Changes in nurses' decision making during a 12-h day shift.

BACKGROUND: Although shift work is necessary in many health-care settings, research suggests that it can have detrimental effects on performance in health-care providers. AIMS: To determine if a change in decision-making occurred across a 12-h day shift in a sample of registered nurses. METHODS: The participants were nurses working a 12-h day shift (7 a.m.-7 p.m.) at a large hospital in the south-eastern USA. Participants completed a policy-capturing questionnaire, examining their likelihood of calling a physician in response to specific patient symptoms, at the beginning and end of the shift. They also completed self-report surveys on alertness, stress and sleepiness. RESULTS: Sixty-five nurses completed the study, an overall response rate of 41%. Participants significantly changed their decision-making policies from the beginning to the end of the work shift and also became significantly less alert and more stressed. However, there was no correlation between decision-making and reported alertness and stress. CONCLUSIONS: These results suggest that medical judgment in registered nurses changed from the beginning to the end of a 12-h day shift. One possible underlying mechanism responsible for the changes seen across the shift could be the ability to maintain attention, as suggested by the Controlled Attention Model. The current results expand upon previous research, indicating there are a variety of negative outcomes associated with shift work.

The prevalence of daytime napping and its relationship to nighttime sleep.

Many healthy adults report daytime napping. Surprisingly few studies, however, have examined spontaneous napping behavior, especially very short naps, in healthy adults. The authors examined the prevalence of power naps (lasting less than 20 minutes) and longer naps (20 minutes or more) and their effects on nighttime sleep in a group of healthy young and middle-aged adults. The young and middle-aged adults reported very similar sleep and napping patterns, with approximately 74% of the participants in both groups reporting they had napped during a 7-day sleep-log period. Almost half of the participants reported that the average nap lasted less than 20 minutes. A multivariant analysis of variance (MANOVA) found no significant differences between the no-nap and the power-nap or long-nap groups in sleep quantity or quality for either age group. The current data suggested that power napping occurs frequently in healthy adults and that spontaneous napping does not negatively affect nighttime sleep.

Work/rest cycles in railroad operations: effects of shorter than 24-h shift work schedules and on-call schedules on sleep.

The current study examined the frequency with which shorter than 24-h work/rest cycles occur in locomotive engineer work schedules, and what effects these work/rest cycles had on sleep quantity and sleep quality. The results indicated that shorter than 24-h work/rest cycles occurred in 33.6% of the work days reported by 198 locomotive engineers. In addition, the shorter than 24-h work/rest cycles occurred more frequently in work schedules that created an on-call work system, such as road pool turn and extra board assignments, than in work schedules that used more predictable or regular work times, such as regular road assignments and yard/local work. As would be expected, when engineers worked shorter than 24-h work/rest cycles, they reported less sleep and poorer sleep than under the longer than 24-h work/rest cycles. Similarly, on-call work assignments resulted in less sleep and poorer sleep than regular work assignments. These results indicate that specific aspects of the work schedules used in railroad operations, particularly on-call operations that result in shorter than 24-h work/rest cycles, can lead to increased sleep-related problems. Although the North American railroad industry is making significant changes in on-call operations to minimize sleep-related problems from on-call schedules, better fatigue-related models validated within the railroad industry are needed.

Self-report sleep habits as predictors of subjective sleepiness.

Although sleepiness is pervasive in our society, there is little agreement on how to measure sleepiness or on how well sleepiness is actually related to sleep habits. To better assess how subjective sleepiness is related to sleep, the authors used self-report measures of sleep quantity, sleep quality, and napping to predict 4 different sleepiness-related measures in a group of healthy young and middle-aged-to-older adults. A forward regression analysis indicated that sleep quality was better than sleep quantity as a predictor of participants' sleepiness. The sleep measures, furthermore, predicted sleepiness better in the older adults than in the younger adults. Finally, the 4 sleepiness measures differed in how well they were related to sleep. The findings in the study suggest that sleepiness is a complex phenomenon rather than a simple reflection of sleep quantity.

Differential effects of permanent and rotating shifts on self-report sleep length: a meta-analytic review.

