Sleepiness and driving events in shift workers: the impact of circadian and homeostatic factors.

🎖️ Top 10% JournalMar 19, 2019Sleep

Sleepiness and driving problems in shift workers linked to body clock and sleep pressure

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Abstract

Subjective and objective sleepiness significantly increased following night shifts in shift workers.

Driving events related to sleepiness rose after night shifts compared to pre-shift levels.
The highest rates of subjective sleepiness and driving-related incidents occurred during post-night shift commutes.
Sleep-related driving events peaked following the first night shift, while inattention-related events were more common after consecutive night shifts.
Driving events increased after more than 16 hours of wakefulness.
Subjective measures of sleepiness were highest during commutes within ±3 hours of peak melatonin levels, particularly when wakefulness was prolonged.
An interaction between the body’s internal clock and wakefulness duration was noted, affecting sleepiness during drives.

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We aimed to characterize objective and subjective sleepiness and driving events during short work commutes and examine the impact of circadian and homeostatic factors across different shift types in a shift worker population. Thirty-three nurses were monitored for 2 weeks over day (07:00-15:30), evening (13:00-21:30), and night shifts (21:00-07:30). Sleep was measured via daily sleep logs and wrist actigraphy. Driving logs were completed for each work commute, reporting driving events and a predrive Karolinska Sleepiness Scale (KSS). Ocular data from a subset of participants (n = 11) assessed objective sleepiness using infrared oculography during commutes. Circadian phase was assessed at three time points via urinary 6-sulphatoxymelatonin (aMT6s) collected over 24-48 hours. Subjective and objective sleepiness and sleep-related and hazardous driving events significantly increased following night shift compared with preshift. There were significant shift differences with KSS, sleep-related and inattention-related events highest during the postnight shift commute, compared with day and evening shifts. Sleep-related events were highest following the first night shift, while inattention-related events were most frequent after consecutive night shifts. KSS, sleep-related and hazardous events were increased during drives following ≥16 hours of wakefulness. KSS and sleep-related events increased during drives within ±3 hours of aMT6s acrophase. An interaction between homeostatic and circadian processes was observed, with KSS and sleep-related events highest within ±3 hours of acrophase, when wakefulness was ≥16 hours. In naturalistic conditions, subjective and objective sleepiness and driving events are increased following night shifts, even during short (~30 minutes) commutes and exacerbated by an interaction between circadian phase and duration of wakefulness.

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