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. 2009 Jun 1;4(2):257-271.
doi: 10.1016/j.jsmc.2009.03.001.

Sleep Loss and Fatigue in Shift Work and Shift Work Disorder

Torbjörn Akerstedt  1 , Kenneth P Wright Jr
Affiliations

Sleep Loss and Fatigue in Shift Work and Shift Work Disorder

Torbjörn Akerstedt et al. Sleep Med Clin. .

Abstract

Shift work is highly prevalent in industrialized societies (>20%) but, when it includes night work, it has pronounced negative effects on sleep, subjective and physiological sleepiness, performance, accident risk, as well as on health outcomes such as cardiovascular disease and certain forms of cancer. The reason is the conflict between the day oriented circadian physiology and the requirement for work and sleep at the "wrong" biological time of day. Other factors that negatively impact work shift sleepiness and accident risk include long duration shifts greater than 12 hours and individual vulnerability for phase intolerance that may lead to a diagnosis of shift work disorder; i.e., those shift workers with the greatest sleepiness and performance impairment during the biological night and insomnia during the biological day. Whereas some countermeasures may be used to ameliorate the negative impact of shift work on nighttime sleepiness and daytime insomnia (combined countermeasures may be the best available), there seems at present to be no way to eliminate most of the negative effects of shift work on human physiology and cognition.

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Figures

Figure 1
Figure 1
Subjective sleepiness (KSS) and psychomotor vigilance test performance scores (PVT Lapses of Attention; Reaction times > 500 msec) across 40 hours of total sleep deprivation. As seen, sleepiness and performance lapses are low during the habitual day across the first ~16 hours of wakefulness, whereas thereafter, sleepiness and PVT lapses of attention increase across the habitual night with peaks around 26 hours awake. PVT lapses, and to a lesser extent KSS sleepiness, then improve the next day because the circadian clock promotes wakefulness even though sleep did not occur. These data show what would likely happen to sleepiness and performance on the first night shift in a series if shift workers did not nap prior to the shift.
Figure 2
Figure 2
Subjective sleepiness (KSS) in rapidly rotating shift workers (mean±se). Filled points (grey) indicate sleepiness during work hours.
Figure 3
Figure 3
Mean subjective sleepiness in oil platform workers on 12 night shifts and 6 days off (dashed lines).
Figure 4
Figure 4
Mean sleepiness in air crew before, during and after a westward flight across nine time zones (Copenhagen - Los Angelos). O = outbound flight day; L=Layover day in Los Angeles; H = Homebound flight day. Ratings are made from awakening to bedtime.
See this image and copyright information in PMC

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