Assessing quality of sleep, its functional outcome and excessive day time sleepiness in shift workers and non-shift workers

Background and aims: . Shift work has been growing more prevalence and involves irregular working hours when compared to daytime work schedule. this study aims to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnea between shift and non-shift workers. Methods: the study candidates were randomly drawn nepalese, from age 18 years and older, and were enrolled between January 2018 to January 2019. the subjects were divided into either: Shift work or non-Shift work. the assessment measures were done with Pittsburgh Sleep Quality index (PSQi), epworth Sleepiness Scale (eSS), StOP-Bang and FOSQ-10 (Functional Outcome of Sleep Quality – 10), using a standard form. results: a total of 358 participants were included in the main study (176 non-shift workers, and 182 Shift-workers). the mean BMi among the two group were not significantly different (p =0.43). there was significant difference with 25% non-Shift workers and 41.21% of Shift workers were found to have abnormal Sleepiness in the epworth Sleepiness Scale score (p=0.004). Shift workers showed comparatively higher values for epworth Sleepiness scale compared to non-Shift workers in Mann-Whitney analysis, with mean rank 194.11 versus 164.39, respectively, p=0.006. Similarly, 26.29% non-Shift workers and 36.72% Shift workers were found to have abnormal FOSQ-10 scores, χ2 (1) =4.44, p=0.035. 7.95% of non-Shift workers and 6.59% of Shift-workers were found to have high risk of OSa in StOP Bang questionnaire, with no significant association, p=0.725 conclusions: Shift work caused excessive daytime sleepiness and had worse functional outcome but did not increase probability of obstructive sleep apnea. Sanjeet Krishna Shrestha1, Sanjeev Shrestha1, lucky Sharma2, Subash Pant2, trilok Shrivastava1, rinki Mahaseth2, arpana neopane2 Original article Department of Pulmonary, critical care and Sleep Medicine, nepal Mediciti Hospital, lalitpur, nepal 2Department of internal Medicine, Division of Pulmonary, critical care and Sleep Medicine, Kathmandu Medical college teaching Hospital, Kathmandu, nepal this work is licensed under a creative commons attribution 4.0 Unported license. introduction Shift work’ involves irregular or unusual hours, compared to those of a normal daytime work schedule.1 any 24 hour job mandates shift work and rotating duties. changing hours of duties and night shifts have direct impact on sleep rhythm, quality of sleep and sleep related abnormalities.2 With the decreased sleep quality and duration, shift work has been associated with excessive daytime sleepiness. it contributes towards the negative impacts of shift work. there may be association of other sleep disorders and sleep related breathing abnormalities with shift work sleep disorder.3 Hence, assessing sleep quality and its functional outcome is important in order to identify potential medical condition associated with it and increase efficiency of work. Journal of Advances in Internal Medicine | Original Article 10 (JAIM): 15th issue, Volume 08, Number 01; January June 2019 according to 3rd european Survey on Working conditions, the classical working day that comprises of 7-8 a.m. to 5-6 p.m., Monday to Fridays work only encompasses around 27% of employed and 8% of self-employed population.4 Hence majority of works, according to recent data, are mostly those with shift duties, night duties, that can include prolonged duty periods, which can be around 12 hours night shifts.5 innumerable jobs operate shift-wise and innumerable people work day in and day out. in particular night shifts bring changes in circadian rhythm. Professions that are associated with shift work include drivers, nurses, doctors, laboratory technicians, paramedics, pilots, air traffic controllers, industrial workers, guards, and police officers.5 Junior doctors, trainees, nurses and paramedical staff spend maximum amount of their early carriers in shift duties including nights. ill formulated night shifts can have negative effects on professional, educational and social aspect of their lives.6 there is a range of health problems associated with shift work, which includes conditions like insomnia, constipation, as well as severe problems such as depression, metabolic syndrome, cardiovascular diseases & cancer. Mental problems associated with rotating duties can consist of anxiety, mood disorders, and fatigue-related accidents; and “the length of hours is a key factor for fatigue-related disorders”.7 Biochemically, nocturnal sleep disturbance has been positively correlated with levels of inflammatory markers like tnF alpha.8 risk of near driving accidents and actual accidents are reported in night shift workers after returning home from work.9 in light of growing prevalence of shift work and its already massive impact on health and social life, we intend to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnoea between shift and nonshift workers. all four measures are standard access points in sleep disorders and are assessed by standard tools.

