies, the significant predictors that increased severity insomnia were acceptance, denial and self-blame. Predictors that decreased severity insomnia were use of emotional support and venting. Furthermore, the relationship between both active coping and self-distraction strategies and insomnia was significant for part-time students. CONCLUSIONS Insomnia is significant phenomena among novice nurses and are exacerbated by increased stress in the workplace. Choosing appropriate coping strategies for stress that are dependent on the individuals' activities significantly reduce the severity of insomnia caused by work stress.
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Affiliation(s)
| | - Maja Fukowska
- Department of Clinical Nursing, Medical University of Warsaw, Warszawa, Poland
| | - Diana Zyskowska
- Department of Clinical Nursing, Medical University of Warsaw, Warszawa, Poland
| | - Justyna Olechowska
- Department of Clinical Nursing, Medical University of Warsaw, Warszawa, Poland
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13
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Li J, Zhao D, Liu J, Wang M, Sun J, Liu J, Li Y, Deng Q, Qi Y. Association of apolipoprotein Cs with new-onset type 2 diabetes mellitus: findings from the Chinese multi-provincial cohort study. BMJ Open 2021; 11:e052388. [PMID: 34785554 PMCID: PMC8596042 DOI: 10.1136/bmjopen-2021-052388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Apolipoprotein Cs (apoCs), especially apoC-II and apoC-III, as the components of triglyceride-rich lipoproteins, play a key role in the pathophysiology of diabetes. However, prospective studies examining direct associations between apoCs and diabetes are not reproducible. The aim of this study was to evaluate the impact of apoCs on the risk of developing diabetes in a middle-aged population, and to explore possible mediators responsible for the relationship between apoCs and diabetes. DESIGN Prospective cohort study. SETTING Community-based study carried out in Beijing. METHODS ApoCs were measured in 1085 participants aged 45-74 years and free of type 2 diabetes mellitus (T2DM) at baseline from the Chinese Multi-Provincial Cohort Study-Beijing Project. Multivariate logistic regression was performed to examine the association of apoCs with a 5-year risk of new-onset T2DM. The impacts of triglycerides, insulin and high-sensitivity C reactive protein (hs-CRP) on the association between apoC-III and the risk of T2DM were explored by a mediation test. RESULTS During the 5 years of follow-up, 97 (8.9%) participants developed T2DM. ApoC-III was significantly associated with the risk of developing T2DM after multivariable adjustment (OR=1.40; 95% CI 1.07 to 1.82). This association was mainly mediated by triglyceride levels with a significant indirect effect (OR 1.61; 95% CI 1.19 to 2.18), followed by hs-CRP and insulin. CONCLUSIONS Our findings demonstrated that higher serum apoC-III was independently associated with increased 5-year risk of new-onset T2DM in the Chinese population, and triglyceride plays a crucial role in mediating this relationship. More attention should be paid to preventive strategies of T2DM targeting apoC-III.
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Affiliation(s)
- Jiangtao Li
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Miao Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jiayi Sun
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yan Li
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Qiuju Deng
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yue Qi
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
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14
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Shin S, Kim S. Rotating between day and night shifts: Factors influencing sleep patterns of hospital nurses. J Clin Nurs 2021; 30:3182-3193. [PMID: 34046951 DOI: 10.1111/jocn.15819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate sleep patterns of hospital nurses using a wearable electronic device and determine the influence of rotating day and night shifts and lifestyle factors on their sleep efficiency. BACKGROUND Nurses working in shifts are vulnerable to sleep disturbances. However, little is known about the influence of rotating day and night shift schedules and healthy lifestyle on nurses' daily sleep patterns. DESIGN Descriptive correlational design. METHODS Thirty-two hospital nurses working in shifts and 32 hospital nurses not working in shifts participated in data collection. Their sleep patterns were measured for six consecutive days using Fitbit Charge 3™ , and information on alcohol consumption, exercise, and eating habits were assessed using a questionnaire. Data were analysed using repeated measures analysis of variance with post hoc Scheffe's test and hierarchical multiple regression analysis. The study was conducted in accordance with the STROBE guideline. RESULTS Overall, nurses working on rotating day and night shifts had significantly shorter total sleep time, longer sleep onset latency, and lower sleep efficiency than those not working in shifts. In particular, nurses working for 3 or 4 consecutive night shifts had significantly shorter total sleep time, lower sleep efficiency and longer sleep onset latency than those working for 0-2 consecutive night shifts. Rotating day and night shifts and alcohol consumption significantly influenced sleep efficiency. CONCLUSIONS A work schedule of ≥3 consecutive night shifts and the habit of alcohol consumption before bed time influence nurses' sleep efficiency. RELEVANCE TO CLINICAL PRACTICE Given the poor sleep pattern among nurses working in shifts, particularly those working on ≥2 consecutive night shifts, it is necessary to develop an optimal shift schedule and a program to promote healthy lifestyle among hospital nurses.
