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Night shift work can associate with an increased risk for depression. As night workers experience a ‘misalignment’ between their circadian system and daily sleep–wake behaviors, with negative health consequences, we investigated whether exposure to circadian misalignment underpins mood vulnerability in simulated shift work. We performed randomized within-subject crossover laboratory studies in non-shift workers and shift workers. Simulated night shifts were used to induce a misalignment between the endogenous circadian pacemaker and sleep/wake cycles (circadian misalignment), while environmental conditions and food intake were controlled. Circadian misalignment adversely impacted emotional state, such that mood and well-being levels were significantly decreased throughout 4 days of continuous exposure to circadian misalignment in non-shift workers, as compared to when they were under circadian alignment (interaction of “circadian alignment condition” vs. “day”, mood: p  < 0.001; well-being: p  < 0.001; adjusted p -values). Similarly, in shift workers, mood and well-being levels were significantly reduced throughout days of misalignment, as compared to circadian alignment (interaction of “circadian alignment condition” vs. “day”, mood: p  = 0.002; well-being: p  = 0.002; adjusted p -values). Our findings indicate that circadian misalignment is an important biological component for mood vulnerability, and that individuals who engage in shift work are susceptible to its deleterious mood effects.

Background Shift work can disturb circadian homeostasis and result in fatigue, excessive sleepiness, and reduced quality of life. Light therapy has been shown to impart positive effects in night shift workers. We sought to determine whether or not prolonged exposure to bright light during a night shift reduces sleepiness and enhances psychomotor performance among ICU nurses. Methods This is a single-center randomized, crossover clinical trial at a surgical trauma ICU. ICU nurses working a night shift were exposed to a 10-h period of high illuminance (1500–2000 lx) white light compared to standard ambient fluorescent lighting of the hospital. They then completed the Stanford Sleepiness Scale and the Psychomotor Vigilance Test. The primary and secondary endpoints were analyzed using the paired t test. A p  value <0.05 was considered significant. Results A total of 43 matched pairs completed both lighting exposures and were analyzed. When exposed to high illuminance lighting subjects experienced reduced sleepiness scores on the Stanford Sleepiness Scale than when exposed to standard hospital lighting: mean (sem) 2.6 (0.2) vs. 3.0 (0.2), p  = 0.03. However, they committed more psychomotor errors: 2.3 (0.2) vs. 1.7 (0.2), p  = 0.03. Conclusions A bright lighting environment for ICU nurses working the night shift reduces sleepiness but increases the number of psychomotor errors. Trial registration ClinicalTrials.gov, NCT03331822 . Retrospectively registered on 6 November 2017.

Effective countermeasures against the adverse cardiovascular effects of circadian misalignment, such as effects experienced due to night work or jet lag, remain to be established in humans. Here, we aim to test whether eating only during daytime can mitigate such adverse effects vs. eating during the night and day (typical for night shift workers) under simulated night work (secondary analysis of NCT02291952). This single-blind, parallel-arm trial randomized 20 healthy participants (non-shift workers) to simulated night work with meals consumed during night and day (Nighttime Meal Control Group) or only during daytime (Daytime Meal Intervention Group). The primary outcomes were pNN50 (percentage consecutive heartbeat intervals >50 ms), RMSSD (root mean square of successive heartbeat differences), and LF/HF (low/high cardiac frequency). The secondary outcome was blood concentrations of prothrombotic factor plasminogen activator inhibitor-1 (PAI-1). These measures were assessed under Constant Routine conditions, before (baseline) and after (postmisalignment) simulated night work. The meal timing intervention significantly modified the impact of simulated night work on cardiac vagal modulation and PAI-1 ( p FDR = 0.001). In the Control Group, the postmisalignment Constant Routine showed a decrease in p NN50 by 25.7% ( p FDR = 0.008) and RMMSD by 14.3% ( p FDR = 0.02), and an increase in LF/HF by 5.5% ( p FDR = 0.04) and PAI-1 by 23.9% ( p FDR = 0.04), vs. the baseline Constant Routine. In the Intervention Group, there were no significant changes in these outcomes. For exploratory outcomes, the intervention significantly modified the impact of simulated night work on blood pressure ( P < 0.05), with no significant change in the Control Group, and a significant reduction by 6-8% ( P < 0.01) in the Intervention Group; without significant effects for heart rate or cortisol. These findings indicate that daytime eating, despite mistimed sleep, may mitigate changes in cardiovascular risk factors and offer translational evidence for developing a behavioral strategy to help minimize the adverse changes in cardiovascular risk factors in individuals exposed to circadian misalignment, such as shift workers. Circadian misalignment, which typically occurs in shift work, associates with cardiovascular diseases. Here the authors report that eating only in the daytime during simulated night work mitigates adverse changes in cardiovascular risk factors (including autonomic cardiac control, prothrombotic factor, and blood pressure) in a secondary analysis of a randomized controlled trial.

