Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2014 Aug 12;2014(8):CD009776.
doi: 10.1002/14651858.CD009776.pub2.

Pharmacological interventions for sleepiness and sleep disturbances caused by shift work

Juha Liira  1 , Jos H Verbeek, Giovanni Costa, Tim R Driscoll, Mikael Sallinen, Leena K Isotalo, Jani H Ruotsalainen
Affiliations
Meta-Analysis

Pharmacological interventions for sleepiness and sleep disturbances caused by shift work

Juha Liira et al. Cochrane Database Syst Rev. .

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 in their present job and to assess their cost-effectiveness.

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 vigilance test in the same patient group. Post-marketing, severe skin reactions have been reported. Adverse effects reported by trial participants were headache, nausea and a rise in blood pressure. There were no trials in non-patient shift workers.Based on one trial, caffeine plus pre-shift naps taken before the night shift decreased sleepiness (KSS) (MD -0.63, 95% CI -1.09 to -0.17).We judged most trials to have a low risk of bias even though the randomisation method and allocation concealment were often not described.

Authors' conclusions: There is low quality evidence that melatonin improves sleep length after a night shift but not other sleep quality parameters. Both modafinil and armodafinil increase alertness and reduce sleepiness to some extent in employees who suffer from shift work sleep disorder but they are associated with adverse events. Caffeine plus naps reduces sleepiness during the night shift, but the quality of evidence is low. Based on one low quality trial, hypnotics did not improve sleep length and quality after a night shift.We need more and better quality trials on the beneficial and adverse 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. We also need systematic reviews of their adverse effects.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included trial.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included trials.
4
4
Funnel plot of comparison: 1 Melatonin versus placebo, outcome: 1.1 Total sleep time, next day.
1.1
1.1. Analysis
Comparison 1 Melatonin versus placebo, Outcome 1 Total sleep time, next day.
1.2
1.2. Analysis
Comparison 1 Melatonin versus placebo, Outcome 2 Total sleep time, next night.
1.3
1.3. Analysis
Comparison 1 Melatonin versus placebo, Outcome 3 Sleep onset latency, next day.
1.4
1.4. Analysis
Comparison 1 Melatonin versus placebo, Outcome 4 Sleep onset latency, next night.
1.5
1.5. Analysis
Comparison 1 Melatonin versus placebo, Outcome 5 Sleep quality (visual analog scale).
1.6
1.6. Analysis
Comparison 1 Melatonin versus placebo, Outcome 6 Alertness during the night shift work (VAS).
1.7
1.7. Analysis
Comparison 1 Melatonin versus placebo, Outcome 7 Sleepiness during the night shift work (KSS).
1.8
1.8. Analysis
Comparison 1 Melatonin versus placebo, Outcome 8 Sleepiness during the day shift work (KSS).
2.1
2.1. Analysis
Comparison 2 Armodafinil versus placebo, Outcome 1 Karolinska Sleepiness Scale (KSS) at final visit.
2.2
2.2. Analysis
Comparison 2 Armodafinil versus placebo, Outcome 2 Multiple sleep latency test (MSLT).
2.3
2.3. Analysis
Comparison 2 Armodafinil versus placebo, Outcome 3 Mean simple reaction time.
2.4
2.4. Analysis
Comparison 2 Armodafinil versus placebo, Outcome 4 Adverse events.
3.1
3.1. Analysis
Comparison 3 Modafinil versus placebo, Outcome 1 Karolinska Sleepiness Scale (KSS).
3.2
3.2. Analysis
Comparison 3 Modafinil versus placebo, Outcome 2 Multiple sleep latency test (MSLT).
3.3
3.3. Analysis
Comparison 3 Modafinil versus placebo, Outcome 3 Psychomotor Vigilance Test (number of lapses during 20 min test).
3.4
3.4. Analysis
Comparison 3 Modafinil versus placebo, Outcome 4 Adverse events.
4.1
4.1. Analysis
Comparison 4 Caffeine plus naps versus placebo, Outcome 1 Karolinska sleepiness scale.
5.1
5.1. Analysis
Comparison 5 Hypnotics versus placebo, Outcome 1 Total sleep time (after first and second the night shift).
6.1
6.1. Analysis
Comparison 6 Melatonin dose‐response, Outcome 1 Total sleep time, next day.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Bjorvatn 2007 {published data only}
