de Bruijn Linske, Berentzen Nina E, Vermeulen Roel C H, Vlaanderen Jelle J, Kromhout Hans, van Leeuwen Flora E, Schaapveld Michael
Department of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands.
Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
J Sleep Res. 2025 Apr;34(2):e14308. doi: 10.1111/jsr.14308. Epub 2024 Aug 19.
Chronotype may affect tolerance for circadian disruption induced by shift work. This study examines the association between chronotype, self-reported sleep timing, shift type preference, and sleep problems among nurses, and studies chronotype stability over time. The study included 37,731 Dutch female nurses who completed a baseline (2011) and follow-up questionnaire (2017), with information on shift work (e.g., job history, shift type preference [collected in 2017 only]), and sleep characteristics (e.g., chronotype, preferred sleep-wake time in a work-free period [collected in 2017 only], and sleep problems between working days according to Medical Outcomes Study-Sleep Problem Index II [MOS-SPI-II]). The association between chronotype and sleep timing was examined using (age-adjusted) linear regression. Associations between chronotype and shift type preference and sleep problems (MOS-SPI-II >30) were examined using ordered logistic and Poisson regression, respectively. With later chronotype, midsleep time increased (definite evening vs. intermediate types [reference]: β = 55 min, 95% confidence interval [95% CI]: 54-55), the odds ratio (OR) for 1-point increase in preference for night (2.68; 95% CI: 2.48-2.90) and evening shifts increased (OR 2.20; 95% CI: 2.03-2.38), while the odds for day (OR 0.17; 95% CI: 0.16-0.18) and morning shifts (OR 0.22; 95% CI: 0.21-0.24) decreased. Intermediate chronotype was associated with fewer sleep problems (median MOS-SPI-II = 27.2, p < 0.01), compared with definite morning (28.9) and evening types (31.7). This study shows that chronotype is associated with sleep-wake times in a work-free period, shift type preference, and sleep problems in nurses. Future studies on the association of shift work-induced circadian disruption and health outcomes should therefore consider chronotype as effect-modifier.
昼夜节律类型可能会影响对轮班工作引起的昼夜节律紊乱的耐受性。本研究调查了护士的昼夜节律类型、自我报告的睡眠时间、轮班类型偏好和睡眠问题之间的关联，并研究了昼夜节律类型随时间的稳定性。该研究纳入了37731名荷兰女性护士，她们完成了一份基线调查问卷（2011年）和一份随访调查问卷（2017年），问卷内容包括轮班工作信息（如工作经历、轮班类型偏好[仅在2017年收集]）以及睡眠特征（如昼夜节律类型、非工作期间偏好的睡眠-觉醒时间[仅在2017年收集]，以及根据医学结局研究-睡眠问题指数II[MOS-SPI-II]得出的工作日之间的睡眠问题）。使用（年龄调整后的）线性回归分析昼夜节律类型与睡眠时间之间的关联。分别使用有序逻辑回归和泊松回归分析昼夜节律类型与轮班类型偏好和睡眠问题（MOS-SPI-II>30）之间的关联。随着昼夜节律类型变晚，入睡时间增加（确定的夜晚型与中间型[参照]：β = 55分钟，95%置信区间[95%CI]：54 - 55），夜间（优势比[OR]为2.68；95%CI：2.48 - 2.90）和晚班偏好增加1分的OR增加（OR为2.20；95%CI：2.03 - 2.38），而白班（OR为0.17；95%CI：0.16 - 0.18）和早班（OR为0.22；95%CI：0.21 - 0.24）的OR降低。与确定的早晨型（28.9）和夜晚型（31.7）相比，中间型昼夜节律类型与较少的睡眠问题相关（MOS-SPI-II中位数 = 27.2，p < 0.01）。本研究表明，昼夜节律类型与非工作期间的睡眠-觉醒时间、轮班类型偏好以及护士的睡眠问题相关。因此，未来关于轮班工作引起的昼夜节律紊乱与健康结局之间关联的研究应将昼夜节律类型视为效应修饰因素。
