Overnight duty impairs behaviour, awake activity and sleep in medical doctors.

BACKGROUND: The impact of prolonged work cycles among senior doctors remains disputed. We evaluated the effects of overnight duty on awake activity and sleep quality in senior doctors in emergency medical specialties. METHODS: Thirty-six healthy doctors were monitored during a 2-week period including three separate 84 h on-call cycles. An on-call cycle consisted of the night and the day before night duty; the night duty itself and the subsequent 2 days and nights after night duty. The first day after night duty could either be worked or not. Actigraphy was used to measure physical activity and to evaluate sleep duration and quality. A standardized questionnaire was used to assess daytime performance and night sleep quality. RESULTS: Night actigraphy demonstrated that on-call work induced a significant reduction in sleep duration that was not recovered during the subsequent two nights. Sleep during the night duty itself was fragmented and of poor quality. Awake activity was significantly impaired on the day after night duty. Although subjectively night sleep quality did not differ between the nights before and after night duty, all subjective daytime parameters were impaired the day after night duty, and mood, fatigue and concentration remained altered on the second day. Working the day after night duty impaired objective measurements of daytime activity and sleep quality during the subsequent two nights. CONCLUSIONS: On-call night work in acute specialties induces sleep debt associated with prolonged impairment of awake activity, sleep quality and performance. Not working the following day after an on-call night allows partial recovery of sleep quality to begin.     

Comparison of exogenous melatonin versus placebo on sleep efficiency in emergency medicine residents working night shifts: A randomized trial

BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectiveness of melatonin versus placebo on sleep efficiency in emergency medicine (EM) residents.METHODS: A randomized, double-blind, replicated crossover trial was performed on EM residents. This study consisted of 4 phases within a month with intervention periods of 2 nights and washouts of 6 days. In our study, EM residents had nine-hour shifts on 6 consecutive days, 2 mornings, 2 evenings and 2 nights and then 2 days off. At the end of shifts’ cycle, 24 EM residents were given 3 mg melatonin or placebo (12 in each arm of the study) for 2 consecutive nights after the second night shift with crossover to the other arm after a six-day off drug. This crossover intervention was repeated for two more another time. Finally, we created 48 cases and comparisons in each arm. Different items related to sleep quality were assessed and compared both within the same group and between the two groups.RESULTS: In the melatonin group, daytime sleepiness (calculated by Karolinska Sleep Scale) had a significant reduction after taking the second dose of drug (P=0.003) but the same result was not observed when comparing the 2 groups. Mood status (calculated by Profile of Mood States) showed no remarkable difference between the 2 groups.CONCLUSION: Melatonin might have a limited benefit on sleep quality in EM residents working night shifts.     

Rotating Shiftwork Schedules: Can We Enhance Physician Adaptation to Night Shifts?

Objectives : To evaluate the effectiveness of a broad, literature-based night shiftwork intervention for enhancement of emergency physicians' (EPs') adaptation to night rotations. Methods : A prospective, double-blind, active placebo-controlled study was conducted on 6 attending physicians in a university hospital ED. Three data sets were collected under the following conditions: baseline, after active placebo intervention, and after experimental intervention. In each condition, data were collected when the physicians worked both night and day shifts. Measurements included ambulatory polysomnographic recordings of the main sleep periods, objective performance tests administered several times during the subjects' shifts, and daily subjective ratings of the subjects' sleep, moods, and intervention use. Results : The subjects slept an average of 5 hr 42 min across all conditions. After night shifts, the subjects slept significantly less than they did after day shifts (5 hr 13 min vs 6 hr 20 min; p < 0.05). The physicians' vigilance reaction times and times for intubation of a mannequin were significantly slower during night shifts than they were during day shifts (p = 0.007 and p < 0.04, respectively), but performances on ECG analysis did not significantly differ between night and day shifts. Mood ratings were significantly more negative during night shifts than they were during day shifts (more sluggish p < 0.04, less motivated p < 0.03, and less clear thinking p < 0.04). The strategies in the experimental intervention were used 85% of the time according to logbook entries. The experimental and active placebo interventions did not significantly improve the physician's performance, or mood on the night shift, although the subjects slept more after both interventions. Conclusions : Although the experimental intervention was successfully implemented, it failed to significantly improve attending physicians' sleep, performance, or mood on night shifts. A decrease in speed of intubation, vigilance reaction times, and subjective alertness was evident each time the physicians rotated through the night shift. These findings plus the limited sleep across all conditions and shifts suggest that circadian-mediated disruptions of waking neurobehavioral functions and sleep deprivation are problems in EPs.     

