The effects of a gradual shift rotation and a split shift nap intervention on cognitive, physiological and subjective responses under simulated night shift settings

Introduction: Shift work, particularly work that occurs at night has been associated with numerous challenges to occupational safety and productivity. This stems from the associated extended wakefulness, circadian disruptions and sleep loss from the inversion of the sleep wake cycle, which predisposes shift workers to reduced alertness, increased fatigue and decrements in performance capacity. These effects may be exacerbated over consecutive night shifts as a result of reductions in sleep length associated with attempting to sleep against the alerting signals of the circadian rhythm during the day. Although a variety of shift work countermeasures exist, new and innovative fatigue management strategies are needed to mitigate the effects of night work. This study proposed two night shift interventions; the Rolling rotation and a split shift nap combination. Aims: The aim of this study was to explore the effects of these interventions to a conventional Fixed night shift arrangement. Selected performance, physiological and subjective measures were applied to track any effects during a five-day shift work study. Methods: The study was laboratory-based and performance was quantified through the application of computer-based perceptual, cognitive and motor tests. Student participants (24 females and 21 males) partook in the study, which adopted a nonrepeated measures design and spanned five consecutive days. During this time, participants were required to perform a simple beading task over five 8-hour shifts. Participants were split according to sex and chronotype between four independent conditions; 1. Fixed night condition required participants to complete one afternoon shift (14h00 – 22h00) and four consecutive night shifts (22h00 - 06h00) 2. Rolling rotation condition gradually “rolled” participants into the night shift by delaying the start and end of an afternoon shift by two hours each day (16h00 – 00h00, 18h00 – 02h00, 20h00 – 04h00, 22h00 – 06h00) until the times matched that of the Fixed night condition. 3. The split shift nap system was made up of two independent groups, both of which completed one afternoon (14h00 to 22h00) and four night shifts. The Nap early condition worked from 20h00 to 08h00, napping between 00h00 and 04h00, while the Nap late condition worked from 00h00 to 12h00 and napped between 04h00 and 08h00 during the night shifts. Napping, the opportunity for which was 200 minutes occurred in the laboratory, but post shift recovery sleep, for all conditions, happened outside the laboratory. During each shift, six test batteries were completed, in which the following measures were taken: 1. Performance: beading output, eye accommodation time, choice reaction time, visual vigilance, simple reaction time, processing speed and object recognition, working memory, motor response time and tracking performance. 2. Physiological: heart rate, heart rate variability (r-MSSD, normalised Low frequency power: LFnu). 3. Self-reported measures: subjective sleepiness and reported sleep length and quality while outside the laboratory. Results: Analyses revealed that: 1. Measures of beading performance, simple reaction time, vigilance and object recognition, working memory, motor response time and control, all physiological measures, except LFnu and subjective sleepiness demonstrated the effects of time of day / fatigue, irrespective of condition. 2. There was no evidence of cumulative fatigue over the four night shifts in the performance and subjective measures and most of the physiological indicators. Beading output decreased significantly over the course of the night shifts, while reported post shift sleep length was significantly reduced with the start of the night shifts, irrespective of condition. 3. The majority of the physiological and performance measures did not differ significantly between conditions. However, there were some effects: the Rolling rotation condition produced the highest beading output compared to the Nap late condition; working memory was significantly lower in the Nap late condition compared to the other conditions. Furthermore, the nap opportunity in both the Nap early and Nap late conditions reduced subjective sleepiness, while napping during the night shift reduced post shift sleep length compared to the Rolling rotation and Fixed night conditions. There was also evidence of sleep inertia following pre-post nap test comparisons, which mainly affected visual perception tasks in both nap conditions. Sleep inertia possibly also accounted for an apparent dissociation between subjective and performance measures. Conclusions: Quantifying and interpreting the effects of night shift work in a laboratory setting has limitations. These stem mainly from the limited ecological validity of the performance outcome measures adopted and the characteristics of the sample that is tested. However, in order to fully understand the efficacy of any shift work countermeasure, the laboratory setting offers a safe, controlled environment in which to do so. The conclusions should thus be considered in light of these limitations. Night shift work negatively affected all elements of human information processing. The combination of reduced physiological arousal, extended wakefulness, increased perceptions of sleepiness and reduced total sleep obtained explained these decrements in performance. While cumulative fatigue has been reported as a challenge associated with night shift work, there was no conclusive evidence of this in the current study. In the case of the Rolling rotation, the gradual introduction to the night shift delayed the inevitable reduction in alertness and performance, which limits the viability of this intervention. The inclusion of the nap interventions was associated with reduced perceptions of sleepiness, which did not translate into improved performance, relative to the Rolling rotation and Fixed night conditions. Apart from considerations of how to manage sleep inertia post nap, the split shift nap intervention can provide an alternative to conventional night shift work arrangements