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Affiliation(s)
- Seunghwa Shin
- Department of Nursing, Andong Science College, Kyungpook, Korea
| | - SuHyun Kim
- College of Nursing, Kyungpook National University, Daegu, Korea
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15
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Kervezee L, Gonzales-Aste F, Boudreau P, Boivin DB. The relationship between chronotype and sleep behavior during rotating shift work: a field study. Sleep 2021; 44:6128439. [PMID: 33538307 DOI: 10.1093/sleep/zsaa225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/17/2020] [Indexed: 01/13/2023] Open
Abstract
Shift work, an essential part of our 24/7 society, inevitably leads to displacement of the habitual sleep period and thereby to misalignment of the internal circadian timing system with the rest-activity cycle and the environment. How interindividual differences in circadian organization affect sleep duration and timing during rotating shift work is not fully understood. The objective of this study was to assess the effect of chronotype, shift type, and their interaction on actigraphy-based sleep behavior in 74 police officers (20 women and 54 men; age [mean ± SD]: 32.1 ± 5.4 years) involved in rotating shift work throughout a 28- to 35-day work cycle consisting of morning, evening, and night shifts. Using linear mixed modeling, we found that chronotype was associated with sleep duration depending on the shift type: increasing morningness was correlated with longer sleep duration during series of consecutive morning shifts, while increasing eveningness was correlated with longer sleep duration during series of evening shifts. During series of night shifts, increasing eveningness was associated with a longer duration of the main sleep episode, but this relationship was attenuated and no longer significant when naps were taken into account due to increased napping in morning chronotypes during series of night shifts. Providing a detailed within-subject characterization of sleep behavior across a complete work cycle consisting of morning, evening, and night shifts, this study advances the understanding of the relationship between chronotype and sleep in rotating shift workers and supports the implementation of work schedules that take into account chronobiological principles.
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Affiliation(s)
- Laura Kervezee
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada.,Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fernando Gonzales-Aste
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Phillipe Boudreau
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Diane B Boivin
- Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
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16
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Wang Y, Yu L, Gao Y, Jiang L, Yuan L, Wang P, Cao Y, Song X, Ge L, Ding G. Association between shift work or long working hours with metabolic syndrome: a systematic review and dose-response meta-analysis of observational studies. Chronobiol Int 2021; 38:318-333. [PMID: 33557625 DOI: 10.1080/07420528.2020.1797763] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This meta-analysis investigates the relationship between both shift work and long working hours and risk of developing metabolic syndrome (MetS). PubMed, EMBASE, and Web of Science databases were searched from the outset to December 10, 2019. Two reviewers independently screened studies, extracted data, and assessed the risk of bias of included studies. A total of 36 (30 cross-sectional, 5 cohort, and a nested case-control) studies, involving 274,263 participants, were included. The pooled odds ratio of shift work and development of MetS was 1.35 (95% confidence interval: 1.24-1.48), and the pooled odds ratio of long working hours and development of MetS was 1.19 (95% confidence interval: 0.97-1.46). In the subgroup analysis stratified by gender, the pooled odds ratios for male and female shift workers were 1.25 (95% confidence interval: 1.14-1.37) and 1.47 (95% confidence interval: 1.18-1.82), respectively. The dose-response (number of years of shift work and development of MetS) analysis showed the pooled odds ratio for 5 years of shift work was 1.07 (95% confidence interval: 1.05-1.09) and for 10 years of shift work 1.11 (95% confidence interval: 1.06-1.15). Our meta-analysis confirmed shift work is significantly associated with risk of metabolic syndrome, but the relationship between long working hours and MetS was not substantiated. Additionally, there was a nonlinear dose-response relationship between the number of years of shift work and risk of MetS, showing positive relationship to about 20 years of shift work but not for longer than 20 years. Prospective cohort studies regarding specific shift work schedules are needed to confirm these results.