Circadian Profile of an Emergency Medicine Department: Scheduling Practices and Their Effects on Sleep and Performance

BackgroundShiftwork causes circadian disruption and is the primary reason for attrition from Emergency Medicine.ObjectivesWe aimed to develop concrete recommendations to mitigate negative effects of shiftwork based on measures of work, sleep, alertness, and performance in emergency physicians.MethodsThirty-one Emergency Medicine residents were surveyed retrospectively about sleep and alertness on different shifts. Additionally, the sleep, performance, and alertness of 22 Emergency Medicine resident and attending physicians was tracked continuously over 4 weeks via sleep logs, actigraphy, real-time reported sleepiness, and performance on a vigilance task. Schedules were analyzed for circadian disruption. Physicians also predicted their sleep schedules, which were compared with actual schedules; participants tracked extensions of shifts, schedule changes, and shifts in other hospitals.ResultsDaily rhythms were apparent in real-time performance and alertness data, with peaks at around 4 pm. Sleep difficulty was highest, sleep shortest, and alertness and performance lowest for night shifts. Emergency Medicine residents tended to cluster multiple night shifts in a row, despite evidence of accumulating sleep debt over consecutive shifts. There were many shifts that caused high circadian disruption, which could be avoided by simple amendments to scheduling practices.ConclusionsCircadian principles should be applied as suggested by the American College of Emergency Physicians. Chronotype should be considered in scheduling. Night shifts, particularly, should not be extended. Clustering all night shifts in a row should probably be discouraged. The additional vulnerabilities for night shift could be mitigated by adopting napping mid- or post night shift and by providing pay differentials.     

Testing Alertness of Emergency Physicians: A Novel Quantitative Measure of Alertness and Implications for Worker and Patient Care

BackgroundEstablishing practical solutions to manage fatigue in health care settings could reduce errors. Predictive Safety SRP Inc.’s AlertMeter is a 2-min cognitive assessment tool currently used in high-hazard industries to identify fatigued staff.ObjectiveNo prior study has attempted to address fatigue in emergency medicine (EM). We objectively assessed provider alertness to determine potential application of software-based fatigue recognition for risk reduction.MethodsIn a double-blind, prospective evaluation from July 1 to September 30, 2016, we applied the AlertMeter to EM residents at an academic level I trauma center. The tool was applied before and after shifts to evaluate alertness in three types of shifts: day, evening, and night. All residents were invited to participate—27 of 30 enrolled. Analysis of covariance (ANCOVA) was implemented to examine shift and completion effects on alertness score using baseline score as a covariate. Additionally, three separate ANCOVAs were conducted to examine alertness score differences between portion (start vs. end) and type of shift (day, evening, or night).ResultsResidents were significantly less alert at the completion of the evening shift. Scores at the end of the night shift were significantly lower than the start of the night shift.ConclusionsAlertness software can be reliably integrated into the emergency department. Alertness was lower at the end of the evening shift and end of the night shift. This work could have positive implications on shift and task scheduling and potentially reduce errors in patient care by quantifying providers’ fatigue and identifying areas for countermeasures.     

Sleep characteristics,exercise capacity and physical activity in patients with chronic fatigue syndrome

Abstract

Purpose: Unrefreshing sleep and lowered physical activity are commonly observed in chronic fatigue syndrome (CFS) patients, but how they might influence each other remains unexplored. Therefore, this study simultaneously examined the exercise capacity, sleep characteristics and physical activity in CFS patients. Methods: Handgrip strength and cycle exercise capacity were assessed in 42 female CFS patients and 24 inactive control subjects. During four consecutive days and nights, energy expenditure, activity and sleep–wake pattern were objectively registered using a Sensewear Armband. Results: Exercise capacity was significantly lower in CFS patients. In both groups VO₂peak correlated with the time subjects were physically active. In CFS patients only, VO₂peak correlated negatively with sleeping during the day whilst physical activity level and energy expenditure correlated negatively with sleep latency and lying awake at night. Conclusions: In the present study, CFS patients with higher VO₂peak tend to sleep less over day. Occupation in physical activities was negatively associated with sleep latency and lying awake at night. Increased physical activity potentially has beneficial effects on sleep quality in CFS. However, a close monitoring of the effects of increasing physical activity is essential to avoid negative effects on the health status of patients.

• Implications for Rehabilitation

• Female patients with chronic fatigue syndrome (CFS) have normal sleep latency and sleep efficiency, but sleep more and spent more time in bed as compared to healthy inactive women.

