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

Diagnostic and Therapeutic Approach to Sleep Disorders, High Blood Pressure and Cardiovascular Diseases: A Consensus Document by the Italian Society of Hypertension (SIIA)

“…Finally, there are few studies on the BP effects of sleep disorder treatment in shift workers. A recent systematic Cochrane review of the pharmacological interventions for sleepiness and sleep disorders caused by shift work highlighted the need for further and better-quality studies on the effects and costs of all pharmacological agents that induce sleep or promote alertness in shift workers, both with and without a diagnosis of shift work sleep disorder [79].…”

Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health

“…Insufficient hydration has been documented for a number of populations and has been linked to diverse negative health outcomes (Kenney 2015). Moreover, caffeine has been shown to improve concentration among certain populations, such as shift workers (Ker 2010; Liira 2014), which suggests that a decrease in the consumption of caffeinated SSB might have the potential to decrease productivity and safety among certain occupational groups. Alcoholic beverages are a potential substitute for SSB, which has led to the concern that interventions targeting SSB may lead to increased alcohol consumption (Quirmbach 2018), while it has also been shown that consuming SSB with a high caffeine content, such as energy drinks, with alcohol may increase the urge to drink alcohol compared to drinking alcohol alone (McKetin 2014).…”

The concept of chronotypes and its clinical importance for depressive disorders

“…Melatonin and other compounds (e.g., modafinil and zopiclone) were moderately effective in the treatment of jet lag and sleep disorders related to shift work. 77 For the antidepressants agomelatin, mirtazapine, and trimipramine and for the mood stabilizer lithium, positive findings with regard to the reestablishment of circadian rhythms and the improvement of sleep duration and sleep efficiency with low negative or even positive effects on sleep architecture have been reported. Lithium seems to act on cellular CLOCK genes, 78 a direct pharmacological influence on the CLOCK gene protein synthesis (e.g., by REV-ERB agonists) 79 is currently investigated.…”