    1. Bjørvatn B, Stangenes K, Oyane N, Forberg K, Lowden A, Holsten F, et al. Randomized placebo‐controlled field study of the effects of bright light and melatonin in adaptation to night work. Scandinavian Journal of Work, Environment and Health 2007;33(3):204‐14. - PubMed
Cavallo 2005 {published data only}
    1. Cavallo A, Ris MD, Succop P, Jaskiewicz J. Melatonin treatment of pediatric residents for adaptation to night shift work. Ambulatory Pediatrics 2005;5(3):172‐7. - PubMed
Czeisler 2005 {published data only}
    1. Czeisler CA, Walsh JK, Roth T, Hughes RJ, Wright KP, Kingsbury L, et al. Modafinil for excessive sleepiness associated with shift‐work sleep disorder. New England Journal of Medicine 2005;353(4):476‐86. - PubMed
Czeisler 2009 {published data only}
    1. Black JE, Hull SG, Tiller J, Yang R, Harsh JR. The long‐term tolerability and efficacy of armodafinil in patients with excessive sleepiness associated with treated obstructive sleep apnea, shift work disorder, or narcolepsy: an open‐label extension study. Journal of Clinical Sleep Medicine 2010;6(5):458‐66. - PMC - PubMed
    1. Czeisler CA, Walsh JK, Wesnes KA, Arora S, Roth T. Armodafinil for treatment of excessive sleepiness associated with shift work disorder: a randomized controlled study. Mayo Clinic Proceedings 2009;84(11):958‐72. - PMC - PubMed
Erman 2011 {published data only}
    1. Erman MK, Seiden DJ, Yang R, Dammerman R. Efficacy and tolerability of armodafinil: effect on clinical condition late in the shift and overall functioning of patients with excessive sleepiness associated with shift work disorder. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine 2011;53(12):1460‐5. - PubMed
Folkard 1993 {published data only}
    1. Folkard S, Arendt J, Clark M. Can melatonin improve shift workers' tolerance of the night shift? Some preliminary findings. Chronobiology International 1993;10(5):315‐20. - PubMed
James 1998 {published data only}
    1. James M, Tremea MO, Jones JS, Krohmer JR. Can melatonin improve adaptation to night shift?. American Journal of Emergency Medicine 1998;16(4):367‐70. - PubMed
Jockovich 2000 {published data only}
    1. Jockovich M, Cosentino D, Cosentino L, Wears RL, Seaberg DC. Effect of exogenous melatonin on mood and sleep efficiency in emergency medicine residents working night shifts. Academic Emergency Medicine 2000;7(8):955‐8. - PubMed
Jorgensen 1998 {published data only}
    1. Jorgensen, K‐M. Witting MD. Does exogenous melatonin improve day sleep or night alertness in emergency physicians working night shifts?. Annals of Emergency Medicine 1998;31(6):699‐704. - PubMed
Quera‐Salva 2002 {published data only}
    1. Quera‐Salva MA, Philip P, Taillard J, Letrequeser R, Allain H, Garcia‐Acosta S, et al. Improvement of insomnia in shift workers treated with zopiclone: A study in the real work environment. Revue Neurologique 2002;158(11):1102‐6. - PubMed
Sadeghniiat‐Haghighi 2008 {published data only}
    1. Sadeghniiat‐Haghighi K, Aminian O, Pouryaghoub G, Yazdi Z. Efficacy and hypnotic effects of melatonin in shift‐work nurses: double‐blind, placebo‐controlled crossover trial. Journal of Circadian Rhythms 2008;6(10):1‐5. - PMC - PubMed
Sastre‐y‐Hernandez 1982 {published data only}
    1. Sastre‐y‐Hernández M, Vass K, Fichte K, Paschelke G. Drug therapy of sleep disorders in shift workers [Probleme der medikamentosen Behandlung von Schlafstorungen bei Schichtarbeitern]. Medizinische Klinik (Praxis‐Ausg.) 1982;77(8):52‐5. - PubMed
Schweitzer 2006 {published data only}
    1. Schweitzer PK, Randazzo AC, Stone K, Erman M, Walsh JK. Laboratory and field studies of naps and caffeine as practical countermeasures for sleep‐wake problems associated with night work. Sleep 2006;29(1):39‐50. - PubMed
Wright 1998 {published data only}
    1. Wright SW, Lawrence LM, Wrenn KD, Haynes ML, Welch LW, Schlack HM. Randomized clinical trial of melatonin after night‐shift work: efficacy and neuropsychologic effects. Annals of Emergency Medicine 1998;32(3 Pt 1):334‐40. - PubMed
Yoon 2002 {published data only}
    1. Yoon IY, Song BG. Role of morning melatonin administration and attenuation of sunlight exposure in improving adaptation of night‐shift workers. Chronobiology International 2002;19(5):903‐13. - PubMed

