CoChat
Sign Up
Cited by 56Sleep and Work-Related FatigueCircadian rhythm and melatoninSleep and related disorders

A field investigation of the relationship between rotating shifts, sleep, mental health and physical activity of Australian paramedics

Open access
Khan, Wahaj Anwar A., Jackson, Melinda L., Kennedy, Gerard A., Conduit, Russell·2021·Scientific Reports
DOI 10.1038/s41598-020-79093-5PMC PMC7806923
Open this paper in CoChat — free accountOpen PDF

Abstract

Paramedics working on a rotating shift are at an increased risk of developing chronic health issues due to continuous circadian rhythm disruption. The acute effects of shift rotation and objectively measured sleep have rarely been reported in paramedics. This study investigated the relationships between a rotating shift schedule and sleep (using actigraphy), subjective reports of sleepiness, mood, stress and fatigue. Galvanic Skin Response, energy expenditure and physical activity (BodyMedia SenseWear Armband) were also recorded across the shift schedule. Paramedics were monitored for a period of eight consecutive days across pre-shift, day shift, night shift, and 2 days off. Fifteen paramedics (M age = 39.5 and SD = 10.7 years) who worked rotational shifts experienced sleep restriction during night shift compared to pre-shift, day shift and days off (p < 0.001). Night shift was also associated with higher levels of stress (p < 0.05), fatigue (p < 0.05), and sleepiness (p < 0.05). One day off was related to a return to pre-shift functioning. Such shift-related issues have a compounding negative impact on an already stressful occupation with high rates of physical and mental health issues. Therefore, there is an urgent need to investigate methods to reduce rotating shift burden on the health of paramedics. This could be through further research aimed at providing recommendations for shift work schedules with sufficient periods for sleep and recovery from stress.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1038/s41598-020-79093-5

Cites

9 of 9 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Rotational shifts caused participants to experience sleep restriction.

    “This was in addition to the finding that rotational shifts caused the participants to experience sleep restriction (Khan et al., 2021).”

    From Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing (2024) · cites this paper as Khan et al., 2021

    The Discussion reports significantly shorter sleep during night duty and describes sleep restriction among the paramedics. Its conclusion says rotating-shift work was associated with sleep restriction, however, not that the shifts caused it; the causal wording overstates this observational finding. The supplied passages have no page numbers. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Night shifts were associated with higher levels of fatigue, sleepiness, and stress in Australian paramedics.

    “It was found that night shifts were associated with higher levels of fatigue, sleepiness, and stress.”

    From Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing (2024) · cites this paper as Khan et al., 2021

  • The nature of shift work may be detrimental to the workers' health.

    “and that the nature of shift work may be detrimental to the workers' health.”

    From Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing (2024) · cites this paper as Khan, W., Jackson, M., Kenne- dy, G. & Conduit, R. 2021

  • Among Australian paramedics working rotating shifts full-time, levels of stress, fatigue and sleepiness were related to sleep restriction that occurred due to night shift.

    “Levels of stress, fatigue and sleepiness were related to sleep restriction that occurred due to night shift”

    From Understanding the Occupational Factors that Influence Paramedic Health and Wellbeing (2024) · cites this paper as Khan, W., Jackson, M., Kenne- dy, G. & Conduit, R. 2021