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Affiliation(s)
- Yihui Wang
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Li Yu
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Yinyan Gao
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Lili Jiang
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Lin Yuan
- Department of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, Gansu, China
| | - Pengju Wang
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Yanwen Cao
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Xuping Song
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
| | - Long Ge
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China.,Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Gansu, China
| | - Guowu Ding
- Department of Social Medicine and Health Administration, School of Public Health, Lanzhou University, Gansu, China
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17
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Choshen-Hillel S, Ishqer A, Mahameed F, Reiter J, Gozal D, Gileles-Hillel A, Berger I. Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers. MEDICAL EDUCATION 2021; 55:174-184. [PMID: 32697336 PMCID: PMC7854866 DOI: 10.1111/medu.14296] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision-making. Medical professionals and specifically resident physicians, who are involved in long-term nightshift schedules during their post-graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute-on-chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. METHODS Thirty-three medical and surgical residents were evaluated twice - at baseline and after a 26-hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high-sensitivity C-reactive protein (hs-CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk-taking questionnaire and the Pittsburgh Sleep Quality Index. RESULTS Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs-CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk-taking tendencies which were assessed in a separate cohort. CONCLUSIONS In a real-life setting, resident physicians exhibit increased low-grade systemic inflammation (hs-CRP) and impaired HPA-axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short-term and potential long-term risks to physicians in training.
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Affiliation(s)
- Shoham Choshen-Hillel
- School of Business Administration and the Federmann Center for the Study of Rationality, Hebrew University of Jerusalem
| | - Ahmad Ishqer
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - Fadi Mahameed
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - Joel Reiter
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
| | - David Gozal
- Department of Child Health, MU Women’s and Children’s Hospital, University of Missouri School of Medicine
| | - Alex Gileles-Hillel
- Pediatric Pulmonary & Sleep Unit, Hadassah-Hebrew University Medical Center
- The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center
| | - Itai Berger
- Pediatric Neurology; Department of Pediatrics, Assuta-Ashdod University Medical Center
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva
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18
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Khosravipour M, Khanlari P, Khazaie S, Khosravipour H, Khazaie H. A systematic review and meta-analysis of the association between shift work and metabolic syndrome: The roles of sleep, gender, and type of shift work. Sleep Med Rev 2021; 57:101427. [PMID: 33556868 DOI: 10.1016/j.smrv.2021.101427] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 12/13/2022]
Abstract
This study was conducted to investigate the association between shift work and metabolic syndrome (MetS) and quantify the roles of sleep, gender, and type of shift work. We searched online databases, including PubMed, Scopus, and Web of Science on November 17, 2019. Of the 821 articles identified, 38 observational studies (27 cross-sectional, 10 cohorts, and one nested case-control), conducted on 128,416 participants, met our eligibility criteria. The pooled Odds ratio (OR) and 95% Confidence interval (CI) of MetS in shift-versus day-workers were estimated as 1.14 (1.07, 1.21) and 1.11 (1.06, 1.17) for the unadjusted and adjusted models. This association remained significant only for the studies with a cross-sectional design. There was a significantly higher odds of MetS in the studies conducted only on females (1.13 [1.06, 1.20]) or males (1.12 [1.02, 1.21]). The pooled adjusted OR (95% CI) for the studies without and with sleep adjustment was calculated as 1.14 (1.08, 1.21) and 1.29 (1.06, 1.52). We observed that rotating shift workers had stronger odds of MetS than the other shift workers. In conclusion, our findings revealed the significant odds of an association between shift work and MetS and different effects for sleep, gender, and type of shift work.
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Affiliation(s)
- Masoud Khosravipour
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Department of Occupational Health Engineering, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran; Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Payam Khanlari
- Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran; Department of Ergonomics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Sepideh Khazaie
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran; Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hadis Khosravipour
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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19
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FREQUENCY OF DAYTIME SLEEPINESS OF FACTORY WORKERS WORKING IN SHIFTS AND ITS EFFECT ON ANXIETY. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.720685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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20
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Chang WP, Jen HJ. BMI differences between different genders working fixed day shifts and rotating shifts: a literature review and meta-analysis. Chronobiol Int 2020; 37:1754-1765. [PMID: 32873091 DOI: 10.1080/07420528.2020.1800027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The objective of this study was to perform a systematic literature review and meta-analysis to understand the BMI differences between different genders working fixed day shifts and rotating shifts. The Pubmed, Medline, and Embase databases were searched using set keywords, thereby producing 42 studies. Study quality was assessed using appraisal criteria from the Joanna Briggs Institute (JBI), and meta-analysis was performed using Comprehensive Meta-Analysis Software (CMA) version 3. The indices were the means and standard deviations of BMI values from different genders working fixed day shifts and rotating shifts. The participants of the studies included a total of 43,193 individuals working rotating shifts and 185,875 individuals working fixed day shifts. The pooling effect size (SMD, standardized mean difference) presented was 0.19. The 95% confidence interval ranged from 0.10 to 0.281. The meta-regression analysis results showed that women had higher BMI values than men, the difference was statistically significant (p <.001). The heterogeneity test indicated statistically significant differences (p <.05), and the percentage of heterogeneity (I square) was 97.91%, which indicates that a high degree of heterogeneity exists among studies. A subgroup analysis by gender was conducted. For women, the pooling effect size was 0.25, and the 95% confidence interval ranged from 0.20 to 0.30. For men, the pooling effect size was 0.19, and the 95% confidence interval ranged from 0.05 to 0.33. This meta-analysis found that both women and men working rotating shifts have significantly higher BMI values than those working fixed day shifts. Finally, we divided the data into a cross-sectional group and a cohort group based on study design, and a meta-regression analysis conducted after controlling for age and nature of work variables revealed that in the cohort study, women presented higher BMI values than men, and the difference was statistically significant (p =.010). Thus, in terms of long-term effects, these results indicate that working rotating shifts exerts a greater impact on the BMI of women.