• Female CFS patients have lower exercise capacity, and a lower physical activity level as compared to healthy inactive women.

• CFS patients appear to be more sensitive for sleep quality (sleep latency and lying awake at night), which is associated with a low physical activity level.

     

Effects of Napping During Shift Work on Sleepiness and Performance in Emergency Medical Services Personnel and Similar Shift Workers: A Systematic Review and Meta-Analysis

Abstract

Background: Scheduled napping during work shifts may be an effective way to mitigate fatigue-related risk. This study aimed to critically review and synthesize existing literature on the impact of scheduled naps on fatigue-related outcomes for EMS personnel and similar shift worker groups. Methods: A systematic literature review was performed of the impact of a scheduled nap during shift work on EMS personnel or similar shift workers. The primary (critical) outcome of interest was EMS personnel safety. Secondary (important) outcomes were patient safety; personnel performance; acute states of fatigue, alertness, and sleepiness; indicators of sleep duration and/or quality; employee retention/turnover; indicators of long-term health; and cost to the system. Meta-analyses were performed to evaluate the impact of napping on a measure of personnel performance (the psychomotor vigilance test [PVT]) and measures of acute fatigue. Results: Of 4,660 unique records identified, 13 experimental studies were determined relevant and summarized. The effect of napping on reaction time measured at the end of shift was small and non-significant (SMD 0.12, 95% CI ?0.13 to 0.36; p = 0.34). Napping during work did not change reaction time from the beginning to the end of the shift (SMD ?0.01, 95% CI ?25.0 to 0.24; p = 0.96). Naps had a moderate, significant effect on sleepiness measured at the end of shift (SMD 0.40, 95% CI 0.09 to 0.72; p = 0.01). The difference in sleepiness from the start to the end of shift was moderate and statistically significant (SMD 0.41, 95% CI 0.09 to 0.72; p = 0.01). Conclusions: Reviewed literature indicated that scheduled naps at work improved performance and decreased fatigue in shift workers. Further research is required to identify the optimal timing and duration of scheduled naps to maximize the beneficial outcomes.     

Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy

Fatigue is the most prevalent and distressing symptom experienced by patients receiving adjuvant chemotherapy for early stage breast cancer. Higher fatigue levels have been related to sleep maintenance problems and low daytime activity in patients who have received chemotherapy, but knowledge describing these relationships prior to chemotherapy is sparse. The Piper Integrated Fatigue Model guided this study, which describes sleep/wake, activity/rest, circadian rhythms, and fatigue and how they interrelate in women with Stage I, II, or IIIA breast cancer during the 48 hours prior to the first adjuvant chemotherapy treatment. The present report describes these variables in 130 females, mean age=51.4 years; the majority were married and employed. Subjective sleep was measured by the Pittsburgh Sleep Quality Index and fatigue was measured by the Piper Fatigue Scale. Wrist actigraphy was used to objectively measure sleep/wake, activity/rest, and circadian rhythms. Mean Pittsburgh Sleep Quality Index score was 6.73+/-3.4, indicating poor sleep. Objective sleep/wake results were within normal limits established for healthy individuals, except for the number and length of night awakenings. Objective activity/rest results were within normal limits except for low mean daytime activity. Circadian rhythm mesor was 132.3 (24.6) and amplitude was 97.2 (22.8). Mean Piper Fatigue Scale score was 2.56+/-2, with 72% reporting mild fatigue. There were significant relationships between subjective and objective sleep, but no consistent patterns. Higher total and subscale fatigue scores were correlated with most components of poorer subjective sleep quality (r=0.25-0.42, P< or =0.005).     

Systematic Review and Meta-analysis of the Effects of Caffeine in Fatigued Shift Workers: Implications for Emergency Medical Services Personnel