References to studies excluded from this review

Babkoff 2002 {published data only}
    1. Babkoff H, French J, Whitmore J, Sutherlin R. Single‐dose bright light and/or caffeine effect on nocturnal performance. Aviation, Space and Environmental Medicine 2002;73(4):341‐50. - PubMed
Beaumont 2001 {published data only}
    1. Beaumont M, Batejat D, Pierard C, Coste O, Doireau P, Beers P, et al. Slow release caffeine and prolonged (64‐h) continuous wakefulness: effects on vigilance and cognitive performance. Journal of Sleep Research 2001;10(4):265‐76. - PubMed
Beaumont 2005 {published data only}
    1. Beaumont M, Batéjat D, Coste O, Doireau P, Chauffard F, Enslen M, et al. Recovery after prolonged sleep deprivation: residual effects of slow‐release caffeine on recovery sleep, sleepiness and cognitive functions. Neuropsychobiology 2005;51(1):16‐27. - PubMed
Bonnet 1994 {published data only}
    1. Bonnet MH, Arand DL. The use of prophylactic naps and caffeine to maintain performance during a continuous operation. Ergonomics 1994;37(6):1009‐20. - PubMed
Caldwell 2003 {published data only}
    1. Caldwell JL, Prazinko BF, Rowe T, Norman D, Hall KK, Caldwell JA. Improving daytime sleep with temazepam as a countermeasure for shift lag. Aviation, Space and Environmental Medicine 2011;74(2):153‐63. - PubMed
Carrier 2009 {published data only}
    1. Carrier J, Paquet J, Fernandez‐Bolanos M, Girouard L, Roy J, Selmaoui B, et al. Effects of caffeine on daytime recovery sleep: A double challenge to the sleep‐wake cycle in aging. Sleep Medicine 2009;10(9):1016‐24. - PubMed
Cohen 2010 {published data only}
    1. Cohen DA, Wang W, Klerman EB, Rajaratnam SM. Ramelteon prior to a short evening nap impairs neurobehavioral performance for up to 12 hours after awakening. Journal of Clinical Sleep Medicine 2010;6(6):565‐71. - PMC - PubMed
Crowley 2003 {published data only}
    1. Crowley SJ, Lee C, Tseng CY, Fogg LF, Eastman CI. Combinations of bright light, scheduled dark, sunglasses, and melatonin to facilitate circadian entrainment to night shift work. Journal of Biological Rhythms 2003;18(6):513‐23. - PubMed
Dagan 2006 {published data only}
    1. Dagan Y, Doljansky JT. Cognitive performance during sustained wakefulness: A low dose of caffeine is equally effective as modafinil in alleviating the nocturnal decline. Chronobiology International 2006;23(5):973‐83. - PubMed
Dawson 1995 {published data only}
    1. Dawson D, Encel N, Lushington K. Improving adaptation to simulated night shift: timed exposure to bright light versus daytime melatonin administration. Sleep 1995;18(1):11‐21. - PubMed
Erman 2007 {published data only}
    1. Erman MK, Rosenberg R, Modafinil Shift Work Sleep Disorder Study Group. Modafinil for excessive sleepiness associated with chronic shift work sleep disorder: effects on patient functioning and health‐related quality of life. Primary Care Companion to the Journal of Clinical Psychiatry 2007;9(3):188‐94. - PMC - PubMed
Giggli 1993 {published data only}
    1. Gigli GL, Maschio MCE, Diomedi M, Moroni M, Dell'orso S, Placidi F, et al. Brotizolam and cognitive performance: A double‐blind, crossover study versus placebo in a population of shift workers. Current Therapeutic Research 1993;53(2):129‐36.
Grady 2010 {published data only}
    1. Grady S, Aeschbach D, Wright KP Jr, Czeisler CA. Effect of modafinil on impairments in neurobehavioral performance and learning associated with extended wakefulness and circadian misalignment. Neuropsychopharmacology 2010;35(9):1910‐20. - PMC - PubMed
Hart 2005 {published data only}
    1. Hart CL, Haney M, Nasser J, Foltin RW. Combined effects of methamphetamine and zolpidem on performance and mood during simulated night shift work. Pharmacology, Biochemistry and Behavior 2005;81(3):559‐68. - PubMed
Hart 2006 {published data only}
    1. Hart CL, Haney M, Vosburg SK, Comer SD, Gunderson E, Foltin RW. Modafinil attenuates disruptions in cognitive performance during simulated night‐shift work. Neuropsychopharmacology 2006;31(7):1526‐36. - PubMed