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Affiliation(s)
- Wen-Pei Chang
- School of Nursing, College of Nursing, Taipei Medical University , Taipei, Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University , New Taipei City, Taiwan
| | - Hsiu-Ju Jen
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University , New Taipei City, Taiwan
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21
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Pickel L, Sung HK. Feeding Rhythms and the Circadian Regulation of Metabolism. Front Nutr 2020; 7:39. [PMID: 32363197 PMCID: PMC7182033 DOI: 10.3389/fnut.2020.00039] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 03/20/2020] [Indexed: 12/16/2022] Open
Abstract
The molecular circadian clock regulates metabolic processes within the cell, and the alignment of these clocks between tissues is essential for the maintenance of metabolic homeostasis. The possibility of misalignment arises from the differential responsiveness of tissues to the environmental cues that synchronize the clock (zeitgebers). Although light is the dominant environmental cue for the master clock of the suprachiasmatic nucleus, many other tissues are sensitive to feeding and fasting. When rhythms of feeding behavior are altered, for example by shift work or the constant availability of highly palatable foods, strong feedback is sent to the peripheral molecular clocks. Varying degrees of phase shift can cause the systemic misalignment of metabolic processes. Moreover, when there is a misalignment between the endogenous rhythms in physiology and environmental inputs, such as feeding during the inactive phase, the body's ability to maintain homeostasis is impaired. The loss of phase coordination between the organism and environment, as well as internal misalignment between tissues, can produce cardiometabolic disease as a consequence. The aim of this review is to synthesize the work on the mechanisms and metabolic effects of circadian misalignment. The timing of food intake is highlighted as a powerful environmental cue with the potential to destroy or restore the synchrony of circadian rhythms in metabolism.
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Affiliation(s)
- Lauren Pickel
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Wang B, Liu L, Qiao D, Xue Y, Liu X, Zhang D, Liu C, Mao Z, Yu S, Shen F, Zhang Y, Wang C, Li W, Li X. The association between frequency of away-from home meals and type 2 diabetes mellitus in rural Chinese adults: the Henan Rural Cohort Study. Eur J Nutr 2020; 59:3815-3825. [DOI: 10.1007/s00394-020-02212-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 02/26/2020] [Indexed: 01/31/2023]
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23
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Zhang X, Li Y, Wang Y, Hu K, Tu R, Zhang H, Tian Z, Qiao D, Zhang G, Wang C. Contribution of serum lipids as effect modifiers to a relationship between mean arterial pressure and coronary heart disease in Chinese rural population: the Henan Rural Cohort Study. BMJ Open 2019; 9:e029179. [PMID: 31699722 PMCID: PMC6858237 DOI: 10.1136/bmjopen-2019-029179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between mean arterial pressure (MAP) and coronary heart disease (CHD) in Chinese rural population. In addition, we hypothesised that this relationship might be mediated by some degree of serum lipids. DESIGN This is a cross-sectional study. SETTING The participants were from the Henan Rural Cohort Study, initiated in five rural areas (Tongxu county of Kaifeng city, Yima county of Sanmenxia city, Suiping county of Zhumadian city, Xinxiang county of Xinxiang city and Yuzhou county of Xuchang city) in Henan Province, China, during July 2015 and September 2017. PARTICIPANTS The study included 39 020 subjects aged 18-79 years as current research population. OUTCOME MEASURES Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using an electronic sphygmomanometer. MAP was calculated by one-third SBP plus two-thirds DBP. The study used restricted cubic splines and logistic regression models to evaluate the ORs and 95% CIs. Mediation analysis using bootstrap was performed to examine the contribution of serum lipids to MAP-related CHD. RESULTS The adjusted OR (95% CI) for the highest MAP quartile with the risk of CHD was 1.45 (1.24 to 1.69) compared with the lowest quartile. Simultaneously, each 1-SD increment in MAP was significantly associated with a 12% increased risk of CHD. A linear dose-response relationship between MAP and CHD was found (p value for non-linear=0.1169) in the fully adjusted model. We further reported that 36.07% of proportion explained risk of CHD was mediated through serum lipids. CONCLUSIONS Increased MAP was a significant marker of CHD in Chinese rural population. Meanwhile, the relationship was mediated by some degree of serum lipids, and triglyceride was the strongest mediator. TRIAL REGISTRATION NUMBER Henan Rural Cohort study has been registered at Chinese Clinical Trial Register (ChiCTR-OOC-15006699) and the stage it relates to is Post-results.