Abstract

Background: Emergency Medical Services (EMS) workers may experience fatigue as a consequence of shift work. We reviewed the literature to determine the impact of caffeine as a countermeasure to fatigue in EMS personnel and related shift workers. Methods: We employed the GRADE methodology to perform a systematic literature review and search multiple databases for research that examined the impact of caffeine on outcomes of interest, such as patient and EMS personnel safety. For selected outcomes, we performed a meta-analysis of pooled data and reported the pooled effect in the form of a Standardized Mean Difference (SMD) with corresponding 95% confidence intervals. Results: There are no studies that investigate caffeine use and its effects on EMS workers or on patient safety. Four of 8 studies in shift workers showed that caffeine improved psychomotor vigilance, which is important for performance. Caffeine decreased the number of lapses on a standardized test of performance [SMD = 0.75 (95% CI: 0.30 to 1.19), p = 0.001], and lessened the slowing of reaction time at the end of shifts [SMD = 0.52 (95% CI: 0.19 to 0.85); p = 0.002]. Finally, 2 studies reported that caffeine reduced sleep quality and sleep duration. Conclusions: Although the quality of evidence was judged to be low to moderate, when taken together, these studies demonstrate that caffeine can improve psychomotor performance and vigilance. However, caffeine negatively affects sleep quality and sleep duration. More systematic, randomized studies need to be conducted in EMS workers in order to address the critical outcomes of health and safety of EMS personnel and patients. The risk/benefit ratio of chronic caffeine use in shift workers is currently unknown.     

Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer

Goals Previous investigations have shown that women undergoing chemotherapy for breast cancer experience both disturbed sleep and fatigue. However, most of the previous research examined women either during or after chemotherapy. This study examined sleep, fatigue, and circadian rhythms in women with breast cancer before the start of chemotherapy.Patients and methods Eighty five women with Stages I–IIIA breast cancer who were scheduled to begin adjuvant or neoadjuvant anthracycline-based chemotherapy participated. Each had sleep/wake activity recorded with actigraphy for 72 consecutive hours and filled out questionnaires on sleep, fatigue, depression, and functional outcome.Main results On average, the women slept for about 6 h a night and napped for over an hour during the day. Sleep was reported to be disturbed and fatigue levels were high. Circadian rhythms were robust, but women who were more phase-delayed reported more daily dysfunction (p<0.01).Conclusions The data from the current study suggest that the women with breast cancer likely experience both disturbed sleep and fatigue before the beginning of chemotherapy. Although their circadian rhythms are robust, breast cancer patients with more delayed rhythms experience more daily dysfunction secondary to fatigue. These data suggest that strategies to improve disturbed sleep and to phase-advance circadian rhythms prior to initiation of chemotherapy may be beneficial in improving daily function in breast cancer patients.     

Sleep patterns and fatigue in new mothers and fathers

The purpose of this study was to describe the sleep patterns and fatigue of both mothers and fathers before and after childbirth. The authors used wrist actigraphy and questionnaires to estimate sleep and fatigue in 72 couples during their last month of pregnancy and 1st month postpartum. Both parents experienced more sleep disruption at night during the postpartum period as compared to the last month of pregnancy. Compared to fathers, with their stable 24-h sleep patterns over time, mothers had less sleep at night and more sleep during the day after the baby was born. Sleep patterns were also related to parents' work status and type of infant feeding. Both parents self-reported more sleep disturbance and fatigue during the 1st month postpartum than during pregnancy. Mothers reported more sleep disturbance than fathers, but there was no gender difference in ratings of fatigue. At both time points, fathers obtained less total sleep than mothers when sleep was objectively measured throughout the entire 24-h day. Further research is needed to determine the duration of sleep loss for both mothers and fathers, to evaluate the effect of disrupted sleep and sleep loss on psychosocial functioning and job performance, and to develop interventions for improving sleep patterns of new parents.     

Self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction of female nurses working different combination of shifts

AIM: The aim of this study was to describe and compare the self-assessed quality of sleep, occupational health, working environment, illness experience and job satisfaction among female nurses working different combinations of shifts. BACKGROUND: Evidence from several studies indicates that there is an association between the disruption of the circadian cycle caused by shift work and adverse health effects. METHODS: A cross-sectional design was used with a sample of 348 nurses drawn from the registry of the Icelandic Nurses' Association, representing 17% of the workforce of Icelandic nurses. A self-administered questionnaire, measuring occupational health, quality of sleep, the illness experience, job satisfaction and working environment was used. Data were analysed according to type of shift (days only, rotating days/evenings, rotating days/evenings/nights) by use of analysis of variance and chi-square. RESULTS: No difference was found between participants based on type of shift with regard to the illness experience, job satisfaction and quality of sleep. Nurses working rotating day/evening/night shifts reported a longer working day, more stressful environmental risk factors, more strenuous work and that they were less able to control their work-pace. In general, the nurses reported low severity of symptoms; however, nurses working rotating days/evenings shifts experienced more severe gastrointestinal and musculoskeletal symptoms when compared with others. This was explained by the short rest period provided for between evening and morning shifts. CONCLUSIONS: In general Icelandic nurses are satisfied with their work and their shift assignment does not seem to pathologically disrupt their circadian cycle. Nevertheless, nursing directors are advised to look more closely at the organization of nurses' work during night shifts, as well as the rest period for nurses changing from evening to day shifts.     

