[Increased risk of accidents during night shift. An underestimated problem are fatigue-induced accidents].
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Accidents, Occupational↗
Biomedical subjects
T Akerstedt
Publications and source records attributed to T Akerstedt.
Validation of the S and C components of the three-process model of alertness regulation.
This paper summarizes work to validate and develop further the homeostatic and circadian component of a quantitative (computerized) three-process model for predicting alertness/sleepiness in daily living. The model uses sleep data as input and contains circadian and homeostatic components (amount of prior wake and amount of prior sleep), which are summed to yield predicted alertness on a scale between 1 and 16. The present validation was carried out using regression analysis, with sleepiness-related electroencephalographic parameters (alpha power density) from field and laboratory studies as criteria. The results showed that variations in alpha-power density in truck drivers, train drivers and laboratory subjects could be predicted with considerable accuracy (r2 > 0.70) from the model, as could subjective alertness. Levels < or = 7 on the 16-point scale were defined as critically low alertness. The paper also describes a simplified, graphic, paper version of the computation model, visualized as a two-dimensional "alertness nomogram". It is suggested that the studied components of the model may serve as tools for evaluating work/rest schedules in terms of sleep-related safety risks.
Adult↗
Relations between performance and subjective ratings of sleepiness during a night awake.
The present study validated the nine-point Karolinska Sleepiness Scale (KSS) and the new Accumulated Time with Sleepiness (ATS) scale against performance of laboratory tasks. The ATS scale was designed as a method for integrating subjective sleepiness over longer time periods. The subjects were asked if certain symptoms of sleepiness had occurred and, if so, for how long. Six subjects participated twice. Each time they were kept awake during the night (except for a short nap occurring during one of the nights in a counterbalanced order) and were tested at 2200, 0200, 0400 and 0600 hours. The tests included a 10-minute rest period, a 28-minute visual vigilance task and an 11-minute single reaction time task. KSS and visual analogue scale (VAS) ratings were given before each test, and ATS ratings were given after. Performance deteriorated clearly, and all three rating scales reflected increased sleepiness with time of night. Scores on the KSS and VAS showed high correlations with performance tasks (mean intraindividual correlations were between 0.49 and 0.71). Performance correlated even higher with the ATS ratings (r = 0.73-0.79). Intercorrelations between rating scales were also high (r = 0.65-0.86). It was concluded that there were strong relations between ratings of sleepiness and performance, that the ATS rating scale was at least as good as the other scales and that the ratings were affected by type of task.
Adult↗
Age and adjustment to night work.
OBJECTIVE: The study was designed to examine the effects of age on sleep and the circadian rhythms during consecutive night shifts. METHODS: Two groups of letter sorters (19-29 (n = 7) and 53-59 (n = 7) years of age were studied in a sleep laboratory under closely controlled conditions. After two baseline days, circadian adjustment to three night shifts was monitored by continuous measurement of rectal temperature, salivary melatonin, and sleep-wakefulness during the night shifts. RESULTS: Age was significantly related to the adjustment to night work of rectal temperature minimum and of self rated sleepiness. Young subjects delayed their temperature phase and decreased sleepiness more than the older subjects. Age was also significantly related to an increase of alertness and to the feeling of being refreshed after the day sleep. Although there were basic differences in sleep duration and structure between the age groups, the latter did not change across the night shifts. CONCLUSION: Aging decreases the ability to recover after several, but not after the first night shift.
Adaptation, Physiological↗
The subjective meaning of good sleep, an intraindividual approach using the Karolinska Sleep Diary.
The present experiment used an intraindividual design to investigate the meaning and measurement of "good sleep". Each of 16 subjects slept in an isolation unit according to a schedule (15 sleeps) designed to give variable quality of sleep. Self-rated sleep measures (from the Karolinska Sleep Diary) were obtained after each sleep and subjected to intraindividual regression analyses across time. Most subjective sleep measures showed a strong covariation across conditions. Subjective quality of sleep mainly involved variables of sleep continuity, in particular, perceived calmness of sleep and sleep efficiency. "Sleep quality," "calm sleep," "ease of falling asleep," and ability to "sleep throughout" the time allotted strongly covaried and formed an index of sleep quality. Self-rated ease of awakening deviated from the general pattern and was associated with poor sleep quality. So was reported dreaming (related to awakenings). It was concluded that most subjective sleep measures tend to covary across conditions and that "good sleep" is mainly a question of sleep continuity.
