Sleep and circadian misalignment for the hospitalist: A review

Schaefer, Eric; Williams, Mark; Zee, Phyllis C.

doi:10.1002/jhm.1903

Cited by 26 publications

(17 citation statements)

References 62 publications

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“…With our increasing knowledge of the impact of circadian disruptions and novel tools to study circadian phenotypes, such as the ones introduced in this study, effective interventions can be designed to minimize circadian disruption, stabilize circadian rhythmicity, and enhance well-being and performance [48,49]. Studies like this will provide athletes and coaches in the sports world with new insights that will allow them to improve performance, as well as also create awareness in the corporate world to adapt schedules to achieve maximum performance of the workforce and increase safety [50,51].…”

Section: Discussionmentioning

confidence: 97%

The Impact of Circadian Phenotype and Time since Awakening on Diurnal Performance in Athletes

2015

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Circadian rhythms, among other factors, have been shown to regulate key physiological processes involved in athletic performance. Personal best performance of athletes in the evening was confirmed across different sports. Contrary to this view, we identified peak performance times in athletes to be different between human "larks" and "owls" (also called "morningness/eveningness types" or "chronotypes" and referred to as circadian phenotypes in this paper), i.e., individuals with well-documented genetic and physiological differences that result in disparities between their biological clocks and how they entrain to exogenous cues, such as the environmental light/dark cycle and social factors. We found time since entrained awakening to be the major predictor of peak performance times, rather than time of day, as well as significant individual performance variations as large as 26% in the course of a day. Our novel approach combining the use of an athlete-specific chronometric test, longitudinal circadian analysis, and physical performance tests to characterize relevant sleep/wake and performance parameters in athletes allows a comprehensive analysis of the link between the circadian system and diurnal performance variation. We establish that the evaluation of an athlete's personal best performance requires consideration of circadian phenotype, performance evaluation at different times of day, and analysis of performance as a function of time since entrained awakening.

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Section: Discussionmentioning

confidence: 97%

The Impact of Circadian Phenotype and Time since Awakening on Diurnal Performance in Athletes

2015

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“…Some studies also recommend the use of caffeine, especially at the start of a night shift [ 62 , 77 ]. Beaumont and colleagues provided evidence for the positive effects of caffeine on vigilance (reported p < 0.01) and cognitive performance (reported p < 0.05) during a long wakefulness period [ 65 ].…”

Section: Reviewmentioning

confidence: 99%

“…Behavioral measures beyond improved sleep hygiene, such as exercise, can enhance sleep quality and combat insomnia and excessive sleepiness [ 53 ]. Most effective are the optimal timing of work breaks, social activities during breaks, and sensory stimulation, but those techniques still have to be evaluated within a shift work setting [ 62 ]. The post-intervention results of a study by Järnefeld and colleagues [ 71 ] showed significant improvements in self-reported (reported p = 0.002) and actigraphic (reported p < 0.05) sleep onset latency, self-reported sleep efficiency (reported p = 0.006), self-reported sleep quality (reported p < 0.001), and self-reported restedness (reported p < 0.05) through cognitive-behavioral strategies.…”

Section: Reviewmentioning

confidence: 99%

Prevention of fatigue and insomnia in shift workers—a review of non-pharmacological measures