Transient Effects of Sleep on Next-Day Pain and Fatigue in Older Adults With Symptomatic Osteoarthritis

Poor sleep quality has been associated with greater pain and fatigue in people living with osteoarthritis (OA). The objective of this micro-longitudinal study was to determine whether sleep impacts the diurnal pattern of next-day OA-related pain and fatigue. Community-dwelling older adults (≥65 years) with hip and/or knee OA provided data over 5 days using daily diaries and wrist-worn actigraphs. Pain and fatigue intensity were measured on awakening, at 11 am, 3 pm, 7 pm, and bedtime. Subjective previous night sleep quality was measured on awakening. Multilevel linear regression models examined interactions between sleep variables and time of next-day symptom reports. One hundred sixty participants provided 785 days of data (median age = 71 years; 62% female). Analysis of time interaction effects identified an association between poor sleep quality and more morning pain and fatigue. Although the effect on awakening was more pronounced for fatigue, differences in both symptoms attributable to sleep quality attenuated as the day progressed. Investigation of actigraphy-based sleep parameters revealed no significant interactions with time of symptom measurement. These findings observed in a sample of older adults with mild-to-moderate OA symptoms warrant further investigation in a sample with more severe symptoms and more pronounced sleep dysfunction and/or sleep disorders.PerspectiveThis article investigates the impact of sleep on next-day pain and fatigue of older adults with OA. On awakening from a night of poor quality sleep, pain and fatigue intensity were heightened. However, the effect was not sustained throughout the day, suggesting the morning may be an optimal time for symptom interventions.     

Lorazepam-efficacy, side effects, and rebound phenomena

Lorazepam, 4 mg, was evaluated in an 18-night sleep-laboratory study involving five insomniac subjects. Hypnotic effectiveness and effects on sleep stages and related parameters were assessed. Placebo was given on baseline nights 1 to 4, lorazepam on nights 5 to 11, and placebo was given again on withdrawal nights 12 to 18. Subjective and objective data clearly demonstrated that lorazepam was effective for both inducing and maintaining sleep. Sleep latency was reduced from a baseline value of 34.6 min to 17.9 min (P less than 0.01) and total wake time was reduced from 75.9 to 38.5 min (P less than 0.01). On the third and fifth nights of drug withdrawal total wake time rose above baseline levels (termed rebound insomnia) and sleep latency increased by 77% and 60% over baseline (P less than 0.01). Subjective estimates of daytime anxiety also increased above baseline (rebound anxiety) during the withdrawal period. All subjects experienced severe hangover and varying degrees of impaired functioning during the first 3 days on drug. Three subjects also experienced anterograde amnesia during the day after the first drug night. These side effects diminished in intensity over the course of the study. Our results suggest that while 4 mg lorazepam may be effective in inducing and maintaining sleep, this dose induces clinically significant side effects that are followed by consistent rebound phenomena after withdrawal.     

Modafinil [2-[(diphenylmethyl)sulfinyl]acetamide] and circadian rhythms in syrian hamsters: assessment of the chronobiotic potential of a novel alerting compound

In Syrian hamsters, behavioral procedures for inducing arousal (e.g., running in a novel wheel or gentle handling) can shift circadian rhythms when applied during the usual sleep period ("subjective day") and can attenuate phase shifts to light during the active period ("subjective night"). This raises the possibility that drugs that affect behavioral state may have "chronobiotic" potential. We characterized the effects of modafinil (2-[(diphenylmethyl)sulfinyl]acetamide), an atypical alerting compound, on circadian rhythms in male Syrian hamsters. Electroencephalogram recordings and video observations confirmed that modafinil dose dependently increases wakefulness at the expense of slow-wave and paradoxical sleep with no increase in locomotor activity per unit of time awake. Despite inducing arousal, modafinil at these doses (150 or 300 mg/kg), administered in the subjective day or early or late in the subjective night, did not perturb circadian phase. Modafinil (300 mg/kg) also had no effect on phase shifts to light exposure either early or late in the night and did not alter the size of phase shifts induced by running in a novel wheel for 3 h during the mid-day. Modafinil (300 mg/kg) did, however, decrease by approximately 50% the amount of novel wheel-stimulated running, moving leftward the dose-response relation between wheel revolutions and shift magnitude. These results indicate that, in Syrian hamsters, modafinil alone has no significant chronobiotic efficacy. Nevertheless, this agent may increase the sensitivity of the circadian pacemaker to nonphotic stimuli and may thus have some potential as a tool for promoting clock resetting in combination with behavioral strategies.     

