The role of sleep hygiene in the risk of Shift Work Disorder in nurses

Lauren A Booker; Maree Barnes; Pasquale Alvaro; Allison Collins; Ching Li Chai-Coetzer; Marcus McMahon; Steven W Lockley; Shantha M W Rajaratnam; Mark E Howard; Tracey L Sletten

doi:10.1093/sleep/zsz228

The role of sleep hygiene in the risk of Shift Work Disorder in nurses

Sleep. 2020 Feb 13;43(2):zsz228. doi: 10.1093/sleep/zsz228.

Authors

Lauren A Booker^{1

2

3}, Maree Barnes^{3

4}, Pasquale Alvaro⁵, Allison Collins³, Ching Li Chai-Coetzer^{6

7}, Marcus McMahon³, Steven W Lockley^{1

2

8

9}, Shantha M W Rajaratnam^{1

2

8

9}, Mark E Howard^{1

2

3

4}, Tracey L Sletten^{1

2}

Affiliations

¹ School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia.
² Department of Medicine, Cooperative Research Centre for Alertness, Safety and Productivity, University of Melbourne, Melbourne, Victoria, Australia.
³ Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.
⁴ Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
⁵ Flinders University, School of Psychology, Adelaide, South Australia, Australia.
⁶ Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.
⁷ Respiratory and Sleep Services, Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
⁸ Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.
⁹ Division of Sleep Medicine, Harvard Medical School, Boston, MA.

PMID: 31637435
DOI: 10.1093/sleep/zsz228

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.

Keywords: circadian rhythm; health care; hygiene; insomnia; nurses; shift work; sleep; sleepiness.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
Humans
Shift Work Schedule* / adverse effects
Sleep
Sleep Disorders, Circadian Rhythm* / epidemiology
Sleep Hygiene
Sleep Initiation and Maintenance Disorders*
Surveys and Questionnaires
Work Schedule Tolerance