ObjectivesA decreased ability to repair oxidative DNA damage, due to melatonin suppression, is a compelling mechanism by which night shift workers are at an increased risk of cancer. We sought to determine if melatonin supplementation would improve oxidative DNA damage repair among night shift workers.MethodsWe conducted a parallel-arm randomised placebo-controlled trial of melatonin supplementation among 40 night shift workers. Supplements were consumed before engaging in day sleep over a 4-week period. All urine excreted during a representative day sleep and night work period before and during the intervention period was collected for measurement of creatinine-adjusted 8-hydroxy-2′-deoxyguanosine (8-OH-dG) as an indicator of oxidative DNA damage repair capacity, with higher concentrations indicating better repair. Linear regression models were used to analyse the association between ln-transformed 8-OH-dG concentration and intervention status during day sleep and night work.ResultsThe melatonin intervention was associated with a borderline statistically significant 1.8-fold increase in urinary 8-OH-dG excretion during day sleep (95% CI 1.0, 3.2, p=0.06). No statistically significant difference in 8-OH-dG excretion was observed during the subsequent night shift (melatonin vs placebo excretion ratio=0.9; 95% CI 0.6, 1.5; p=0.7).ConclusionsOur results suggest that melatonin supplementation improves oxidative DNA damage repair capacity among night shift workers. Future larger-scale trials are needed to evaluate the impact of varying doses of melatonin supplements and examine the impacts of longer-term use of melatonin supplements by night shift workers.

ObjectiveObservational studies indicate an association between working nights and miscarriage, but inaccurate exposure assessment precludes causal inference. Using payroll data with exact and prospective measurement of night work, the objective was to investigate whether working night shifts during pregnancy increases the risk of miscarriage.MethodsA cohort of 22 744 pregnant women was identified by linking the Danish Working Hour Database (DWHD), which holds payroll data on all Danish public hospital employees, with Danish national registers on births and admissions to hospitals (miscarriage). The risk of miscarriage during pregnancy weeks 4–22 according to measures of night work was analysed using Cox regression with time-varying exposure adjusted for a fixed set of potential confounders.ResultsIn total 377 896 pregnancy weeks (average 19.7) were available for follow-up. Women who had two or more night shifts the previous week had an increased risk of miscarriage after pregnancy week 8 (HR 1.32 (95% CI 1.07 to 1.62) compared with women, who did not work night shifts. The cumulated number of night shifts during pregnancy weeks 3–21 increased the risk of miscarriages in a dose-dependent pattern.ConclusionsThe study corroborates earlier findings that night work during pregnancy may confer an increased risk of miscarriage and indicates a lowest observed threshold level of two night shifts per week.

Background: Shift‐work schedules can cause sleep and psychological problems among nurses, negatively affecting their health and quality of life. This trial examined the effects of low‐energy light therapy on sleep, psychological symptoms, and heart rate variability among shift‐work nurses. Methods: This randomized controlled trial was conducted from July 2021 to June 2022. The inclusion criteria were nurses with self‐reported insomnia who worked in shifts in the last 6 months in a medical center in northern Taiwan. Block randomization was used to assign the study participants to two groups: experimental ( n = 32) and control ( n = 32). A portable Meridian Aura Cap equipped with a low‐level light‐emitting diode was used to provide red and near‐infrared light (660 and 850 nm) for 30 min, three times a week for 4 weeks; the control group did not receive any intervention. The Depression Anxiety Stress Scale‐21 and Insomnia Severity Index were used to measure psychological symptoms and sleep problems, respectively. Heart rate variability was measured by the ANSWatch. Results: No significant differences were reported in preintervention scores. After the 4‐week intervention, the intervention group scored significantly lower in insomnia (4.3 vs. 12.6, respectively; p < 0.001), depression (2.5 vs. 7.9, p < 0.001), anxiety (3.1 vs. 9.2, p < 0.001), and stress (5.6 vs. 12, p < 0.001) than those in the controls. No significant differences were observed in heart rate variability between the two groups. Conclusion: Low‐level light‐emitting diode light therapy improved sleep quality in shift‐work nurses with insomnia and alleviated depression, anxiety, and stress symptoms; however, it did not improve heart rate variability, possibly because of the short intervention duration and the ongoing shift‐work schedule. Implications for Nursing Management: Employers could consider providing phototherapy for shift nurses to improve their health. Trial Registration: ClinicalTrials.gov identifier: NCT05146596

Abstract Study Objectives: Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Methods: Sleep–wake activity of 137 interns and 87 PGY-2/3 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy. Alertness was assessed daily with a brief Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale. Results: Interns averaged 6.93 hours (95% confidence interval [CI] 6.84–7.03 hours) sleep per 24 hours across shifts, significantly less than residents not working overnight shifts (7.18 hours, 95% CI 7.06–7.30 hours, p = .007). Interns obtained on average 2.19 hours (95% CI 2.02–2.36 hours) sleep during on-call nights (17.5% obtained no sleep). Alertness was significantly lower on mornings after on-call nights compared to regular shifts (p < .001). Naps between 9 am and 6 pm on the first day post‐call were frequent (90.8%) and averaged 2.84 hours (95% CI 2.69–3.00 hours), but interns still slept 1.66 hours less per 24 hours (95% CI 1.56–1.76 hours) compared to regular shift days (p < .001). Sleep inertia significantly affected alertness in the 60 minutes after waking on-call. Conclusions: Extended overnight shifts increase the likelihood of chronic sleep restriction in interns. Reduced levels of alertness after on-call nights need to be mitigated. A systematic comparison of sleep, alertness, and safety outcomes under current and past duty hour rules is encouraged.