Individualizing therapy for early, middle-of-the-night and late-night insomnia

Many patients with insomnia describe their sleep problems as an inability to remain asleep throughout the night, resulting in next-day fatigue that may adversely affect daytime functioning. To be most effective, insomnia treatment should be tailored to resolving underlying causes of the condition and managing specific sleep complaints. Therefore, hypnotic therapy administered prior to bedtime, as is currently recommended for most compounds, is not appropriate for all insomnia patients. Ideally, behavioral interventions should be combined with a rapid-acting agent that can be administered at virtually any time during the night without producing residual effects the following day. Zaleplon, a new non-benzodiazepine sleep medication, provides the clinician with an effective and safe pharmacotherapeutic option for insomnia management. Its rapid rates of absorption and elimination allow for treatment of symptoms when they occur, either at bedtime or later at night, without incurring significant risk for the development of next-day impairment of psychomotor and cognitive functioning.     

Correction of sleep disorders and efficacy of antihypertensive monotherapy in elderly patients: use of ivadal]

AIM: To assess effects of ivadal (zolpidem) on arterial pressure (AP) in the cycle sleep-awake in aged patients with insomnia who have failed hypotensive monotherapy with different drugs, i.e. whose AP remained abnormal at night. MATERIALS AND METHODS: The trial included 25 aged patients (17 females, 8 males, mean age 66.4 +/- 3.7 years) with isolated systolic arterial hypertension (AH) of the first-second degree (WHO classification, 1999) and insomnia. AH duration averaged 8.7 +/- 3.7 years. All the patients have received antihypertensive monotherapy. As shown by the initial 24-h monitoring, patients with elevated night AP had significantly lower mean score by the questionnaire "Subjective Sleep Characteristics" and more frequently suffer from insomnia. These patients were given a hypnotic drug ivadal (zolpidem) in a single daily dose 5 mg in the evening for 10 days. On the treatment night 10 monitoring of AP was repeated. RESULTS: Ivadal treatment has significantly improved all the subjective parameters of sleep and 24-h AP profile, lowered sleep and awake AP. CONCLUSION: Ivadal treatment raises efficacy of a hypotensive monotherapy in aged patients with isolated systolic AH and insomnia.     

ICU护士工作反应时间现况及影响因素分析

目的 :比较可反映工作执行力的客观指标反应时间在ICU护士白、夜班上班前和下班后之间的差异及其影响因素。方法 :采用便利抽样法选取2家医院6个ICU的118名护士,通过自设一般资料问卷进行调查,使用精神运动警觉测试仪器实施测量。结果 :护士下班后(白班后为296.75 ms,夜班后为310.25 ms)反应时间均长于上班前(白班前为290.64 ms,夜班前为288.44 ms),夜班后(310.25 ms)长于白班后(296.75 ms),差异有统计学意义(P<0.05)。存在睡眠障碍的护士,夜班前(299.64 ms)及夜班后(363.33 ms)的反应时间均长于无睡眠障碍组(夜班前为285.56 ms,夜班后为306.40 ms)(P<0.05)。性别、孩子个数、医院工作年限、日工作时长、摄入咖啡因饮料、摄入甜品会对ICU护士上班前后反应时间产生不同程度的影响。结论 :建议护理管理者合理运用反应时间指标改善排班方法,识别其保护因素和危险因素,提高ICU护士工作执行能力。     

The effects of nightwork on psychological changes during the menstrual cycle

This study investigated whether the temporal stress of working at night interferes with nurses' experience of different phases of the menstrual cycle Twenty-four, rotatmg-shift nurses recorded data on a hand-held computer at the start and end of each day and every 2 hours during their shifts for a period of 28 days The measures included a sleep diary, self-ratings of mood and symptoms, and two cognitive performance tasks Using a pooled time series analysis, it was found that some of the self-report measures showed a significant interaction between type of shift worked and menstrual cycle phase For example, alertness was found to be lower towards the end of the night shift during the premenstrual phase compared to other phase and shift combinations However, some of the measures showed only main effects of cycle phase or were nonsignificant Retrospective measures from a larger sample showed an association between the number of nights worked per year and duration of premenstrual and menstrual problems, and seventy of premenstrual problems The results suggest that nightwork may alter some aspects of nurses' psychological experience of the menstrual cycle