JAMA子刊:護士在向前和向後輪班中的睡眠和注意力指標的比較

快速倒轉輪班工作(即下午、上午和夜班的逆時針順序)與衛生保健工作者的睡眠-覺醒品質、白天注意力和疲倦的主觀和客觀測量之間的關聯尚未確定。



 



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摘要

重要性  快速倒轉輪班工作(即下午、上午和夜班的逆時針順序)與衛生保健工作者的睡眠-覺醒品質、白天注意力和疲倦的主觀和客觀測量之間的關聯尚未確定。

目的  探討前、後輪班護士輪班方向與疲倦、嗜睡和持續注意力的關係。

設計、場所和參與者  本隊列研究的數據來自在義大利 5 家中型醫院工作的護士。護士有一個向前輪換的時間表(即,從早上到下午到晚上)或一個向後輪換的時間表(即,從下午到早上到晚上)。數據收集時間為2017年7月至2020年2月。數據分析時間為2020年5月至2020年10月。

暴露  參與者按向前或向後輪換的時間表工作,其中 3 個班次(上午、下午和晚上)按順時針或逆時針方向變化。

主要結果和測量  使用卡羅林斯卡嗜睡量表和匹茲堡睡眠品質指數收集睡眠數據。使用心理運動警戒任務測量持續的注意力。使用疲勞症狀量表評估疲勞。

結果  共有 144 名護士(平均 [SE] 年齡,41.3 [0.8] 歲;92 名女性 [63.9%])參與了研究;80 名護士有向前輪換的時間表,64 名有向後輪換的時間表。因夜班工作而睡眠-覺醒不規律的護士睡眠品質較差(前輪班組 46 人 [57.5%];後輪班組 37 人 [57.8%])。向後輪班的護士表現出明顯更嚴重的嗜睡(1,139  = 41.23;P  < .001)和認知減慢(即中位反應時間更長;1,139  = 42.12;P < .001)而不是那些向前旋轉的人。重要的是,這些差異不受年齡、工作年限和睡眠品質的影響。在倒班工作的護士中,60 名 (93.8%) 報告夜班後嗜睡程度增加(卡羅琳斯卡嗜睡量表評分點7)。中位反應時間 ( 1,139  = 42.12; P  < .001)、10% 最快反應時間 ( 1,139  = 97.07; P  < .001)、輕微失誤 ( 1,139  = 46.29; P  < .001) 和反應時間分佈 ( 1,139  = 60.13; P < .001) 後輪班的護士表示警惕水準較低,這與神經行為表現呈負相關。

結論和相關性  在這項研究中,兩種輪班輪換模型都與健康和認知表現呈負相關。這些發現表明,對於一些測量的表現注意力結果和睏倦,向前輪換可能比向後輪換更有益。應實施輪班優化,以減少與輪班工作相關的負面結果的組合,並降低醫療保健系統中醫療錯誤的潛在風險。



Abstract

Importance  The association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established.

Objective  To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward- and backward-rotating shifts.

Design, Setting, and Participants  Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). The data were collected from July 2017 to February 2020. Data analysis was performed from May to October 2020.

Exposures  Participants were working either forward- or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction.

Main Outcomes and Measures  Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention was measured using the Psychomotor Vigilance Task. Tiredness was evaluated using the Tiredness Symptom Scale.

Results  A total of 144 nurses (mean [SE] age, 41.3 [0.8] years; 92 women [63.9%]) participated in the study; 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules. Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 [57.5%] in forward-rotating schedule group; 37 [57.8%] in backward-rotating schedule group). Nurses working backward-rotating shifts exhibited significantly greater sleepiness (F1,139 = 41.23; P < .001) and cognitive slowing (ie, longer median reaction times; F1,139 = 42.12; P < .001) than those working forward rotations. Importantly, these differences were not affected by age, years of employment, and quality of sleep. Of nurses working on a backward-rotating schedule, 60 (93.8%) reported elevated sleepiness (Karolinska Sleepiness Scale score 點7) after the night shift. The median reaction time (F1,139 = 42.12; P < .001), 10% fastest reaction time (F1,139 = 97.07; P < .001), minor lapses (F1,139 = 46.29; P < .001), and reaction time distribution (F1,139 = 60.13; P < .001) of nurses on backward-rotating schedules indicated a lower level of vigilance, which is negatively associated with neurobehavioral performance.

Conclusions and Relevance  In this study, both shift rotation models were negatively associated with health and cognitive performance. These findings suggest that forward shift rotation may be more beneficial than backward rotation for several measured performance attentional outcomes and sleepiness. Optimization of shift rotations should be implemented to decrease the combination of the negative outcomes associated with shift work and reduce the potential risk of medical errors in health care systems.



 

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原文連結:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785077


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