STUDY OBJECTIVES: The current study used the meta-analytic technique to quantitatively assess the effects of permanent and rotating shift-work schedules on sleep length. DESIGN: A meta-analysis was completed on 36 primary studies resulting in 165 effect sizes. Effect sizes comparing shift-workers to a permanent day shift control group were calculated for permanent evening shifts, permanent night shifts, and morning, evening, and night shifts worked as part of slowly and rapidly rotating shift systems. SETTING: NA PATIENTS OR PARTICIPANTS: NA INTERVENTIONS: NA RESULTS: Permanent night shifts resulted in a decrease, whereas permanent evening shifts resulted in an increase in sleep length. The shifts within rotating schedules followed the same pattern, with the addition of morning shifts having a moderate detrimental effect on sleep length. Furthermore, the speed of shift rotation had an impact. Slowly rotating shifts, in general, had the least detrimental effect on sleep length of the permanent and rotating shift-work schedules studied here. The pattern of effects among morning, evening, and night shifts was the same for rapidly and slowly rotating shifts, with night shifts having the greatest detrimental effect, morning shifts having a moderate detrimental effect and evening shifts having a positive effect on sleep length. In addition, nights on rotating shifts had a greater negative effect on sleep length than permanent night shifts. CONCLUSIONS: Slowly rotating shifts have the least negative impact on sleep length of shift-work schedules including a night shift. However, permanent night shifts could be an alternative shift-work schedule in operational settings that require many workers at night.

The relationships between sleep and measures of health and well-being in college students: a repeated measures approach.

The stability of subjective measures of sleep, health, and well-being, as well as the stability of the relationships between sleep and health and well-being were assessed over 3 months. Healthy college students with no consistent sleep complaints completed a 7-day sleep log and battery of surveys related to health and well-being at 3 separate times during the 3 months. Measures of health and well-being were more strongly related to the quality than to the quantity of sleep. Further analyses using the repeated measures results found that participants reported improved sleep and better health, but the affect balance, life satisfaction, and mood states were unchanged across the 3 testing periods. The relationships between the measures of sleep and measures of health and well-being remained constant across the experimental period. Even when working with a non-sleep-disturbed population, healthcare professionals should consider sleep quality as a consistent correlate of daily health and well-being.

Scopolamine-induced impairment in concurrent fixed-interval responding in a radial maze task.

The present study investigated the effects of scopolamine hydrobromide (SCOP: 0.06-1.0 mg/kg IP) and its quartenary analogue, scopolamine methylbromide (SCOPMB), on performance in a radial arm maze foraging task, to dissociate general drug-induced alterations of motor performance from measurement of impairments on more complex behaviors involving timing and memory. In this paradigm. rats are trained to free run a radial maze under an eight-alternative concurrent fixed-interval (FI) schedule of food reinforcement. The eight FIs (55 to 759 s) were assigned randomly to the arms of the maze, with a different pattern for each animal. SCOP produced dose-dependent degradation in response patterning and response rates in the concurrent FI schedules without significantly affecting the rates of arm entries or arm traversal latencies. The peripheral cholinergic antagonist, SCOPMB, generally produced small to moderate depressions in all measures with the exception of patterning of arm entries and pellets earned, but there were no clear dose-response relationships evident in the data. These results are consistent with the notion that central cholinergic mechanisms are involved in the mediation of complex conditioned behaviors.

How sleep deprivation affects psychological variables related to college students' cognitive performance.

The effects of sleep deprivation on cognitive performance psychological variables related to cognitive performance were studied in 44 college students. Participants completed the Watson-Glaser Critical Thinking Appraisal after either 24 hours of sleep deprivation or approximately 8 hours of sleep. After completing the cognitive task, the participants completed 2 questionnaires, one assessing self-reported effort, concentration, and estimated performance, the other assessing off-task cognitions. As expected, sleep-deprived participants performed significantly worse than the nondeprived participants on the cognitive task. However, the sleep-deprived participants rated their concentration and effort higher than the nondeprived participants did. In addition, the sleep-deprived participants rated their estimated performance significantly higher than the nondeprived participants did. The findings indicate that college students are not aware of the extent to which sleep deprivation negatively affects their ability to complete cognitive tasks.

