Pharmacological interventions for sleepiness and sleep disturbances caused by shift work

Abstract

BACKGROUND: Shift work results in sleep-wake disturbances, which cause sleepiness during night shifts and reduce sleep length and quality in daytime sleep after the night shift. In its serious form it is also called shift work sleep disorder. Various pharmacological products are used to ameliorate symptoms of sleepiness or poor sleep length and quality. OBJECTIVES: To evaluate the effects of pharmacological interventions to reduce sleepiness or to improve alertness at work and decrease sleep disturbances whilst off work, or both, in workers undertaking shift work. METHODS: Search methods: We searched CENTRAL, MEDLINE, EMBASE, PubMed and PsycINFO up to 20 September 2013 and ClinicalTrials.gov up to July 2013. We also screened reference lists of included trials and relevant reviews. Selection criteria: We included all eligible randomised controlled trials (RCTs), including cross-over RCTs, of pharmacological products among workers who were engaged in shift work (including night shifts) in their present jobs and who may or may not have had sleep problems. Primary outcomes were sleep length and sleep quality while off work, alertness and sleepiness, or fatigue at work. Data collection and analysis: Two authors independently selected studies, extracted data and assessed risk of bias in included trials. We performed meta-analyses where appropriate. MAIN RESULTS: We included 15 randomised placebo-controlled trials with 718 participants. Nine trials evaluated the effect of melatonin and two the effect of hypnotics for improving sleep problems. One trial assessed the effect of modafinil, two of armodafinil and one examined caffeine plus naps to decrease sleepiness or to increase alertness. Melatonin (1 to 10 mg) after the night shift may increase sleep length during daytime sleep (mean difference, MD, 24 minutes, 95% confidence interval, CI, 9.8 to 38.9; seven trials, 263 participants, low quality evidence) and night-time sleep (MD 17 minutes, 95% CI 3.71 to 30.22; three trials, 234 participants, low quality evidence) compared to placebo. We did not find a dose-response effect. Melatonin may lead to similar sleep latency times as placebo (MD 0.37minutes, 95% CI-1.55 to 2.29; five trials, 74 participants, low quality evidence). Hypnotic medication, zopiclone, did not result in significantly longer daytime sleep length compared to placebo in one low quality trial and we could not use the data from the study on lormetazepam. Armodafinil taken before the night shift probably reduces sleepiness by one point on the Karolinska Sleepiness Scale (KSS) (MD-0.99, 95% CI-1.32 to-0.67; range 1 to 10; two trials, 572 participants, moderate quality evidence) and increases alertness by 50 ms in a simple reaction time test (MD-50.0, 95% CI-85.5 to-15.5) at three months' follow-up in shift work sleep disorder patients. Modafinil probably has similar effects on sleepiness (KSS) (MD-0.90, 95% CI-1.45 to-0.35; one trial, 183 participants, moderate quality evidence) and alertness in the psychomotor

Sleep Disorders in Shift Workers in the Emergency Department and Efficacy of Melatonin

“…Taking melatonin (1-10 mg) after a night shift was found to increase daytime sleep duration (mean difference 24 minutes, 95% CI: 9.8-38.9; seven studies, 263 participants, low level of evidence) and nighttime sleep duration (mean difference 17 minutes, 95% CI: 3.71-30.22; three studies, 234 participants, low level of evidence), when compared with placebo (66). Melatonin did not affect the period of falling asleep in night shift workers, when compared with placebo (mean difference 0.37 min, 95% CI: 1.55-2.29; five studies, 74 participants, low level of evidence) (66).…”

“…Studies on the effect of melatonin for improving sleep irregularities in shift workers are generally conducted on a small number of patients and have durations of one week or less (65). In a meta-analysis of 15 randomized placebo-controlled studies on 718 patients reported in the Cochrane Library in 2014, nine studies were conducted with melatonin, two with hypnotics, two with armodafinil, one with modafinil, and one with "caffeine + nap" (66).…”

“…In a meta-analysis of 15 randomized placebo-controlled studies on 718 patients reported in the Cochrane Library in 2014, nine studies were conducted with melatonin, two with hypnotics, two with armodafinil, one with modafinil, and one with "caffeine + nap" (66). Taking melatonin (1-10 mg) after a night shift was found to increase daytime sleep duration (mean difference 24 minutes, 95% CI: 9.8-38.9; seven studies, 263 participants, low level of evidence) and nighttime sleep duration (mean difference 17 minutes, 95% CI: 3.71-30.22; three studies, 234 participants, low level of evidence), when compared with placebo (66).…”

“…However, in modafinil users (200 mg), headache (34% modafinil vs. 23% placebo) and nausea (11% modafinil vs. 23% placebo) have been determined to be more frequent. In addition, modafinil was shown to be associated with Stevens-Johnson syndrome (66). Zopiclone (7.5 mg), which is a non-benzodiazepine hypnotic drug, did not lead to an increase in daytime sleep duration when compared with placebo (low level of evidence).…”

Towards Personalized Treatment of Depression

“…Сердечно-сосудистые за-болевания -ведущая причина смертности среди пациентов с биполярным расстройством (БАР): в 1,5 и 2,5 раза выше, чем в популяции, выше смерт-ности от суицидов/несчастных случаев. Предиа-бетические нарушения выявлены у 27% больных с БАР [30]. Депрессивная симптоматика характер-на и для хронических заболеваний печени [9].…”