Adolescent↗
The adjustment of the circadian rhythm of body temperature to simulated time-zone transitions: a comparison of the effect of using raw versus unmasked data.
Deep body temperature and sleep/activity diaries data were recorded during control days and for 6 days after simulated time zone transitions of 8 h to the east (six subjects) or west (seven subjects). Circadian rhythms were assessed by cosinor analysis of both raw data (the conventional method) and purified data (corrected for the effects of sleep and activity). Analysis of raw data gives misleading information about the phase and amplitude of the rhythms due to the masking effects of the exogenous component. Use of purified data indicates that during the process of adjustment after an eastward shift (a) phase changes are more erratic than after a shift to the west; (b) no marked decrease in the amplitude of the rhythms is evident; and (c) no clear evidence exists that the circadian rhythm breaks up temporarily. The masking effect was less after the time zone transition if sleep maintenance was poor.
Adolescent↗
Nocturnal eating and serum cholesterol of three-shift workers.
OBJECTIVES: The goal of this study was to examine the effect of rotating three-shift work on the circadian distribution of dietary intake and to investigate the relationships between displaced eating and nutritional status variables [blood lipids, blood glucose, body mass index (BMI)]. METHODS: Dietary data were collected by 147 replicate 24-h dietary recalls from 22 male industrial workers in rotating three-shift work. The intakes of energy and nutrients were estimated by the use of a nutrient data base. The BMI was calculated, and blood glucose, serum triglycerides, high-density lipoprotein (HDL) cholesterol and low-density lipoprotein (LDL) cholesterol were measured once. RESULTS: The dietary intakes of energy, protein, total fat, saturated fat, total carbohydrates, sucrose, and dietary fiber did not differ between 24-h periods but did differ between work shifts and were lowest during the night. Correlation analyses between dietary intakes and nutritional status parameters showed that those who redistributed their eating most to the night shift had higher levels of serum total cholesterol and LDL and a higher LDL:HDL ratio; 63% of the LDL cholesterol level was explained by carbohydrate intake during night shifts. In contrast, the total intake for whole 24-h periods or across entire shift cycles was not related to serum variables or BMI. CONCLUSIONS: Dietary intake is lower during night shifts (34-37% of 24-h intake of various nutrients) than during morning shifts (43-47%) and afternoon shifts (47-59%). The redistribution of food intake to the night may be associated with metabolic disturbances in lipid metabolism.
Adult↗
Sleepiness in long distance truck driving: an ambulatory EEG study of night driving.
Eighteen truck drivers had their EEG recorded continuously during a night or evening drive between southern Sweden and Stockholm (500 km). They also carried out self ratings of sleepiness and performance every hour. The EEG was subjected to spectral analysis. The drivers were divided into two groups with a night group (n = 7) who drove between 20:30 to 97:20 and an evening group (n = 11) who drove between 18:20 and 04:00. The night group showed higher subjective sleepiness and lower subjective performance, and increased alpha and theta burst activity during the last three hours of the drive. The groups did not differ for the first 2-3 h of the drive. For the night group, a significant intraindividual correlation was found between subjective sleepiness and EEG alpha burst activity. End-of-the-drive subjective sleepiness and alpha burst activity were significantly correlated with total work hours and arrival time but not with age, diurnal type, prior (rated) sleep length, total break time, drive time or prior time awake. A regression analysis showed that total work hours and total break time predicted 66% of the variance of alpha burst activity during the end of the drive.
Adult↗
Regulation of sleep and naps on an irregular schedule.