Scopolamine impairs spatial working memory in the radial maze: an analysis by error type and arm choice.

The effects of scopolamine hydrobromide on performance in uninterrupted and delayed radial maze trials were studied in the rat. In addition to defining errors as incorrect arm entries, errors were defined by incorrect nose pokes in a food trough and were summed across the number of correct choices remaining. The average time elapsed from arm entry to nose poke was also calculated as a new measure of motivation and mobility. Working memory errors increased significantly following scopolamine injection in the uninterrupted trials and occurred significantly more often before the last correct choice. Errors in nonbaited arms during the last portion of a 3-h delay task increased significantly following scopolamine injection both before and after the first portion of the task and occurred more often before the last correct choice. However, nonbaited errors occurred more readily and at lower doses when scopolamine was injected 20 min before the onset of the task than when scopolamine was injected immediately after the completion of the first portion of the task. These data indicate that scopolamine affects current working memory and specifically affects acquisition more than consolidation of working memory.

Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students.

Two studies assessed whether measures of health, well-being, and sleepiness are better related to sleep quality or sleep quantity. In both studies, subjects completed a 7-day sleep log followed by a battery of surveys pertaining to health, well-being, and sleepiness. In subjects sleeping an average of 7 hours a night, average sleep quality was better related to health, affect balance, satisfaction with life, and feelings of tension, depression, anger, fatigue, and confusion than average sleep quantity. In addition, average sleep quality was better related to sleepiness than sleep quantity. These results indicate that health care professionals should focus on sleep quality in addition to sleep quantity in their efforts to understand the role of sleep in daily life.

Effects of sleep deprivation on performance: a meta-analysis.

To quantitatively describe the effects of sleep loss, we used meta-analysis, a technique relatively new to the sleep research field, to mathematically summarize data from 19 original research studies. Results of our analysis of 143 study coefficients and a total sample size of 1.932 suggest that overall sleep deprivation strongly impairs human functioning. Moreover, we found that mood is more affected by sleep deprivation than either cognitive or motor performance and that partial sleep deprivation has a more profound effect on functioning than either long-term or short-term sleep deprivation. In general, these results indicate that the effects of sleep deprivation may be underestimated in some narrative reviews, particularly those concerning the effects of partial sleep deprivation.

Sleep deprivation in the rat: XIII. The effect of hypothyroidism on sleep deprivation symptoms.

Previous studies of rats subjected to total sleep deprivation by the disk-over-water method had shown a large increase in energy expenditure (EE) and an initial increase followed by a later decrease in body temperature (Tb). It had been proposed that the increase in Tb resulted from regulation toward a higher temperature or setpoint, that the later decline in Tb resulted from excessive heat loss, and that the increase in EE supported both of these thermoregulatory changes. To evaluate this proposed role of the increase in EE, we examined whether blunting the EE rise in sleep-deprived rats by making them hypothyroid attenuated and/or shortened the initial increase in Tb and accelerated the later decline in Tb. Rats made hypothyroid by propylthiouracil administration (TxD rats) were totally sleep deprived and compared to hypothyroid yoked control (TxC) rats and to previously studied, untreated, totally sleep-deprived (TSD) rats. Neither TxD nor TxC rats showed large increases in EE like those of TSD rats. TxD rats did not initially increase Tb, as TSD rats had. Presumably, TSD rats had been able to support an initially elevated Tb, in spite of excessive heat loss, by large increases in EE, although even these increases were eventually insufficient. TxD rats showed much earlier and greater declines in Tb than TxC and TSD rats, eventually becoming severely hypothermic. These results support the interpretation that the large increase in EE previously seen in TSD rats had been compensatory for deprivation-induced thermoregulatory deficits. TxD rats survived an average of 17.1 days, which was not significantly different from survival time in TSD rats. However, there were differences in mortal processes between the two groups. TxD rats died or were sacrificed after chronic, severe hypothermia without observable signs of other morbid pathology. TSD rats had not shown similarly low Tb until just prior to death, but had shown signs of severe pathology, including severely debilitated appearance, disheveled fur, and severe lesions on their tails and on the plantar surfaces of their paws. These signs were diminished or absent in TxD rats, possibly due to blunted EE, lower Tb, or other effects of hypothyroidism. Because the skin changes seen in TSD rats were minimal in TxD rats, they could not have been responsible for the excessive heat loss.