Jay 2006 {published data only}
    1. Jay SN, Petrilli RM, Ferguson SA, Dawson D, Lamond N. The suitability of a caffeinated energy drink for night‐shift workers. Physiology & Behavior 2006;87(5):925‐31. - PubMed
Kantelip 1994 {published data only}
    1. Kantelip JP, Patay M, Levy P, Mougin F, Didier JM. Effect of night medical guard on following day vigilance. Influence of hypnotic medication on recovery night and on the vigilance during the following day [Effet d'une nuit de garde medicale sur la vigilance du lendemain. Influence d'un hypnotique sur la nuit de recuperation et la vigilance dans la journee qui suit]. Therapie 1994;49(2):107‐12. - PubMed
McLellan 2004 {published data only}
    1. McLellan TM, Bell DG, Kamimori GH. Caffeine improves physical performance during 24 h of active wakefulness. Aviation Space and Environmental Medicine 2004;75(8):666‐72. - PubMed
McLellan 2005 {published data only}
    1. McLellan TM, Kamimori GH, Voss DM, Bell DG, Cole KG, Johnson D. Caffeine maintains vigilance and improves run times during night operations for special forces. Aviation Space and Environmental Medicine 2005;76(7):647‐54. - PubMed
Muehlbach 1995 {published data only}
    1. Muehlbach MJ, Walsh JK. The effects of caffeine on simulated night‐shift work and subsequent daytime sleep. Sleep 1995;18(1):22‐9. - PubMed
Nickelsen 2002 {published data only}
    1. Nickelsen T, Samel A, Vejvoda M, Wenzel J, Smith B, Gerzer R. Chronobiotic effects of the melatonin agonist LY 156735 following a simulated 9H time shift: Results of a placebo‐controlled trial. Chronobiology International 2002;19(5):915‐36. - PubMed
Porcu 1997 {published data only}
    1. Porcù S, Bellatreccia A, Ferrara M, Casagrande M. Acutely shifting the sleep‐wake cycle: nighttime sleepiness after diurnal administration of temazepam or placebo. Aviation, Space and Environmental Medicine 1997;68(8):688‐94. - PubMed
Schweitzer 1992 {published data only}
    1. Schweitzer PK, Muehlbach MJ, Walsh JK. Countermeasures for night work performance deficits: The effect of napping or caffeine on continuous performance at night. Work and Stress 1992;6(4):355‐65.
Sharkey 2001 {published data only}
    1. Sharkey KM, Fogg LF, Eastman CI. Effects of melatonin administration on daytime sleep after simulated night shift work. Journal of Sleep Research 2001;10(3):181‐92. - PMC - PubMed
Smith 1993 {published data only}
    1. Smith AP, Brockman P, Flynn R, Maben A, Thomas M. Investigation of the effects of coffee on alertness and performance during the day and night. Neuropsychobiology 1993;27(4):217‐23. - PubMed
Smith 2005 {published data only}
    1. Smith MR, Lee C, Crowley SJ, Fogg LF, Eastman CI. Morning melatonin has limited benefit as a soporific for daytime sleep after night work. Chronobiology International 2005;22(5):873‐88. - PubMed
Walsh 1990 {published data only}
    1. Walsh JK, Muehlbach MJ, Humm TM, Dickens QS, Sugerman JL, Schweitzer PK. Effect of caffeine on physiological sleep tendency and ability to sustain wakefulness at night. Psychopharmacology (Berl) 1990;101(2):271‐3. - PubMed
Walsh 1991 {published data only}
    1. Walsh JK, Schweitzer PK, Anch AM, Muehlbach MJ, Jenkins NA, Dickins QS. Sleepiness/alertness on a simulated night shift following sleep at home with triazolam. Sleep 1991;14(2):140‐6. - PubMed
Walsh 2004 {published data only}
    1. Walsh JK, Randazzo AC, Stone KL, Schweitzer PK. Modafinil improves alertness, vigilance, and executive function during simulated night shifts. Sleep 2004;27(3):434‐9. - PubMed
Wesensten 2007 {published data only}
    1. Wesensten NJ, Reichardt RM, Balkin TJ. Ampakine (CX717) effects on performance and alertness during simulated night shift work. Aviation, Space and Environmental Medicine 2007;78(10):937‐43. - PubMed
Wright 1997 {published data only}
    1. Wright KP Jr, Badia P, Myers BL, Plenzler SC. Combination of bright light and caffeine as a countermeasure for impaired alertness and performance during extended sleep deprivation. Journal of Sleep Research 1997;6(1):26‐35. - PubMed