assessing quality of sleep, its functional outcome and excessive day time sleepiness in shift workers and non-shift workers abstract Background and aims: . Shift work has been growing more prevalence and involves irregular working hours when compared to daytime work schedule. this study aims to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnea between shift and non-shift workers. Methods: the study candidates were randomly drawn nepalese, from age 18 years and older, and were enrolled between January 2018 to January 2019. the subjects were divided into either: Shift work or non-Shift work. the assessment measures were done with Pittsburgh Sleep Quality index (PSQi), epworth Sleepiness Scale (eSS), StOP-Bang and FOSQ-10 (Functional Outcome of Sleep Quality -10), using a standard form. there is a range of health problems associated with shift work, which includes conditions like insomnia, constipation, as well as severe problems such as depression, metabolic syndrome, cardiovascular diseases & cancer. Mental problems associated with rotating duties can consist of anxiety, mood disorders, and fatigue-related accidents; and "the length of hours is a key factor for fatigue-related disorders". 7 Biochemically, nocturnal sleep disturbance has been positively correlated with levels of inflammatory markers like tnF alpha. 8 risk of near driving accidents and actual accidents are reported in night shift workers after returning home from work. 9 in light of growing prevalence of shift work and its already massive impact on health and social life, we intend to assess sleep quality, its functional outcome, excessive daytime sleepiness and incidence of obstructive sleep apnoea between shift and nonshift workers. all four measures are standard access points in sleep disorders and are assessed by standard tools.

| MetHODOlOgY:
Subjects: all subjects were required to be 18 years or older consenting to the study. nepali males and females of different ethnicities were enrolled in the study. Subjects were drawn randomly from different working sectors in Kathmandu, nepal. Standard forms were used primarily as a mode for data collection, with english as being the primary language of the forms. For subjects who were not apt with the english language, printed format of the same form was used with appropriate translation in nepali language.
We contacted 500 eligible candidates for the study, of these 359 completed the interview and were enrolled in the study between Jan 2018 to Jan 2019. all who completed the study were nepalese by nationality. We reached out to random working population in Kathmandu, since it is the capital city and people working here represent all of the country geographically. all the 4 questionnaire tools were completed by all the subjects. there was no incidence of not understanding the questions in the forms by the any subjects. the subjects were not paid for the study. Definitions: Household workers were included as non-Shift workers, together with daytime job holders working 9 aM to 5 PM were included in non-shift workers. Shift workers included medical staffs, including interns, trainees and junior faculties. Variables: the independent variable in the study was type of work, with the subjects divided into either: Shift work or non-Shift work. Both shift workers with night duties and Shift workers without night duties were included in Shift work group. the assessment measures were done with Pittsburgh Sleep Quality index (PSQi), epworth Sleepiness Scale (eSS), StOP-Bang and FOSQ-10 (Functional Outcome of Sleep Quality -10). assessment: email, telephone were used as initial assessment. Personal visit to staffs of medical teams for consent was also carried out. Subjects were asked to select the category that best described their current work schedule. response choices included "non-Shift work", "Shift work without night duties" and "Shift work with night duties". Standard set of PSQi questions were asked the google form, the total score of PSQi was calculated using online calculator, provided by the original researcher. the absolute total score was assessed and individual data were categorically divided into: normal (total PSQi score<5) and abnormal (total PSQi score≥5).
For eSS, a composite total score was manually calculated for all the data. then the data were divided categorically into normal Sleepiness (eSS total score<7), average Sleepiness (eSS total score 7-8) and abnormal "Probably pathological" Sleepiness (eSS total Score ≥9).
StOP-Bang questions included "Yes or no" questions to Snoring, tiredness, Observed breathing cessation while asleep, treated for high blood pressure and shirt collar size greater than or smaller than 16 inches. Weight in kilograms and height in feet and inches were asked and after conversion to meters, BMi were calculated for each participants. the total StOPBang score was assessed and then categorically divided into: low risk of OSa (StOPBang total score ≤2), intermediate risk of OSa (StOPBang total score 3-4) and High risk of OSa (StOPBang total score ≥5). in the same study mean PSQi global score in 351 Shift workers was 7.409 ± 3.406 and in 159 non-Shift workers was 6.271 ± 3.374 (p-value=0.001). 14 However, in our study we did not find any significant differences between Shift and non Shift workers (χ2 = 1.523, p-value=0.217; Mean rank for non-shift workers=174.34 vs Shift workers=182; p-value=0.349).
in a recent study eSS was compared among day workers, night workers and rotating workers. the data presented as mean ± SD for eSS are 8±4.5, 9.2±5.2 and 8.6±4.6 respectively for Day workers, night workers and rotating workers, with post hoc comparison showing values for night and rotating workers more than the day workers.18 PSQi was also studied among retired Shift workers with retired non shift workers, and the effect of Shift work was also noted in retired workers with worse PSQi score by 0.