et al. 2016

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BackgroundExcessive fatigue and insomnia are common among shift workers and can lead to negative effects such as reduced work performance, processing errors, accidents at work, absenteeism, reduced quality of life, and symptoms of depression. Moreover, work in rotating shifts can be a risk factor for different somatic and psychiatric diseases and may contribute to poor health, especially in elder adults and women. This review aims to show non-pharmacological preventive measures against fatigue and insomnia in shift workers.MethodComputerized literature searches in MedLine and in the Cochrane Library were performed with the following key words: shift work disorder, fatigue, insomnia, shift work, measures, treatment, therapy, strategies and coping. The search was limited to non-pharmacological studies that were conducted on human subjects and published as English-language articles in peer-reviewed journals since 1970. Additional studies were identified through the reference sections of relevant articles. Eighteen articles on fatigue in shift workers, including six original research articles with a total sample size of 3504 probands consisting of industrial workers, office employees, aircraft maintenance engineers, and non-shift workers working in simulated shifts, were analyzed, as well as seven articles on insomnia, including an original research article with a sample size of 26 media workers. Also, 4 reviews on shift work disorder were analyzed.MainThe occurrence of fatigue and insomnia in shift workers associated with a working period is described as shift work disorder. Estimations on the prevalence of shift work disorder in shift workers vary between 5 % and about 20 %; about one in three shift workers is affected by insomnia and up to 90 % of shift workers report regular fatigue and sleepiness at the workplace. We concluded that there is a necessity for treatments to improve the sleep quality of the shift working population. The most common non-pharmacological recommendations to improve sleep quality and to reduce insomnia and fatigue were scheduling, bright light exposure, napping, psychoeducation for sleep hygiene, and cognitive-behavioral measures.ConclusionSome important preventive coping strategies for fatigue associated with shift work such as napping and exposure to bright light have already been investigated and are generally approved. A few studies also provide good evidence for the efficacy of cognitive-behavioral techniques in the treatment of chronic primary and comorbid insomnia. These coping strategies summarized in this paper should be considered in the workplace health promotion programs of each work environment to improve working conditions for shift workers and to save money.

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“…A misalignment between the circadian pacemaker and the sleep–wake cycle can result in a shift work disorder (Barger et al , ; Wright, Bogan, & Wyatt, ). Hospitalists can help to limit fatigue and improve performance and safety through circadian adaptation (Schaefer, Williams, & Zee, ). In other words, optimal timing of the nap that is taken after a night shift and the worker's bedtime that night not only prevents cumulative fatigue, but also could prevent disruption of the circadian rhythm and lower the risk of a shift work disorder.…”

Section: Discussionmentioning

confidence: 99%

Association between sleep and fatigue in nurses who are engaged in 16 h night shifts in Japan: Assessment using actigraphy

Kagamiyama

Sumi

Yoshida

et al. 2018

Japan Journal Nursing Sci

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Aim:To determine the association between sleep and fatigue in nurses who are working in a two-shift system, including 16 h night shifts. Methods: Sixty-one nurses were assessed on their sleeping and napping over 9 days, using actigraphy and a sleep diary. Work-related feelings of fatigue were measured by using the "Jikaku-sho shirabe" questionnaire and the Cumulative Fatigue Symptoms Index. Results: The main night-time sleep started after 00:00 hours in half of the participants and the average start and end times were significantly delayed among the participants in their 20s, compared to those in their 40s . Although~90% of the participants napped during and/or after a night shift, only 50.8% napped for >2 h during their shift and 32.8% napped in the morning after a night shift. In the high-fatigue group, significantly more nurses went to sleep after 00:25 hours than before 00:26 hours the night after a night shift. Furthermore, those nurses who napped for >2 h during their night shift exhibited a significantly lower rate of some cumulative fatigue symptoms, compared to those who did not. In addition, a combination of napping in the morning after a night shift and beginning the following night-time sleep before 00:26 hours were associated with a significant decrease in fatigue symptoms. Conclusions: Naps at an appropriate time and of an appropriate duration, along with the practice of beginning the night-time sleep early after a night shift, might relieve cumulative mental fatigue in nurses who are working 16 h night shifts.

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Sleep and circadian misalignment for the hospitalist: A review

Cited by 26 publications

References 62 publications

The Impact of Circadian Phenotype and Time since Awakening on Diurnal Performance in Athletes

The Impact of Circadian Phenotype and Time since Awakening on Diurnal Performance in Athletes

Prevention of fatigue and insomnia in shift workers—a review of non-pharmacological measures

Association between sleep and fatigue in nurses who are engaged in 16 h night shifts in Japan: Assessment using actigraphy

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