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Affiliation(s)
- Xia Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, China
| | - Yanhua Wang
- Department of Encephalopathy District, The First Affiliated Hospital of Henan University of CM, Zhengzhou, Henan, China
| | - Kai Hu
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, Henan, China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhongyan Tian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Dou Qiao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Gongyuan Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
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24
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Shi Y, Liu L, Hamada T, Nowak JA, Giannakis M, Ma Y, Song M, Nevo D, Kosumi K, Gu M, Kim SA, Morikawa T, Wu K, Sui J, Papantoniou K, Wang M, Chan AT, Fuchs CS, Meyerhardt JA, Giovannucci E, Ogino S, Schernhammer ES, Nishihara R, Zhang X. Night-Shift Work Duration and Risk of Colorectal Cancer According to IRS1 and IRS2 Expression. Cancer Epidemiol Biomarkers Prev 2019; 29:133-140. [PMID: 31666286 DOI: 10.1158/1055-9965.epi-19-0325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/05/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We hypothesized that the risk of colorectal cancer in night-shift workers might be different according to insulin receptor substrate status. METHODS Among 77,470 eligible women having night work assessed in the Nurses' Health Study, we documented a total of 1,397 colorectal cancer cases, of which 304 or 308 had available data on IRS1 and IRS2, respectively. We used duplication-method Cox proportional hazards regression analysis for competing risks to calculate HRs and 95% confidence intervals (CI) for each colorectal cancer subtype. We measured tumor IRS1 or IRS2 expression by immunohistochemistry (IHC). RESULTS Compared with women who never worked night shifts, those working ≥15 years night shifts had a marginal trend of increased overall risk of colorectal cancer (P trend = 0.06; multivariable HR = 1.20; 95% CI, 0.99-1.45). Longer duration of night-shift work was associated with a higher risk of IRS2-positive tumors (multivariable HR = 2.69; 95% CI, 1.48-4.89; P trend = 0.001, ≥15 years night shifts vs. never) but not with IRS2-negative tumors (multivariable HR = 0.90; 95% CI, 0.54-1.51; P trend = 0.72; P heterogeneity for IRS2 = 0.008). Similarly, the corresponding multivariable HRs were 1.81 for IRS1-positive tumors (95% CI, 0.94-3.48; P trend = 0.06) and 1.13 for IRS1-negative tumors (95% CI, 0.71-1.80; P trend = 0.56; P heterogeneity for IRS1 = 0.02). CONCLUSIONS Our molecular pathologic epidemiology data suggest a potential role of IRS in mediating carcinogenesis induced by night-shift work. IMPACT Although these findings need validation, rotating night shift might increase colorectal cancer risk in women with abnormal insulin receptor pathways.
