Santhi Nayantara, Aeschbach Daniel, Horowitz Todd S, Czeisler Charles A
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
J Biol Rhythms. 2008 Aug;23(4):341-52. doi: 10.1177/0748730408319863.
The prevalence of hazardous incidents induced by attentional impairment during night work and ensuing commute times is attributable to circadian misalignment and increased sleep pressure. In a 10-day shift work simulation protocol (4 day shifts and 3 night shifts), the efficacies of 2 countermeasures against nighttime (2300 to 0700 h) attentional impairment were compared: (1) Morning Sleep (0800 to 1600 h; n = 18) in conjunction with a phase-delaying light exposure (2300 to 0300 h), and (2) Evening Sleep (1400 to 2200 h; n = 17) in conjunction with a phase-advancing light exposure (0300 to 0700 h). Analysis of the dim light salivary melatonin onset indicated a modest but significant circadian realignment in both sleep groups (evening sleep: 2.27 +/- 0.6 h phase advance, p < 0.01; morning sleep: 4.98 +/- 0.43 h phase delay, p < 0.01). Daytime sleep efficiency and total sleep time did not differ between them or from their respective baseline sleep (2200 to 0600 h; p > 0.05). However, on the final night shift, the evening sleep subjects had 37% fewer episodes of attentional impairment (long response times: 22 +/- 4 vs. 35 +/- 4; p = 0.02) and quicker responses (p < 0.01) on the Psychomotor Vigilance Task than their morning sleep counterparts. Their response speed recovered to near daytime levels (p = 0.47), whereas those of the morning sleep subjects continued to be slower than their daytime levels (p = 0.008). It is concluded that partial circadian realignment to night work in combination with reduced homeostatic pressure contributed to the greater efficacy of a schedule of Evening Sleep with a phase-advancing light exposure as a countermeasure against attentional impairment, over a schedule of Morning Sleep with a phase-delaying light exposure. These results have important implications for managing patients with shift work disorder.
夜间工作及随后通勤期间因注意力受损引发的危险事件的发生率,可归因于昼夜节律失调和睡眠压力增加。在一项为期10天的轮班工作模拟方案(4个白班和3个夜班)中,比较了两种针对夜间(23:00至07:00)注意力受损的对策的效果:(1)早晨睡眠(08:00至16:00;n = 18)并结合延迟相位的光照暴露(23:00至03:00),以及(2)晚上睡眠(14:00至22:00;n = 17)并结合提前相位的光照暴露(03:00至07:00)。暗光下唾液褪黑素开始分泌时间的分析表明,两个睡眠组均出现了适度但显著的昼夜节律调整(晚上睡眠:相位提前2.27±0.6小时,p < 0.01;早晨睡眠:相位延迟4.98±0.43小时,p < 0.01)。白天睡眠效率和总睡眠时间在两组之间或与各自的基线睡眠(22:00至06:00)相比均无差异(p > 0.05)。然而,在最后一个夜班时,晚上睡眠的受试者在心理运动警觉任务中的注意力受损发作次数减少了37%(长反应时间:分别为22±4次和35±4次;p = 0.02),且反应更快(p < 0.01)。他们的反应速度恢复到接近白天的水平(p = 0.47),而早晨睡眠的受试者的反应速度仍比白天慢(p = 0.008)。研究得出结论,与夜班工作进行部分昼夜节律调整并结合降低内稳态压力,使得采用提前相位光照暴露的晚上睡眠方案作为针对注意力受损的对策,比采用延迟相位光照暴露的早晨睡眠方案更有效。这些结果对管理患有轮班工作障碍的患者具有重要意义。