Treatment of Circadian Disruption from Shiftwork in Older Adults

老年人轮班工作造成的昼夜节律紊乱的治疗

• 批准号: 9890984
• 负责人: Jeanne F Duffy
• 金额: $ 44.71万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-15 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9890984
• 关键词: Accidents; Acute; Address; Adopted; Adoption; Adverse effects; Affect; Age; Aging; American; Beds; Biological Clocks; Caffeine; Circadian Dysregulation; Circadian Rhythm Sleep Disorders; Circadian Rhythms; Commuting; Development; Drowsiness; Elderly; Environment; Exercise; Fatigue; Focus Groups; Future; Gastrointestinal Diseases; Grant; Health; Home environment; Hormones; Hour; Hydrocortisone; Impairment; Individual; Injury; Intervention; Laboratories; Laboratory Study; Lead; Life; Light; Lighting; Malignant Neoplasms; Medical; Melatonin; Mental Depression; Metabolic Diseases; Middle Insomnia; Moods; Nurses; Occupations; Older Population; Participant; Perception; Performance; Performance at work; Phototherapy; Physiological; Productivity; Quality of life; Randomized; Reporting; Research Design; Risk; Safety; Schedule; Sleep; Sleep Deprivation; Sleep disturbances; Societies; Stress; Surveys; Testing; Translating; Treatment Efficacy; Wakefulness; Work; adverse outcome; alertness; base; cardiovascular disorder risk; circadian; field study; improved; inattention; pressure; safety outcomes; sex; shift work; sleep regulation; social; willingness

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.

项目概要/摘要 美国劳动力正在老龄化；到 2020 年，四分之一的劳动力年龄将超过 55 岁。正如睡眠和 老年人的昼夜节律挑战被放大，针对这些工人，特别是那些工作的人的对策 夜班，势在必行。夜班工作导致昼夜节律时间不匹配 工作/睡眠时间表的时间安排。这反过来会导致夜间工作时犯困，增加风险 表现失误和伤害。夜班工人通常也会在早上下班回家后睡觉 工作，因此在下一次夜班前 8 小时以上起床。因此，他们在大量睡眠的情况下开始工作 长时间清醒带来的压力，进一步加剧了他们的睡意。虽然采取了一些策略 改善轮班工人的睡眠和警觉性已经过测试，但很少有针对老年人的此类研究 成年人。在上一个资助期间，我们在一项针对老年人的实验室研究中测试了睡眠计时策略：安排时间 睡眠从下午早些时候开始，一直持续到晚上，这样就可以在睡觉前 1-2 小时醒来。 下一个夜班。我们发现，年龄较大的参与者能够在下午至晚上在床上度过 8 小时，他们 与随意睡觉的参与者相比，他们的睡眠时间明显更多（且中断更少），他们的夜班警觉性和 他们的表现得到了提高，并且压力荷尔蒙皮质醇的水平降低了。 我们现在建议将经过实验室测试的睡眠干预转化为操作环境，并 评估其有效性、可行性和可接受性。在现场试验中，我们将进行一项随机研究 对老年护士进行8小时下午-晚上睡眠干预，评估其改善睡眠的功效 连续 3 个夜班的持续时间/质量和表现/警觉性。探索性分析将集中于 压力、主观疲劳、情绪和生活质量。我们还将调查一大群老年夜班工人 确定他们的典型睡眠时间、影响其睡眠时间的因素以及夜班后的持续时间， 以及对下午 8 小时和晚上 8 小时睡眠的挑战，以探索传播和 在广大老年夜班工人中实施这一干预措施。进一步了解8h如何 下午和晚上的睡眠会影响“现实生活”中的上班和下班活动，并阻碍采用这种睡眠模式 日程安排上，我们将开展焦点小组讨论，讨论睡眠干预的可行性和可接受性 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操作中进行测试 设置。这项经过严格设计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。