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Affiliation(s)
- Yan Shi
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology, Chinese PLA General Hospital, Beijing, China
| | - Li Liu
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology and Biostatistics, and the Ministry of Education Key Lab of Environment and Health, School of Public Health, Huazhong University of Science and Technology, Wuhan, China
| | - Tsuyoshi Hamada
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Jonathan A Nowak
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marios Giannakis
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts.,Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Yanan Ma
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning, China
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Nevo
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Keisuke Kosumi
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Mancang Gu
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Sun A Kim
- Laboratory of Human Carcinogenesis, NCI, NIH, Bethesda, Maryland
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jing Sui
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Kyriaki Papantoniou
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Andrew T Chan
- Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.,Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Charles S Fuchs
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Yale Cancer Center, New Haven, Connecticut.,Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Smilow Cancer Hospital, New Haven, Connecticut
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Edward Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shuji Ogino
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Reiko Nishihara
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts. .,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Broad Institute of Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, Massachusetts.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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25
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Mackay D, Mollard RC, Granger M, Bruce S, Blewett H, Carlberg J, Duhamel T, Eck P, Faucher P, Hamm NC, Khafipour E, Lix L, McMillan D, Myrie S, Ravandi A, Tangri N, Azad M, Jones PJH. The Manitoba Personalized Lifestyle Research (TMPLR) study protocol: a multicentre bidirectional observational cohort study with administrative health record linkage investigating the interactions between lifestyle and health in Manitoba, Canada. BMJ Open 2019; 9:e023318. [PMID: 31604781 PMCID: PMC6797260 DOI: 10.1136/bmjopen-2018-023318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lifestyle factors, such as diet, physical activity and sleep, are associated with the development of many chronic diseases. The objective of The Manitoba Personalized Lifestyle Research study is to understand how these lifestyle factors interact with each other and with other factors, such as an individual's genetics and gut microbiome, to influence health. METHODS An observational study of adults, with extensive phenotyping by objective health and lifestyle assessments, and retrospective assessment of early life experiences, with retrospective and prospective utilisation of secondary data from administrative health records. STUDY POPULATION A planned non-random convenience sample of 840 Manitobans aged 30-46 recruited from the general population, stratified by sex (equal men and women), body mass index (BMI; 60% of participants with a BMI>25 kg/m2) and geography (25% from rural areas). These stratifications were selected based on Manitoba demographics. MEASUREMENTS Lifestyle factors assessed will include dietary pattern, physical activity, cardiovascular fitness, and sleep. Factors such as medical history, socioeconomic status, alcohol and tobacco consumption, cognition, stress, anxiety, and early life experiences will also be documented. A maternal survey will be performed. Body composition and bone density will be measured by dual energy X-ray absorptiometry. Blood pressure, pulse wave velocity, and augmentation index will be measured on two consecutive days. Chronic disease risk biomarkers will be measured in blood and urine samples. DNA will be extracted for genetic analysis. A faecal sample will be collected for microbiome analysis. Participants may provide their Manitoba personal health information number to link their study data with administrative health records. ETHICS AND DISSEMINATION Ethics approval has been obtained from the University of Manitoba Health Research Ethics Board (protocol # HS18951; 05/01/2016). Data analysis, release of results and publication of manuscripts are scheduled to start in early 2019. Additional information at www.TMPLR.ca. TRIAL REGISTRATION NUMBER NCT03674957; Pre-results.
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Affiliation(s)
- Dylan Mackay
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Rebecca C Mollard
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Granger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharon Bruce
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Blewett
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Agriculture and Agri-Food Canada, Winnipeg, Manitoba, Canada
| | - Jared Carlberg
- Department of Agribusiness and Agricultural Economics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd Duhamel
- Health, Leisure and Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
| | - Peter Eck
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Patrick Faucher
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Naomi C Hamm
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Ehsan Khafipour
- Department of Animal Science, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Lisa Lix
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Diana McMillan
- Health, Leisure and Human Performance Research Institute, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba College of Nursing, Winnipeg, Manitoba, Canada
| | - Semone Myrie
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amir Ravandi
- Institute of Cardiovascular Sciences, St. Boniface General Hospital Albrechtsen Research Centre, Winnipeg, Manitoba, Canada
- Section of Cardiology, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
- Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada
| | - Meghan Azad
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter JH Jones
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Richardson Centre for Functional Foods and Nutraceuticals, University of Manitoba, Winnipeg, Manitoba, Canada
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26
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D'Ettorre G, Pellicani V, Greco M, Caroli A, Mazzotta M. Metabolic syndrome in shift healthcare workers. LA MEDICINA DEL LAVORO 2019; 110:285-292. [PMID: 31475690 PMCID: PMC7809991 DOI: 10.23749/mdl.v110i4.8350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022]
Abstract
Background: Shift work including night shifts is generally associated with chronic misalignment between the endogenous circadian timing system and behavior cycles, leading to metabolic disorders including metabolic syndrome (MS). Objectives: The purpose of this research was to analyze the latest developments in assessing and managing the occupational risk of MS in shift-healthcare workers (HCWs). Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the authors used MEDLINE/Pubmed to perform a systematic review of literature from January 2008 to December 2018. Results: Six studies were selected; the topics, discussed in order of frequency from highest to lowest, were: risk assessment, occurrence rates, and risk management. The main occupational determinants for MS were the cumulative shift work including night shifts and the number of nights worked per month per worker. With regard to cumulative lifetime exposure to shift work, the findings of our review suggest a dose–response relationship between increasing years of shift work history and MS in shift-HCWs. Conclusions: The findings suggest the need to better investigate the impact of sleep deprivation in the assessment of MS risk in shift-HCWs and clarify the role of such variables as confounders, mediators, or effect modifiers. Moreover, to date the data regarding management interventions focused on the risk of MS are inconsistent and therefore a special effort is required to detect strategic ways to minimize the likelihood of MS occurring in shift-HCWs.