Sleep deprivation in the rat: XI. The effect of guanethidine-induced sympathetic blockade on the sleep deprivation syndrome.

In earlier studies, rats totally deprived of sleep by a disk-over-water apparatus (TSD rats) had shown an increase in energy expenditure (EE) that could not be explained by increased motor activity or the metabolic expense of wakefulness. Excessive activation of a calorigenic mediator was a possibility, and norepinephrine-mediated sympathetic activation was the most likely candidate, because plasma norepinephrine (NE) levels had risen sharply in TSD rats. To determine whether this activation was necessary for increased EE in sleep deprived rats, the peripheral sympathetic blocking agent guanethidine (GU) was administered to six sleep-deprived (GD) rats and their yoked control (GC) rats. GU attenuated the increase in NE previously seen in TSD rats, but the increase in EE was not attenuated. Apparently, NE-mediated sympathetic activation was not critical for increased EE in sleep-deprived rats. On the other hand, plasma epinephrine (EPI) levels were significantly increased in GD (but not in GC) rats above those previously seen in TSD rats, suggesting the substitution of one calorigenic mediator for another in response to an abnormally elevated need for EE. Temperature data suggest that increased need for EE could arise from an elevated temperature setpoint and an inability to retain body heat. GD (but not GC) rats also showed other effects previously seen in TSD rats, including debilitated appearance; severe ulcerative and hyperkeratotic lesions on the tails and plantar surfaces; initially increased and later decreased body temperature; decreased plasma thyroxine; increased triiodothyronine-thyroxine ratio; and eventual death. Evidently, NE-mediated sympathetic activation was not critical to any of these effects, although a role for catecholamines cannot be ruled out.

Sleep deprivation in the rat: IX. Recovery.

Eight rats were subjected to total sleep deprivation, paradoxical sleep deprivation, or high amplitude sleep deprivation until they showed major deprivation-induced changes. Then they were allowed to sleep ad lib. Three rats that had shown the largest temperature declines died within two to six recovery days. During the first 15 days of ad lib sleep, surviving rats showed complete or almost complete reversal of the following deprivation-induced changes: debilitated appearance, lesions on the paws and tail, high energy expenditure, large decreases in peritoneal temperature, high plasma epinephrine and norepinephrine levels, and low thyroxine levels. The most prominent features of recovery sleep in all rats were immediate and large rebounds of paradoxical sleep to far above baseline levels, followed by lesser temporally extended rebounds. Rebounds of high amplitude non-rapid eye movement (NREM) sleep occurred only in some rats and were smaller and less immediate.

The interaction between EEG and transient muscle activity during sleep in humans.

The EEG and EMG were recorded during 14 nights of sleep for 5 young normal adults and were analyzed automatically with a lab computer system. From the EEG one parameter was computed which is based on the joint frequency-amplitude distribution of EEG waves. The temporal sequence of parameter values displays the time course of the sleep EEG. Another parameter, which results from the automatic analysis of the EMG, represents transient EMG activity, i.e. shortlasting changes of the muscle tone. A comparison of the automatically analyzed EEG and EMG data revealed a close correspondence between both parameters. A peak of EMG transient activity was observed in virtually each ultradian sleep cycle at a well-defined turning point between the phase of EEG synchronization and the subsequent phase of EEG desynchronization. Before and after this turning point there was a gradual decrease in the rate of transient EMG activity with minimal activity immediately preceding the turning point. The results suggest that cortical synchronization during sleep is incompatible with transient activity in the muscle system while desynchronization is invariably accompanied by a high rate of transient EMG activity.