References to studies awaiting assessment

Gill 2006 {published data only}
    1. Gill M, Haerich P, Westcott K, Godenick KL, Tucker JA. Cognitive performance following modafinil versus placebo in sleep‐deprived emergency physicians: a double‐blind randomized crossover study. Academic Emergency Medicine 2006;13(2):158‐65. - PubMed
Walsh 1984 {published data only}
    1. Walsh JK, Muehlbach MJ, Schweitzer PK. Acute administration of triazolam for the daytime sleep of rotating shift workers. Sleep 1984;7(3):223‐9. - PubMed
Wesnes 2005 {published data only}
    1. Wesnes KA, Niebler GE. Cognitive effects of armodafinil in patients with excessive sleepiness and obstructive sleep apnea/hypopnea, narcolepsy or shift work sleep disorder. Sleep Medicine 2005;6(S2):S211.
Wright 2010 {published data only}
    1. Wright KP, Wyatt JK, Dammerman R, Bogan R. Pharmacotherapy for wakefulness in patients with excessive sleepiness associated with shift work disorder: Evaluation of armodafinil and modafinil. Sleep 2010;33:A188.

Additional references

ABS 2004
    1. Australian Bureau of Statistics. Working Arrangements, Australia, Nov 2003. http://www.abs.gov.au/ausstats/abs@.nsf/ProductsbyReleaseDate/7FBCC87078... (accessed 22 July 2009).
Ballon 2006
    1. Ballon JS, Feifel D. A systematic review of modafinil: Potential clinical uses and mechanisms of action. Journal of Clinical Psychiatry 2006;67(4):554‐66. - PubMed
Basner 2005
    1. Basner RC. Shift‐work sleep disorder ‐‐ the glass is more than half empty. New England Journal of Medicine 2005;353(5):519‐21. - PubMed
Buscemi 2006
    1. Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, et al. Efficacy and safety of exogenous melatonin for secondary sleep disorders and sleep disorders accompanying sleep restriction: meta‐analysis. BMJ (Clinical research ed.) 2006;332(7538):385‐93. - PMC - PubMed
Carskadon 1979
    1. Carskadon MA, Dement WC. Effects of total sleep loss on sleep tendency. Perceptual and Motor Skills 1979;48(2):495‐506. - PubMed
Cho 2000
    1. Cho BK, Rosenfeldt F, Turina MI, Karp RB, Ferguson TB, Bodnar E, et al. Joint statement on redundant (duplicate) publication by the editors of the undersigned cardiothoracic journals. Annals of Thoracic Surgery 2000;69(2):663. - PubMed
Costa 2003
    1. Costa G. Shift work and occupational medicine: an overview. Occupational Medicine 2003;53(2):83‐8. - PubMed
Costa 2004
    1. Costa G, Åkerstedt T, Nachreiner F, Baltieri F, Carvalhais J, Folkard S, et al. Flexible working hours, health, and well‐being in Europe: some considerations from a SALTSA project. Chronobiology International 2004;21(6):831‐44. - PubMed
Cursio 2001
    1. Cursio G, Casagrande M, Bertini M. Sleepiness: evaluating and quantifying methods. International Journal of Psychophysiology 2001;41(3):251‐63. - PubMed
Directive 2003/88/EC
    1. Directive 2003/88/EC of the European Parliament and of the Council of 4 November 2003 concerning certain aspects of the organisation of working time. http://eur‐lex.europa.eu/legal‐content/EN/ALL/?uri=CELEX:32003L0088.
Drake 2004
    1. Drake CL, Roehrs T, Richardson G, Walsh JK, Roth T. Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep 2004;27(8):1453‐62. - PubMed
Driscoll 2007
