Treatment of Circadian Disruption from Shiftwork in Older Adults

项目摘要/摘要 美国劳动力正在老龄化；到2020年，四分之一的劳动力将超过55岁。就像睡眠和 昼夜节律的挑战在老年人中被放大，对这些工作者，特别是那些工作的人来说，对策 上夜班是必须的。夜班工作导致昼夜节律的时间与 工作/睡眠时间表的时间安排。这反过来会导致夜间工作时昏昏欲睡，从而增加患病风险 表现错误和受伤的记录。上夜班的人通常也会在早上下班后睡觉 工作，从而在下一次上夜班前8小时起床。因此，他们在大量睡眠的情况下开始工作 由于长时间的清醒而产生的压力，进一步加剧了他们的困倦。虽然有一些策略可以 已经对轮班工人改善睡眠和提高警觉性进行了测试，很少有这样的研究在老年人中进行 成年人。在之前的资助期间，我们在一项针对老年人的实验室研究中测试了一种睡眠计时策略：时间安排 睡眠从下午早些时候开始，一直持续到晚上，这样醒来的时间比睡眠时间早1-2小时。 下个夜班。我们发现，年龄较大的参与者能够在下午和晚上在床上呆上8小时，他们 与随意睡觉的参与者相比，他们的睡眠明显更多(且更少受到干扰)，他们的夜班警觉性和 成绩提高了，他们的压力荷尔蒙皮质醇水平降低了。 我们现在建议将实验室测试的睡眠干预转换到操作环境中，并 评估其有效性、可行性和可接受性。在现场试验中，我们将对 对老年护士进行8H午晚睡眠干预以评价其改善睡眠的效果 连续3个夜班的持续时间/质量和性能/警觉性。探索性分析将重点放在 压力、主观疲劳、情绪和生活质量。我们还将调查一大批上了年纪的夜班工人 为了确定他们典型的睡眠时间，影响他们夜班后睡眠时间和持续时间的因素， 和挑战一个8小时的下午-晚上睡眠插曲，以探索传播和 在广大老年夜班工人中实施这项干预。要进一步了解8小时 下午和晚上的睡眠对“现实生活”中的轮班和下班活动的影响以及采用这种睡眠方式的障碍 时间表，我们将开展焦点小组，在那里睡眠干预的可行性和可接受性将 被探索。 睡眠不足是影响300万美国老年夜班工人的最具挑战性的问题之一。 鉴于我们对睡眠不足如何导致不良表现、健康、安全、 和生活质量，当务之急是将成功的实验室对策转化为可操作的测试方法 设置。这项精心设计的研究将评估这样的对策，并测试其有效性、可行性和 上了年纪的夜班工人的可接受性。

Project Summary/Abstract The American workforce is aging; by 2020, a quarter of the workforce will be over 55 years old. As sleep and circadian challenges are magnified in older adults, countermeasures for these workers, especially those working night shifts, are imperative. Night shift work leads to a mismatch between the timing of circadian rhythms and the timing of the work/sleep schedule. This in turn leads to sleepiness during nighttime work, increasing the risk of performance errors and injuries. Night shift workers also typically sleep in the morning after returning from work, thereby arising 8+ h prior to their next night shift. They thus begin work with a great amount of sleep pressure due to prolonged wakefulness, further exacerbating their sleepiness. While a number of strategies to improve sleep and alertness in shift workers have been tested, few such studies have been carried out in older adults. In the previous grant period we tested a sleep timing strategy in a lab study in older adults: scheduling sleep to begin in the early afternoon and extend into the evening, such that awakening occurs 1-2 h prior to the next night shift. We found that the older participants were able to spend 8 h in bed in the afternoon-evening, they got significantly more (and less disrupted) sleep than participants who slept ad lib, their night shift alertness and performance was increased, and they showed reduced levels of the stress hormone cortisol. We now propose to translate that laboratory-tested sleep intervention to an operational environment and evaluate its efficacy, feasibility and acceptability. In a Field Trial, we will conduct a randomized study of the 8h afternoon-evening sleep intervention in older nurses to evaluate its efficacy for improving sleep duration/quality and performance/alertness across 3 consecutive night shifts. Exploratory analyses will focus on stress, subjective fatigue, mood, and quality of life. We will also Survey a large group of older night shift workers to determine their typical sleep timing, factors influencing their sleep timing and duration following night shifts, and challenges to an 8h afternoon-evening sleep episode, to explore the feasibility of disseminating and implementing this intervention among a broad population of older night workers. To further understand how 8h afternoon-evening sleep impacts on- and off-shift activities in “real life” and barriers to adoption of such a schedule, we will carry out Focus Groups where the feasibility and acceptability of the sleep intervention will be explored. Inadequate sleep is one of the most challenging problems affecting the 3 million older American night workers. Given our increasing understanding of how sleep deficiency contributes to adverse performance, health, safety, and quality of life, it is imperative to translate successful laboratory countermeasures and test them in operational settings. This rigorously designed study will evaluate such a countermeasure and test its efficacy, feasibility and acceptability in older nightshift workers.