For many occupational groups there is an implicit requirement that sleep be taken according to very irregular schedules. The purpose of this study was to investigate the effects of an irregular sleep schedule on sleep and to determine if such effects could be attributed to the timing of sleep. Eight subjects slept in an isolation unit according to an irregular schedule comprising four 8-hour sleep periods, 12 6-hour sleep periods and 12 1-hour naps. The schedule was designed to give normal amounts of time (1/3 of total) in bed. Large variations in mean sleep efficiency (100-46%) were observed, which in individual cases frequently involved a complete absence of sleep. In 6-hour sleep periods the loss was due to an inability to maintain sleep, whereas in naps the loss was due to an inability to initiate sleep. The major causes of reduced sleep were short prior time awake and bedtime close to the circadian acrophase of rectal temperature (i.e. late afternoon). These two components accounted for 46% of the intraindividual variance of total sleep time (TST). TST increased by 9.2 minutes for each hour of prior time awake and by 10 minutes for each hour of deviation from the circadian acrophase of rectal temperature. Prior time awake also exerted a strong influence on slow-wave sleep (SWS), and circadian phase exerted a similar influence on rapid eye movement sleep. We concluded that irregular sleep patterns strongly affect sleep and that circadian and homeostatic influences are clearly discernible despite the irregularity.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Sleep on a shortening day/night schedule.
In 2 experiments subjects were exposed for 3.5 weeks to a gradually (0.2 h/day initially) shortening day/night cycle, ending at 22.8 h and 22.0 h, respectively. Shortening of the cycle led to an initial but temporary increase of sleep latency. When the reduction ceased at 22.8 h and this length was maintained, sleep parameters were not further affected and the temperature rhythm in most subjects remained entrained to the 22.8 h period, although some instability occurred towards the end. In the 22.0 h experiment the continued reduction beyond 22.8 h led to disturbed sleep on day 15, at a day length of 22.4 h. Total sleep time, stage 2 and sleep efficiency were then markedly reduced. At this point sleep coincided with the peak of the body temperature rhythm and the amplitude of the latter was extremely small. This was also the point when the body temperature rhythm 'broke out' from the sleep/wake rhythm and showed a large 6 h phase jump (delay). Towards the end of the experiment, when sleep was initiated in the circadian temperature trough, REM propensity was increased. It was concluded that several sleep parameters were affected by the reduction of the day/night cycle although the specific effects depended on the amount of phase advance and on whether desynchronization occurred. Within the range of entrainment, however, most sleep parameters were remarkably unperturbed by the considerable changes of circadian parameters.
Adult↗
Hypnotics and sleep physiology: a consensus report. European Sleep Research Society, Committee on Hypnotics and Sleep Physiology.
The effects of hypnotics on descriptive and functional aspects of electrophysiological sleep parameters are assessed in this report. Because of the arbitrary definition of some of the criteria underlying the conventional sleep stage scoring procedure, computer-aided methods of EEG analysis have become increasingly important for recording and interpreting pharmacological effects on sleep. Of particular interest are the changes of EEG slow-wave activity, since this parameter varies as a function of prior sleep and waking. Several types of interaction between hypnotics and sleep regulation are discussed, some recent pharmacological developments are highlighted, and some common problems in clinical trials are specified.
Anti-Anxiety Agents↗
Recovery within day-time sleep after slow wave sleep suppression.
Six subjects had their SWS activity suppressed by acoustic stimulation during a day-time (11.00 h) recovery sleep after a 4 h night sleep (03.00-07.00 h). Sleep was disturbed for a period corresponding to 90% of the duration of a preceding undisturbed baseline sleep (also at 11.00 h and preceded by a 4 h night sleep) and thereafter allowed to continue undisturbed until spontaneous awakening. The results showed that SWS and EEG power density were significantly reduced during suppression and that full recovery occurred before spontaneous awakening. The disturbed sleep was significantly longer than the baseline sleep. The increase in duration consisted mainly of SWS, stage 2 and REM. The results suggest that the suppression of SWS activity caused a need for an extension of sleep in order to allow recovery.
Adult↗
Self-reported health and well-being amongst night security guards: a comparison with the working population.
The present study sought to relate the well-being of night workers to that of the working population in general. One hundred and ninety-seven male permanent night security guards were interviewed with regard to the occurrence of various symptoms during the previous 12-month period. The results were compared with the results from similar interviews with a representative national sample of males (n = 1769) in the Swedish workforce. An age standardized morbidity ratio was computed with control for various background variables. The results showed that the security guards had a 2-3 times higher occurrence of sleep disturbances and fatigue than the national sample. Among the variables not differing from the national sample were gastrointestinal problems, headache, nervous problems, depression, nausea, diarrhoea, and haemorrhoids. It was concluded that sleep/wake disturbances are considerably more usual in permanent night security guards than in the working population as a whole.
