Can a simple balance task be used to assess fitness for duty?

Human fatigue, caused by sleep loss, extended wakefulness, and/or circadian misalignment, is a major cause of workplace errors, incidents and accidents. In some industries, employees are required to undertake fitness for duty testing at the start of a shift to identify instances where their fatigue risk is elevated, so that minimisation and/or mitigation strategies can be implemented. Postural balance has been proposed as a fitness for duty test for fatigue, but it is largely untested. Therefore, the purpose of this study was to examine the impact of sleep loss, extended wakefulness and circadian phase on postural balance. Fourteen male participants spent 10 consecutive days in a sleep laboratory, including three adaptation days and eight simulated shiftwork days. To simulate a quickly rotating roster, shiftwork days were scheduled to begin 4h later each day, and consisted of a 23.3-h wake episode and a 4.7-h sleep opportunity. Every 2.5h during wake, balance was measured while standing as still as possible on a force platform with eyes open for one minute, and eyes closed for one minute. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale. Core body temperature, continuously recorded with rectal thermistors, was used to determine circadian phase. For measures of postural balance and subjective sleepiness, data were analysed using three separate repeated measures ANOVA with two within-subjects factors: circadian phase (six phases) and prior wake (nine levels). For subjective sleepiness, there was a significant effect of prior wake and circadian phase. In particular, sleepiness increased as prior wake increased, and was higher during biological night-time than biological daytime. For the eyes open balance task, there was no effect of prior wake or circadian phase. For the eyes closed balance task, there was a significant effect of circadian phase such that balance was poorer during the biological night-time than biological daytime, but there was no effect of prior wake. These results indicate that postural balance may be a viable tool for assessing fatigue associated with time of day, but may not be useful for assessing fatigue associated with extended hours of wake.