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 45

  1. [2]Courtney JA Francis AJ Paxton SJ Caring for the country: Fatigue, sleep and mental health in Australian rural paramedic shiftworkers J. Commun. Health 2013 38 178 186 10.1007/s10900-012-9599-z 22843315 · DOI · Paper page
  2. [3]Costa G Shift work and health: Current problems and preventive actions J. Saf. Health Work 2010 1 112 123 10.5491/SHAW.2010.1.2.112 PMC3430894 22953171 · DOI · Paper page
  3. [4]Knauth P The design of shift systems J. Ergonom. 1993 36 15 28 10.1080/00140139308967850 8440212 · DOI
  4. [5]Alward RR Monk TH A comparison of rotating-shift and permanent night nurses J. Int. J. Nurs. Stud. 1990 27 297 302 10.1016/0020-7489(90)90044-J 2379988 · DOI
  5. [7]Ganesan S The impact of shift work on sleep, alertness and performance in healthcare workers J. Sci. Rep. 2019 9 4635 4635 10.1038/s41598-019-40914-x PMC6420632 30874565 · DOI · Paper page
  6. [8]Angerer P Night work and the risk of depression J. Deutsches Arzteblatt Int. 2017 114 404 411 PMC5499504 28669378
  7. [9]Ma CC Shift work and occupational stress in police officers J. Saf. Health Work 2015 6 25 29 10.1016/j.shaw.2014.10.001 PMC4372186 25830066 · DOI
  8. [11]Chatterjee K Ambekar P Study of insomnia in rotating shift-workers Ind. Psychiatry J. 2017 26 82 85 10.4103/ipj.ipj_59_17 29456327 PMC5810173 · DOI
  9. [12]Lin PC The association between rotating shift work and increased occupational stress in nurses J. Occup. Health. 2015 57 307 315 10.1539/joh.13-0284-OA 25958974 · DOI
  10. [13]Vangelova K The effect of shift rotation on variations of cortisol, fatigue and sleep in sound engineers J. Ind. Health 2008 46 490 493 10.2486/indhealth.46.490 18840940 · DOI
  11. [16]Kawada T Activity and sleeping time monitored by an accelerometer in rotating shift workers J. Work 2008 30 157 160 18413931
  12. [18]Choi SJ Joo EY Light exposure and sleep–wake pattern in rapidly rotating shift nurses J. Sleep Med. 2016 13 8 14 10.13078/jsm.16002 · DOI
  13. [19]Zverev YP Misiri HE Perceived effects of rotating shift work on nurses' sleep quality and duration Malawi Med. J. 2009 21 19 21 10.4314/mmj.v21i1.10984 19780473 PMC3345727 · DOI
  14. [21]Sharif MM BaHammam AS Sleep estimation using BodyMedia's SenseWear™ armband in patients with obstructive sleep apnea J. Ann. Thorac. Med. 2013 8 53 57 10.4103/1817-1737.105720 PMC3573559 23440703 · DOI
  15. [23]Morgenthaler T Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: An update for 2007 J. Sleep. 2007 30 519 529 10.1093/sleep/30.4.519 17520797 · DOI · Paper page
  16. [24]Kushida CA Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients J. Sleep Med. 2001 2 389 396 10.1016/S1389-9457(00)00098-8 14592388 · DOI
  17. [26]Watson D Clark LA Tellegen A Development and validation of brief measures of positive and negative affect: The PANAS scales J. Person. Soc. Psychol. 1988 54 1063 1070 10.1037/0022-3514.54.6.1063 3397865 · DOI · Paper page
  18. [29]Monk TH The Pittsburgh sleep diary J. Sleep Res. 1994 3 111 120 10.1111/j.1365-2869.1994.tb00114.x 11537903 · DOI
  19. [30]Khan WA The relationship between shift-work, sleep and mental health among paramedics in Australia J. Natl. Sleep Found. 2020 6 330 337 32223969
  20. [31]Kato C Shimada J Hayashi K Sleepiness during shift work in Japanese nurses: A comparison study using JESS, SSS, and actigraphy J. Sleep Biol. Rhythms 2012 10 109 117 10.1111/j.1479-8425.2011.00528.x · DOI
  21. [32]Shochat T Burnout, sleep, and sleepiness during day and night shifts in transition from 8- to 12-hour shift rosters among airline ground crew managers J. Clocks Sleep. 2019 1 226 239 10.3390/clockssleep1020020 PMC7445838 33089166 · DOI
  22. [33]Jackson S Banks S Belenky G Investigation of the effectiveness of a split sleep schedule in sustaining sleep and maintaining performance J. Chronobiol. Int. 2014 31 1218 1230 10.3109/07420528.2014.957305 25222346 · DOI
  23. [35]Tremaine R Actigraph estimates of the sleep of Australian midwives: the impact of shift work J. Biol. Res. Nurs. 2013 15 191 199 10.1177/1099800411422249 21998448 · DOI
  24. [36]Ohayon MM Prevalence and consequences of sleep disorders in a shift worker population J. Psychosom. Res. 2002 53 577 583 10.1016/S0022-3999(02)00438-5 12127174 · DOI · Paper page
  25. [37]Shrivastava D How to interpret the results of a sleep study J. Community Hosp. Internal Med. Perspect. 2014 4 24983 10.3402/jchimp.v4.24983 25432643 PMC4246141 · DOI
  26. [38]Åkerstedt T Kecklund G Axelsson J Impaired sleep after bedtime stress and worries J. Biol. Psychol. 2007 76 170 173 10.1016/j.biopsycho.2007.07.010 17884278 · DOI
  27. [39]Morales J Stress and autonomic response to sleep deprivation in medical residents: A comparative cross-sectional study J. PLoS One. 2019 14 e0214858 e0214858 10.1371/journal.pone.0214858 PMC6448892 30947295 · DOI
  28. [40]Owens JA Sleep loss and fatigue in healthcare professionals J. Perinat. Neonatal. Nurs. 2007 21 92 100 10.1097/01.JPN.0000270624.64584.9d 17505227 · DOI
  29. [41]Liu JC Sleep deprived and sweating it out: The effects of total sleep deprivation on skin conductance reactivity to psychosocial stress J. Sleep. 2015 38 155 159 10.5665/sleep.4346 PMC4262950 25325448 · DOI
  30. [42]Stanojevic C Simic S Milutinovic D Health effects of sleep deprivation on nurses working shifts J. Med. Pregl. 2016 69 183 188 10.2298/MPNS1606183S 29693847 · DOI
  31. [43]Papp KK The effects of sleep loss and fatigue on resident–physicians: A multi-institutional, mixed-method study J. Acad. Med. 2004 79 394 406 10.1097/00001888-200405000-00007 15107278 · DOI
  32. [44]Haluza D Schmidt VM Blasche G Time course of recovery after two successive night shifts: A diary study among Austrian nurses J. Nurs. Manag. 2019 27 190 196 10.1111/jonm.12664 30178495 · DOI
  33. [45]Åkerstedt T Sleepiness and days of recovery J. Traffic Psychol. Behav. 2000 3 251 261 10.1016/S1369-8478(01)00009-2 · DOI
  34. [46]van de Langenberg D Diet, physical activity, and daylight exposure patterns in night-shift workers and day workers Ann. Work Expo Health 2019 63 9 21 10.1093/annweh/wxy097 30551215 · DOI
  35. [47]Barker LM Nussbaum MA Fatigue, performance and the work environment: A survey of registered nurses J. Adv. Nurs. 2011 67 1370 1382 10.1111/j.1365-2648.2010.05597.x 21352271 · DOI · Paper page
  36. [48]Yuenyongchaiwat K Effects of 10,000 steps a day on physical and mental health in overweight participants in a community setting: A preliminary study Braz. J. Phys. Ther. 2016 20 367 373 10.1590/bjpt-rbf.2014.0160 27556393 PMC5015672 · DOI
  37. [49]Reilly T Waterhouse J Sports performance: Is there evidence that the body clock plays a role? Eur. J. Appl. Physiol. 2009 106 321 332 10.1007/s00421-009-1066-x 19418063 · DOI
  38. [52]Luber B Extended remediation of sleep deprived-induced working memory deficits using fMRI-guided transcranial magnetic stimulation J. Sleep. 2013 36 857 871 10.5665/sleep.2712 PMC3649828 23729929 · DOI
  39. [53]Belenky G Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: A sleep dose–response study J. Sleep Res. 2003 12 1 12 10.1046/j.1365-2869.2003.00337.x 12603781 · DOI · Paper page
  40. [54]Merkus SL Self-reported recovery from 2-week 12-hour shift work schedules: A 14-day follow-up Saf. Health Work 2015 6 240 248 10.1016/j.shaw.2015.07.003 26929834 PMC4674502 · DOI
  41. [55]Smith L Weekday and weekend patterns of objectively measured sitting, standing, and stepping in a sample of office-based workers: The active buildings study BMC Public Health 2015 15 9 10.1186/s12889-014-1338-1 25595219 PMC4308830 · DOI
  42. [56]Wong K Chan AHS Ngan SC The effect of long working hours and overtime on occupational health: A meta-analysis of evidence from 1998 to 2018 Int. J. Environ. Res. Public Health 2019 16 2102 10.3390/ijerph16122102 PMC6617405 31200573 · DOI · Paper page
  43. [57]Ropponen A The vicious circle of working hours, sleep, and recovery in expert work Int. J. Environ. Res. Public Health 2018 15 1660 4601 10.3390/ijerph15071361 PMC6068518 29958458 · DOI
  44. [58]Vetter C Aligning work and circadian time in shift workers improves sleep and reduces circadian disruption J. Curr. Biol. 2015 25 907 911 10.1016/j.cub.2015.01.064 25772446 · DOI
  45. [59]Silva B Twelve-hour night shifts of healthcare workers: A risk to the patients? Chronobiol. Int. J. 2003 20 351 360 10.1081/CBI-120019341 12723890 · DOI