Abstract A high proportion (20%–30%) of shift workers experience Shift Work Disorder (SWD), characterized by chronic sleepiness and/or insomnia associated with work schedules. The reasons for individual variation in shift work tolerance are not well understood, however. The aim of this study was to identify individual factors that contribute to the risk of SWD. Nurses (n = 202) were categorized as low or high risk of SWD based on the Shift Work Disorder Questionnaire. Participants provided demographic and lifestyle information and completed the Sleep Hygiene Index (SHI) and Morningness–Eveningness Questionnaire (MEQ). High risk of SWD was associated with poorer sleep hygiene (SHI, 35.41 ± 6.19 vs. 31.49 ± 7.08, p < .0001) and greater eveningness (MEQ, 34.73 ± 6.13 vs. 37.49 ± 6.45, p = .005) compared to low risk. No other factors, including body mass index, marital status, having children, or caffeine or alcohol intake were significant. Logistic regression showed that SHI was the most significant contributing factor to SWD risk (odds ratio [OR] = 1.09, 95% confidence interval [CI] = 1.04 to 1.14). Standardized odds ratio further revealed that with every unit increase on the SHI score, the odds of being at high risk of SWD increased by 80% (OR = 1.84). Most individuals at high risk of SWD reported “always” or “frequently” going to bed at different times (79%) and waking at different times (83%; compared to 58%, p = .017, and 61%, p = .002, respectively for the low-risk group), as well as going to bed stressed/angry (67% vs. 41%, p < .0001) and/or planning/worrying in bed (54% vs. 22%, p < .0001). Interventions aimed at improving sleep hygiene practices and psychological health of shift workers may help reduce the risk of SWD.

ObjectivesNight shift work has been classified as probably carcinogenic to humans, possibly related to suppression of melatonin secretion. Although experimental studies suggest that melatonin inhibits intestinal tumor proliferation, epidemiological evidence for a relationship between night shift work and colorectal cancer (CRC) risk is lacking.MethodsWe prospectively examined the association between night shift work and CRC in the Nightingale Study. We included 56 477 Dutch female nurses who completed a questionnaire in 2011, including occupational history with detailed (historical) information on night shift work. Until February 2025, 468 incident CRCs were recorded. Age-adjusted HRs and 95% CIs for associations between night shift work variables and CRC risk were estimated using Cox regressions.ResultsCRC risk did not differ between nurses who ever or never worked night shifts (HR=1.13; 95% CI=0.89 to 1.44). A longer duration of working night shifts (≥20 years: HR=1.19; 95%CI=0.89 to 1.60) was neither associated with CRC risk. However, a higher average number of consecutive night shifts per month (continuous per shift; HR=1.04, 95%CI=1.00 to 1.07) and a higher cumulative number of performed night shifts (continuous per 250 shifts: HR=1.02; 95%CI=1.00 to 1.04) were associated with a slightly increased risk. Chronotype did not affect the associations of CRC risk with night shift work.ConclusionsAlthough a longer duration of night shift work was not associated with CRC risk, both a higher frequency of and a higher cumulative exposure to night shifts were associated with slightly higher risk, suggesting a potential association between extensive exposure to night shift work and CRC risk.

We compared resident physician work hours and sleep in a multicenter clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hr) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours. Three hundred two resident physicians were enrolled and completed 370 1 month pediatric intensive care unit rotations in six US academic medical centers. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep data were collected via daily electronic diary. Resident physicians worked fewer total hours per week during the RCWR compared with the EDWR (61.9 ± 4.8 versus 68.4 ± 7.4, respectively; p < 0.0001). During the RCWR, 73% of work hours occurred within shifts of ≤16 consecutive hours. In contrast, during the EDWR, 38% of work hours occurred on shifts of ≤16 consecutive hours. Resident physicians obtained significantly more sleep per week on the RCWR (52.9 ± 6.0 hr) compared with the EDWR (49.1 ± 5.8 hr, p < 0.0001). The percentage of 24 hr intervals with less than 4 hr of actigraphically measured sleep was 9% on the RCWR and 25% on the EDWR (p < 0.0001). RCWRs were effective in reducing weekly work hours and the occurrence of >16 consecutive hour shifts, and improving sleep duration of resident physicians. Although inclusion of the six operational healthcare sites increases the generalizability of these findings, there was heterogeneity in schedule implementation. Additional research is needed to optimize scheduling practices allowing for sufficient sleep prior to all work shifts.Clinical Trial: Multicenter Clinical Trial of Limiting Resident Work Hours on ICU Patient Safety (ROSTERS), https://clinicaltrials.gov/ct2/show/NCT02134847.