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27
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Ritonja J, Tranmer J, Aronson KJ. The relationship between night work, chronotype, and cardiometabolic risk factors in female hospital employees. Chronobiol Int 2019; 36:616-628. [DOI: 10.1080/07420528.2019.1570247] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jennifer Ritonja
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Joan Tranmer
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- School of Nursing, Queen’s University, Kingston, Ontario, Canada
| | - Kristan J. Aronson
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, Ontario, Canada
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28
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Li Y, Hao Y, Fan F, Zhang B. The Role of Microbiome in Insomnia, Circadian Disturbance and Depression. Front Psychiatry 2018; 9:669. [PMID: 30568608 PMCID: PMC6290721 DOI: 10.3389/fpsyt.2018.00669] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Good sleep and mood are important for health and for keeping active. Numerous studies have suggested that the incidence of insomnia and depressive disorder are linked to biological rhythms, immune function, and nutrient metabolism, but the exact mechanism is not yet clear. There is considerable evidence showing that the gut microbiome not only affects the digestive, metabolic, and immune functions of the host but also regulates host sleep and mental states through the microbiome-gut-brain axis. Preliminary evidence indicates that microorganisms and circadian genes can interact with each other. The characteristics of the gastrointestinal microbiome and metabolism are related to the host's sleep and circadian rhythm. Moreover, emotion and physiological stress can also affect the composition of the gut microorganisms. The gut microbiome and inflammation may be linked to sleep loss, circadian misalignment, affective disorders, and metabolic disease. In this review article, we discuss various functions of the gut microbiome and how its activities interact with the circadian rhythms and emotions of the host. Exploring the effects of the gut microbiome on insomnia and depression will help further our understanding of the pathogenesis of mental disorders. It is therefore important to regulate and maintain a normal gastrointestinal micro-ecological environment in patients when treating mental disorders.
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Affiliation(s)
- Yuanyuan Li
- Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, and School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangdong, China
| | - Yanli Hao
- Department of Anatomy, Guangzhou Medical University, Guangdong, China
| | - Fang Fan
- Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, and School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangdong, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangdong, China
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29
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Hulsegge G, Loef B, van Kerkhof LW, Roenneberg T, van der Beek AJ, Proper KI. Shift work, sleep disturbances and social jetlag in healthcare workers. J Sleep Res 2018; 28:e12802. [DOI: 10.1111/jsr.12802] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/15/2018] [Accepted: 11/01/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Gerben Hulsegge
- Department of Public and Occupational Health; Amsterdam UMC; Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute; Amsterdam The Netherlands
| | - Bette Loef
- Department of Public and Occupational Health; Amsterdam UMC; Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute; Amsterdam The Netherlands
- Centre for Nutrition, Prevention and Health Services; National Institute for Public Health and the Environment; Bilthoven The Netherlands
| | - Linda W. van Kerkhof
- Center for Health Protection; National Institute for Public Health and the Environment, Bilthoven; Bilthoven The Netherlands
| | - Till Roenneberg
- Institute for Medical Psychology; Ludwig Maximilian University of Munich; Munich Germany
| | - Allard J. van der Beek
- Department of Public and Occupational Health; Amsterdam UMC; Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute; Amsterdam The Netherlands
| | - Karin I. Proper
- Centre for Nutrition, Prevention and Health Services; National Institute for Public Health and the Environment; Bilthoven The Netherlands
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30
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Kervezee L, Shechter A, Boivin DB. Impact of Shift Work on the Circadian Timing System and Health in Women. Sleep Med Clin 2018; 13:295-306. [PMID: 30098749 DOI: 10.1016/j.jsmc.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Women who do shift work are a sizable part of the workforce. Shift workers experience circadian misalignment due to shifted sleep periods, with potentially far-reaching health consequences, including elevated risk of sleep disturbances, metabolic disorders, and cancer. This review provides an overview of the circadian timing system and presents the sex differences that can be observed in the functioning of this system, which may account for the lower tolerance to shift work for women compared with men. Recent epidemiologic findings on female-specific health consequences of shift work are discussed.
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Affiliation(s)
- Laura Kervezee
- Department of Psychiatry, Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada
| | - Ari Shechter
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University, 622 West 168th Street, Room 9-300B, New York, NY 10032, USA
| | - Diane B Boivin
- Department of Psychiatry, Centre for Study and Treatment of Circadian Rhythms, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montreal, Quebec H4H 1R3, Canada.