Cited by

Sorted by citations

Authors
Khan, W. A. A., Jackson, M. L., Kennedy, G. A., & Conduit, R.
Affiliations
  • Umm al-Qura University (SA)
  • Austin Hospital (AU)
  • Federation University (AU)
Corresponding author
Conduit, Russell
ORCID
Venue
Scientific Reports
Publisher
Springer Science and Business Media LLC
Published
2021-01-13
Volume
11
Issue
1
Pages
866-866
ISSN
2045-2322 (ISSN-L)
DOI
10.1038/s41598-020-79093-5
PMC
PMC7806923
OpenAlex
W3119690344
Cited by
56
References
9
Citations by year
2026: 5 · 2025: 15 · 2024: 10 · 2023: 12 · 2022: 9 · 2021: 5
FWCI
8.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Scientific Reports (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • FedUni ResearchOnline (Federation University Australia) (submittedVersion, cc-by)
  • RMIT Research Repository (RMIT University Library) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
rotating shifts, paramedics, circadian rhythm disruption, sleep restriction, night shift work, fatigue, sleepiness, stress, mental health, physical activity, energy expenditure, occupational health
MeSH terms
Shift Work Schedule, Adult, Affect, Allied Health Personnel, Attention, Australia, Circadian Rhythm, Fatigue, Female, Humans, Male, Mental Health, Middle Aged, Sleep, Wakefulness, Work Schedule Tolerance, Exercise, Sleep Disorders, Circadian Rhythm, Actigraphy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review