    1. Driscoll TR, Grunstein RR, Rogers NL. A systematic review of the neurobehavioural and physiological effects of shiftwork systems. Sleep Medicine Reviews 2007;11(3):179‐94. - PubMed
EMA 2011
    1. European Medicines Agency. Assessment report for modafinil containing medicinal products. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/... 2011; Vol. EMA/4038/2011.
Erren 2013
    1. Erren TC, Herbst C, Koch MS, Fritschi L, Foster RG, Driscoll TR, et al. Adaptation of shift work schedules for preventing and treating sleepiness and sleep disturbances caused by shift work. Cochrane Database of Systematic Reviews 2013, Issue 7. [DOI: 10.1002/14651858.CD010639] - DOI
Eurofound 2000
    1. Eurofound. Third European Survey on Working Conditions 2000. http://www.eurofound.europa.eu/publications/htmlfiles/ef0121.htm (accessed 31 July 2009).
Folkard 2003
    1. Folkard S, Tucker P. Shift work, safety and productivity. Occupational Medicine 2003;53(2):95‐101. - PubMed
GRADEpro 2008 [Computer program]
    1. Brozek J, Oxman A, Schünemann H. GRADEpro. Version 3.2 for Windows. GRADE working group, 2008.
Herbst 2013
    1. Herbst C, Erren TC, Sallinen M, Fritschi L, Costa G, Driscoll TR, et al. Person‐directed non‐pharmacological interventions for preventing and treating sleepiness and sleep disturbances caused by shift work. Cochrane Database of Systematic Reviews 2013, Issue 7. [DOI: 10.1002/14651858.CD010641] - DOI
Herxheimer 2008
    1. Herxheimer A, Petrie KJ. Melatonin for the prevention and treatment of jet lag. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD001520] - DOI - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Härmä 2002
    1. Härmä M, Sallinen M, Ranta R, Mutanen P, Müller K. The effect of an irregular shift system on sleepiness at work in train drivers and railway traffic controllers. Journal of Sleep Research 2002;11(2):141‐51. - PubMed
Härmä 2008
    1. Härmä M, Partinen M, Repo R, Sorsa M, Siivonen P. Effects of 6/6 and 4/8 watch systems on sleepiness among bridge officers. Chronobiology International 2008;25(2):413‐23. - PubMed
Ker 2010
    1. Ker K, Edwards PJ, Felix LM, Blackhall K, Roberts I. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database of Systematic Reviews 2010, Issue 5. [DOI: 10.1002/14651858.CD008508] - DOI - PMC - PubMed
Keuroghlian 2012
    1. Keuroghlian AS, Barry AS, Weiss RD. Circadian dysregulation, zolpidem dependence, and withdrawal seizure in a resident physician performing shift work. American Journal on Addictions/American Academy of Psychiatrists in Alcoholism and Addictions 2012;21(6):576‐7. - PMC - PubMed
Krystal 2008
    1. Krystal AD, Edinger JD. Measuring sleep quality. Sleep Medicine 2008;9(Suppl 1):S10‐7. - PubMed
Kumar 2008
    1. Kumar R. Approved and investigational uses of modafinil : an evidence‐based review. Drugs 2008;68(13):1803‐39. - PubMed
Liira 2010
    1. Liira J, Ruotsalainen JH, Driscoll TR, Rogers NL, Costa G, Sallinen M, et al. Interventions for sleepiness and sleep disturbances caused by shift work. Cochrane Database of Systematic Reviews 2010, Issue 7. [DOI: 10.1002/14651858.CD008590] - DOI - PMC - PubMed
Morgenthaler 2007
    1. Morgenthaler TI, Lee‐Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep 2007;30(11):1445‐59. - PMC - PubMed