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31
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Zhang H, Li Y, Mao Z, Liu M, Huo W, Liu R, Liu X, Tu R, Yang K, Qian X, Jiang J, Zhang X, Tian Z, Bie R, Wang C. A dose-response association of night sleep duration with hypertension in a Chinese rural population: the Henan Rural Cohort Study. ACTA ACUST UNITED AC 2018; 12:867-879.e3. [PMID: 30425019 DOI: 10.1016/j.jash.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 01/22/2023]
Abstract
The purpose of the study was to determine if there was a relationship between night sleep duration and hypertension, and to evaluate as to whether blood lipid levels played a role in this relationship. A total of 37,317 participants aged 18-79 years were included in this study. Night sleep duration was classified as <5, 5-, 6-, 7-, 8-, 9-, and ≥10 hours. Logistic regression and restricted cubic spline analysis was carried out to evaluate the association of sleep duration with hypertension. Compared with reference sleep duration (7 hours), in males, the multivariate odds ratios (ORs) (95% confidence interval [95% CI]) of the groups with longest sleep duration (≥10 hours) and shortest sleep duration (<5 hours) for hypertension was 1.52 (1.25-1.84) and 1.07 (0.80-1.44), respectively. Similarly, the longest sleep duration was associated with diagnosed hypertension (1.21, 1.00-1.45) in females. The OR for an indirect effect of sleep duration through low-density lipoprotein cholesterol (LDL-C) on hypertension was 1.085 (95% CI 1.038-1.137). Overall, a 3.5% possibility of hypertension being associated with sleep duration was attributable to LDL-C. In summary, a relationship between sleep duration and hypertension was observed in this rural population. LDL-C appeared to partially mediate the effect of sleep duration on hypertension in males.
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Affiliation(s)
- Haiqing Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Yuqian Li
- Department of Clinical Pharmacology, School of Pharmaceutical Science, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Min Liu
- Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruihua Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Kaili Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xinling Qian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jingjing Jiang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xia Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Zhongyan Tian
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ronghai Bie
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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Sun Q, Ji X, Zhou W, Liu J. Sleep problems in shift nurses: A brief review and recommendations at both individual and institutional levels. J Nurs Manag 2018; 27:10-18. [PMID: 30171641 DOI: 10.1111/jonm.12656] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/16/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Abstract
AIMS The purposes of this article are (a) to review briefly the current literature on shift nurses' sleep patterns, sleep quality, and the existing interventions implemented in nursing settings; and (b) to propose solutions that target individual nurses, nurse managers, and health care organisations to improve sleep health in shift nurses. BACKGROUND Sleep problems among shift nurses have been recognized increasingly as a significant issue at both the individual and organisational levels. However, the solutions are not well known. DESIGN Narrative review. METHODS A literature search was conducted using the following databases: CINAHL, PubMed, Embase, and Google Scholar from 1986 to 2016, to include original papers that reported studies on shift nurses' sleep problems and interventions. RESULTS Thirteen papers were included in this review, which all indicated associations between shift nurses' sleep problems and current intervention practices. Despite the higher prevalence of sleep problems in shift nurses compared to the general population, current interventional practices only focus on bright-light exposure, nap breaks, shift schedule rearrangement, and behavioural interventions. CONCLUSIONS To address shift nurses' poor sleep quality, we proposed two levels of approach for consideration-the individual level and the management/institutional level. The recommendations include: improving sleep hygiene; providing a low-stimulation sleep environment; conducting rigorous intervention studies to evaluate the effectiveness of a variety of therapies to deal with shift nurses' sleep disturbances; increasing awareness of sleep health of shift nurses; establishing a flexible rotating work schedule; and putting in place policies such as a 15-30 min nap break, social support, and a suitable working environment. IMPLICATIONS FOR NURSING MANAGEMENT With better awareness and understanding of shift nurses' sleep behaviours, effective interventions can be employed to improve shift nurses' sleep patterns and sleep quality to promote better emotional and health outcomes.
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Affiliation(s)
- Qiuzi Sun
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Nursing Administration, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaopeng Ji
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.,School of Nursing, University of Delaware, Newark, Delaware
| | - Wenqin Zhou
- Department of Nursing Administration, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianghong Liu
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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Ritonja J, Aronson KJ, Day AG, Korsiak J, Tranmer J. Investigating Cortisol Production and Pattern as Mediators in the Relationship Between Shift Work and Cardiometabolic Risk. Can J Cardiol 2018; 34:683-689. [DOI: 10.1016/j.cjca.2018.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/21/2018] [Accepted: 02/06/2018] [Indexed: 12/20/2022] Open
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