Adult↗
Manifest sleepiness and the spectral content of the EEG during shift work.
Twenty-five three-shift workers in a process industry were subjected to ambulatory polysomnography during one afternoon and one night shift. The electroencephalographic (EEG) recordings were analyzed with spectral analysis. Subjective sleepiness increased during the night work but did not reach an extreme level. Five subjects fell asleep during night work and the involuntary naps were preceded by a few minutes of increased alpha (8-11.9 Hz) power density. Alpha and theta activity occurred in very short bursts. The hourly mean EEG alpha power density increased significantly but moderately during the night shift and correlated with subjective ratings of sleepiness. Theta power density (4-7.9 Hz) did not increase during the night shift, nor did it correlate with subjective sleepiness. It was suggested that the shift workers could prevent much of the polysomnographic manifestations of sleepiness by various types of activity (including succumbing to sleep). It was also suggested that averaging power density values across long time periods might not be an optimal strategy for detection of sleepiness, but rather some method of emphasizing the occurrence of alpha or theta bursts.
Adult↗
Stability of day and night sleep--a two-year follow-up of EEG parameters in three-shift workers.
Twenty rotating three-shift workers participated. Night and day sleep in connection with work on afternoon and night shifts, respectively, were recorded using 24-hour polysomnographic recording techniques. The procedure was repeated 2 years later. Both day and night sleep showed high significant correlations between years for rapid eye movement (REM) sleep, slow wave sleep (SWS-stages 3 + 4), total sleep time, slow wave energy, in the delta band (obtained via spectral analysis) and subjective sleep quality. Stage 2, stage 1, percent waking, sleep latency, SWS latency and REM latency were not correlated across years. None of the variables showed a significant difference between years. It was concluded that core variables of sleep show considerable interindividual stability across time and that a 2-year exposure to rotating shift work does not affect sleep in experienced shift workers.
Adult↗
Working hours of medical residents and housestaff.
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Electroencephalography↗
Spectral analysis of sleep electroencephalography in rotating three-shift work.
Fourteen male rotating three-shift workers were subjected to 24-h ambulatory polysomnographic recording in connection with morning, afternoon, and night shift work (at home and at work). Total sleep time, stage 2, rapid-eye-movement sleep, and slow-wave sleep (stages 3 + 4) were significantly reduced during sleep in connection with the night and morning shifts. Other visually scored sleep parameters and slow-wave energy (spectral power density integrated across sleep) were not affected. The content of the sleep cycles did not differ between shifts. The sleep before the morning shift was characterized by subjectively increased difficulties of sleep initiation and sleep termination, as well as by insufficient recuperation. The night shift was characterized by increased subjective difficulties of maintaining sleep, but also by increased ease of sleep initiation. It was concluded that both morning and evening shifts interfered with sleep, although no effects of sleep deprivation were found.
Adult↗
The dynamics of the first sleep cycle.
Eight subjects participated in an experiment in which sleep stages and electroencephalographic (EEG) power density during the first sleep cycles (and where such appeared, also second cycles) were studied in a design involving 8, 4, 2 or 0 hr of progressively postponed night-time sleep. Each of these four manipulations was followed by a day-time sleep beginning at 1100 hr. No significant changes in the duration of the first sleep cycle appeared. As the prior sleep loss increased both SWE (slow-wave energy; accumulated EEG delta power density) and SWA (slow-wave activity; EEG delta power per minute) increased during the 1100-hr sleeps. This was observed for the entire cycles, the nonrapid eye movement (NREM) periods, and the SWS periods, respectively. SWS latency decreased and SWS duration increased, respectively, markedly with prior waking. Also, for the progressively postponed sleeps (started at 2300 hr, 0300 hr, 0500 hr and 1100 hr) there were changes, but not as clear. After 28 hr of continuous waking there was a marked increase of SWA during SWS. Also, at this level there was a spill over of SWA to the second cycle. It is suggested that there might be a limit to the amount and intensity of SWS that can be accommodated in the first sleep cycle and that this limit is reached before the appearance of REM sleep.
Adult↗