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Open Access Research article

Rotating night shifts too quickly may cause anxiety and decreased attentional performance, and impact prolactin levels during the subsequent day: a case control study

Yu-San Chang123, Hsiang-Lan Chen3, Yu-Hsuan Wu3, Chung-Yao Hsu4, Ching-Kuan Liu5* and Chin Hsu6

Author Affiliations

1 Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan

2 Faculty of Nursing Department, Meiho University, No. 23, Pingguang Road, Neipu, Pingtung, Taiwan

3 Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kai-Syuan, 2nd Road, Ling-Ya District, Kaohsiung 802, Taiwan

4 Department of Neurology, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan

5 Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan

6 Department of Physiology, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan

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BMC Psychiatry 2014, 14:218  doi:10.1186/s12888-014-0218-7

Published: 5 August 2014

Abstract

Background

We investigated circadian changes and effects on mood, sleep-related hormones and cognitive performance when nurses worked consecutive night shifts in a rapidly rotating shift system. Daytime cognitive function, sleep propensity and sleep-related hormones (growth hormone, cortisol, prolactin, thyrotropin) were compared after participants worked two and four consecutive night shifts.

Methods

Twenty-three off-duty nurses, 20 nurses working two consecutive night shifts and 16 nurses working four consecutive night shifts were enrolled. All participants completed the Maintenance of Wakefulness Test, State-Trait Anxiety Inventory, Stanford Sleepiness Scale, visual attention tasks (VAT), Wisconsin Card Sorting Test, and modified Multiple Sleep Latency Test. Hormone levels were also measured four times throughout the day, at 2-h intervals.

Results

During the day, the participants in the night shift groups were less able to maintain wakefulness, had poor performance on VAT, and higher thyrotropin levels than did those in the off-duty group. Participants who worked two night shifts were better able to maintain wakefulness, had higher anxiety scale scores, poorer initial performance and lack of learning effect on VAT, and higher prolactin levels compared with those who worked four night shifts. There were no differences in cortisol levels between the two- and four- shift groups.

Conclusions

Rotating night shifts too quickly may cause anxiety and decreased attentional performance, and may impact daytime prolactin levels after night shifts. It is possible that the two-shift group had a higher cortisol level than did the four-shift group, which would be consistent with the group’s higher state anxiety scores. The negative findings may be due to the small sample size. Further studies on the effects of consecutive night shifts on mood and cortisol levels during the daytime after sleep restriction would be valuable.

Keywords:
Anxiety; Cognitive function; Nurse; Night shift; Sleep-related hormone; Circadian; Shift work