Treatment of Circadian Disruption from Shiftwork in Older Adults

项目总结/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。睡眠和 昼夜节律的挑战在老年人中被放大，这些工作者的对策，特别是那些工作 夜班是必须的夜班工作导致昼夜节律的时间不匹配， 工作/睡眠时间表。这反过来又会导致夜间工作时困倦，增加风险 表现失误和受伤。夜班工人也通常在早上睡觉后， 工作，因此在下一个夜班前8小时以上。因此，他们开始工作时有大量的睡眠 由于长时间的清醒，他们的压力，进一步加剧了他们的困倦。虽然有一些战略， 改善轮班工人睡眠和警觉性已经进行了测试，很少有这样的研究已经进行了老年人 成年人了在上一个资助期，我们在老年人的实验室研究中测试了一种睡眠时间策略： 睡眠在下午早些时候开始并延伸到晚上，使得在睡眠前1-2小时醒来。 下个夜班我们发现，年龄较大的参与者能够在下午-晚上在床上度过8小时， 与随意睡觉的参与者相比，他们的夜班警觉性和 他们的表现得到了提高，而且他们的应激激素皮质醇水平也有所下降。 我们现在建议将实验室测试的睡眠干预转化为操作环境， 评价其有效性、可行性和可接受性。在田间试验中，我们将进行一项随机研究， 8h午后-晚间睡眠干预对老年护士睡眠改善效果的评价 连续3个夜班的持续时间/质量和性能/警觉性。探索性分析将侧重于 压力、主观疲劳、情绪和生活质量。我们还将调查一大群年龄较大的夜班工人， 为了确定他们的典型睡眠时间，影响他们睡眠时间的因素和夜班后的持续时间， 和挑战，以一个8小时的下午-晚上的睡眠插曲，探讨传播和 在广大老年夜班工人中实施这种干预。为了进一步了解8h 下午-晚上的睡眠影响“真实的生活”中的轮班和下班活动， 时间表，我们将开展焦点小组，其中睡眠干预的可行性和可接受性将 被探索。 睡眠不足是影响美国300万老年夜班工人的最具挑战性的问题之一。 鉴于我们越来越了解睡眠不足如何导致不良表现，健康，安全， 和生活质量，必须转化成功的实验室对策，并在作战中进行测试。 设置.这项设计严谨的研究将评估这种对策，并测试其有效性、可行性和 老年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.