Purpose This study aimed to explore the association between sleep quality and subjective fatigue in nurses who performed rotational-shift work. Methods A cross-sectional survey was conducted and included nurses working day and night shifts (n = 35) at Toyama University Hospital in Japan. To examine the influence of sleep quality on subjective fatigue, participants were categorized as poor (n = 23) or good (n = 12) sleepers. They assessed their own sleep status using the St Mary's Hospital Sleep Questionnaire and subjective fatigue following shift changes (holiday to day shift, day shift to day shift, before night shift, after night shift, and day shift to holiday). Results Poor sleepers' State-Trait Anxiety Inventory scores were higher relative to those of good sleepers. Moreover, good sleepers recovered from subjective fatigue after sleep following all shift changes. Poor sleepers' subjective fatigue also reduced after sleep following 'before night shift', 'after night shift', and 'day shift to holiday' shift changes but not 'holiday to day shift' or 'day shift to day shift' shift changes. Sleep duration was stable across shift changes in good sleepers, and poor sleepers' sleep durations were significantly longer following 'before night shift', 'after night shift', and 'day shift to holiday' shift changes relative to those following 'holiday to day shift' and 'day shift to day shift' shift changes. Conclusions The results suggested that poor sleepers' subjective fatigue following 'before night shift', 'after night shift', and 'day shift to holiday' could be reduced by increasing sleep duration, indicating that it is important to ensure sufficient sleep duration to improve all nurses' sleep quality and reduce poor sleepers' subjective fatigue. Furthermore, sufficient relaxation at bedtime and the reduction of anxiety are important in maintaining good sleep quality.
Sleep is a physiological state that plays important role in the recovery of fatigue. However, the relationship between the physiological status of sleep and subjective fatigue remains unknown. In the present study, we hypothesized that the non-recovery of fatigue at wake time due to non-restorative sleep might be ascribed to changes in specific parameters of electroencephalography (EEG) and heart rate variability (HRV) in poor sleepers. Twenty healthy female shift-working nurses participated in the study. Subjective fatigue was assessed using the visual analog scale (VAS) at bedtime and wake time. During sleep on the night between 2 consecutive day shifts, the EEG powers at the frontal pole, HRV based on electrocardiograms, and distal-proximal gradient of skin temperature were recorded and analyzed. The results indicated that the subjects with high fatigue on the VAS at wake time exhibited (1) a decrease in deep non-rapid eye movement (NREM) (stageN3) sleep duration in the first sleep cycle; (2) a decrease in REM latency; (3) a decrease in ultra-slow and delta EEG powers, particularly from 30 to 65 min after sleep onset; (4) a decrease in the total power of HRV, particularly from 0 to 30 min after sleep onset; (5) an increase in the very low frequency component of HRV; and (6) a smaller increase in the distal-proximal gradient of skin temperature, than those of the subjects with low fatigue levels. The correlational and structural equation modeling analyses of these parameters suggested that an initial decrease in the total power of HRV from 0 to 30 min after sleep onset might inhibit the recovery from fatigue during sleep (i.e., increase the VAS score at wake time) via its effects on the ultra-slow and delta powers from 30 to 65 min after sleep onset, stageN3 duration in the first sleep cycle, REM latency, and distal-proximal gradient of skin temperature. These findings suggest an important role of these physiological factors in recovery from fatigue during sleep, and that interventions to modify these physiological factors might ameliorate fatigue at wake time.
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