Myrick 2004
    1. Myrick H, Malcolm R, Taylor B, LaRowe S. Modafinil: preclinical, clinical, and post‐marketing surveillance‐‐a review of abuse liability issues. Annals of Clinical Psychiatry 2004;16(2):101‐9. - PubMed
OECD 2004
    1. OECD. Employment Outlook 2004. www.oecd.org/document/62/0,3343,en_2649_33927_31935102_1_1_1_1,00.html (accessed 22 July 2009).
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Rogers 2001a
    1. Rogers NL, Dinges DF. Shiftwork, circadian disruption and consequences. Trends in Evidence Based Psychiatry 2001;6(7):58‐64.
Rogers 2001b
    1. Rogers NL, Szuba MP, Staab JP, Evans DL, Dinges DF. Neuroimmunologic aspects of sleep and sleep loss. Seminars in Clinical Neuropsychiatry 2001;6(4):295‐307. - PubMed
Roth 2007
    1. Roth T, Schwartz JR, Hirshkowitz M, Erman MK, Dayno JM, Arora S. Evaluation of the safety of modafinil for treatment of excessive sleepiness. Journal of Clinical Sleep Medicine 2007;3(6):595‐602. - PMC - PubMed
Roth 2012
    1. Roth T. Appropriate therapeutic selection for patients with shift work disorder. Sleep Medicine 2012;13(4):335‐41. - PubMed
Sallinen 2003
    1. Sallinen M, Härma M, Mutanen P, Ranta R, Virkkala J, Müller K. Sleep‐wake rhythm in an irregular shift system. Journal of Sleep Research 2003;12(2):103‐12. - PubMed
Sanchez‐Barcelo 2010
    1. Sánchez‐Barceló EJ, Mediavilla MD, Tan DX, Reiter RJ. Clinical uses of melatonin: evaluation of human trials. Current Medicinal Chemistry 2010;17(19):2070‐95. - PubMed
Scott 2000
    1. Scott AJ. Shift work and health. Primary Care 2000;27(4):1057‐79. - PubMed
Shy 2011
    1. Shy BD, Portelli I, Nelson LS. Emergency medicine residents' use of psychostimulants and sedatives to aid in shift work. American Journal of Emergency Medicine 2011;29(9):1034‐6. - PubMed
Straif 2007
    1. Straif K, Baan R, Grosse Y, Secretan B, Ghissassi FN, Bouvard V, et al. Carcinogenicity of shift‐work, painting, and fire‐fighting. Lancet Oncology 2007;8(12):1065‐6. - PubMed
Ursin 2009
    1. Ursin R, Baste V, Moen BE. Sleep duration and sleep‐related problems in different occupations in the Hordaland Health Study. Scandinavian Journal of Work, Environment and Health 2009;35(3):193‐202. - PubMed
US BLS 2005
    1. US Bureau of Labor Statistics. Workers in flexible and shift schedules in May 2004. www.bls.gov/cps/ (accessed 22 July 2009).
Wright 2013
    1. Wright KP Jr, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Medicine Reviews 2013;17(1):41‐54. - PubMed
Zawilska 2009
    1. Zawilska JB, Skene DJ, Arendt J. Physiology and pharmacology of melatonin in relation to biological rhythms. Pharmacological Reports 2009;61(3):383‐410. - PubMed
Åkerstedt 1990
    1. Åkerstedt T, Gillberg M. Subjective and objective sleepiness in the active individual. International Journal of Neuroscience 1990;52(1‐2):29‐37. - PubMed
Åkerstedt 1998
    1. Åkerstedt T. Is there an optimal sleep‐wake pattern in shift work?. Scandinavian Journal of Work, Environment and Health 1998;24(Suppl 3):18‐27. - PubMed
Åkerstedt 2008
    1. Åkerstedt T, Ingre M, Broman JE, Kecklund G. Disturbed sleep in shift workers, day workers, and insomniacs. Chronobiology International 2008;25(2):333‐48. - PubMed

Publication types

MeSH terms

LinkOut - more resources