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      The relationship between the pattern of shift work and sleep disturbances in Korean firefighters

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          Abstract

          Purpose

          Sleep disturbances are prevalent in firefighters, but the relationship between patterns of shift work and sleep disturbances has not yet been investigated. Here, this relationship has been evaluated in Korean firefighters.

          Methods

          A cross-sectional study was conducted using an online questionnaire, which captured demographic, psychosocial and work-related characteristics. Sleep disturbance was assessed using the insomnia severity index (ISI). The relationship between insomnia and work-related factors (including type of shift work and the frequency of emergency events and off-duty work which means overtime work on off days) was analyzed.

          Results

          A total of 9810 firefighters completed the survey, representing approximately 21.5% of all Korean firefighters; data from 9738 subjects were included in the analysis. All firefighter roles were significantly associated with insomnia; the odds ratio (OR) was 2.456 (95% confidence interval [CI] 1.461–4.128) for fire suppression and 1.871 (95% CI 1.105–3.167) for the emergency medical services and rescue. However, the pattern of shift work did not show a statistically significant relationship. The OR increased along with the frequency of emergency events and off-duty work ( p value for trend < 0.05).

          Conclusions

          This study found a significant association between the frequency of emergency and off-duty work and insomnia in Korean firefighters, whereas the pattern of shift work showed no significant relationship. Therefore, measures to reduce the frequency of emergency and off-duty work are required to prevent sleep disturbances in firefighters.

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          Most cited references20

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          Validation of the fatigue severity scale in a Swiss cohort.

          Fatigue is highly prevalent and has a negative impact on quality of life and performance in a variety of disorders. The 9-item Fatigue Severity Scale (FSS) is one of the most commonly used self-report questionnaires to measure fatigue, but has only been validated in small sample-sized studies and in single disorders. To validate the FSS in healthy subjects and different disorders known to be commonly associated with fatigue. The FSS was administered to 454 healthy subjects, 188 patients with multiple sclerosis (MS), 235 patients with recent ischemic stroke, and 429 patients with sleep-wake disorders including narcolepsy with cataplexy (n=22), restless legs syndrome (RLS) (n=79), sleep apnea (n=108), insomnia (n=62), parasomnia (n=25), excessive daytime sleepiness/hypersomnia of other origin (n=84, and other sleep-wake disorders (n=49. FSS scores were 4.66 +/- 1.64 (mean +/- SD) in patients with MS, 3.90 +/- 1.85 in patients after ischemic stroke, and 4.34 +/- 1.64 in patients with sleep-wake disorders. Compared to patients, values were significantly lower in healthy subjects (3.00 +/- 1.08, P < 0.01). Scores did not correlate with gender, age, or education. Item analysis showed an excellent internal consistency and reliability (Cronbach alpha = 0.93). Test-retest variability was assessed in 104 healthy subjects, showing stable values over time (2.94 +/- 0.90 vs. 2.90 +/- 0.74; P = 0.27). This first validation of a fatigue scale in a large sample size demonstrates that the FSS is a simple and reliable instrument to assess and quantify fatigue for clinical and research purposes.
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            Do permanent night workers show circadian adjustment? A review based on the endogenous melatonin rhythm.

            "Permanent" or "fixed" night shifts have been argued to offer a potential benefit over rotating shift systems in that they may serve to maximize circadian adjustment and hence minimize the various health and safety problems associated with night work. For this reason, some authors have argued in favor of permanent shift systems, but their arguments assume at least a substantial, if not complete, adjustment of the circadian clock. They have emphasized the finding that the day sleeps taken between successive night shifts by permanent night workers are rather longer than those of either slowly or rapidly rotating shift workers, but this could simply reflect increased pressure for sleep. The present paper reviews the literature on the adjustment to permanent night work of the circadian rhythm in the secretion of melatonin, which is generally considered to be the best known indicator of the state of the endogenous circadian body clock. Studies of workers in "abnormal" environments, such as oil rigs and remote mining operations, were excluded, as the nature of these unique settings might serve to assist adjustment. The results of the six studies included indicate that only a very small minority (<3%) of permanent night workers evidence "complete"adjustment of their endogenous melatonin rhythm to night work, less than one in four permanent night workers evidence sufficiently "substantial" adjustment to derive any benefit from it, there is no difference between studies conducted in normal or dim lighting, and there is no evidence of gender difference in the adjustment to permanent night work. It is concluded that in normal environments, permanent night-shift systems are unlikely to result in sufficient circadian adjustment in most individuals to benefit health and safety.
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              Depression and Sleep

              Impaired sleep is both a risk factor and a symptom of depression. Objective sleep is assessed using the sleep electroencephalogram (EEG). Characteristic sleep-EEG changes in patients with depression include disinhibition of rapid eye movement (REM) sleep, changes of sleep continuity, and impaired non-REM sleep. Most antidepressants suppress REM sleep both in healthy volunteers and depressed patients. Various sleep-EEG variables may be suitable as biomarkers for diagnosis, prognosis, and prediction of therapy response in depression. In family studies of depression, enhanced REM density, a measure for frequency of rapid eye movements, is characteristic for an endophenotype. Cordance is an EEG measure distinctly correlated with regional brain perfusion. Prefrontal theta cordance, derived from REM sleep, appears to be a biomarker of antidepressant treatment response. Some predictive sleep-EEG markers of depression appear to be related to hypothalamo-pituitary-adrenocortical system activity.
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                Author and article information

                Contributors
                om1024@hanmail.net
                Journal
                Int Arch Occup Environ Health
                Int Arch Occup Environ Health
                International Archives of Occupational and Environmental Health
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0340-0131
                1432-1246
                25 November 2019
                25 November 2019
                2020
                : 93
                : 3
                : 391-398
                Affiliations
                [1 ]GRID grid.49606.3d, ISNI 0000 0001 1364 9317, Department of Occupational and Environmental Medicine, College of Medicine, , Hanynag University, ; 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763 Republic of Korea
                [2 ]GRID grid.256753.0, ISNI 0000 0004 0470 5964, Department of Occupational and Environmental Medicine, Hallym Sacred Heart Hospital, , Hallym University College of Medicine, ; Anyang, Republic of Korea
                [3 ]GRID grid.15444.30, ISNI 0000 0004 0470 5454, Department of Preventive Medicine, , Yonsei University Wonju College of Medicine, ; Wonju, Republic of Korea
                [4 ]GRID grid.411061.3, ISNI 0000 0004 0647 205X, Department of Neuropsychiatry, , Eulji University Hospital, ; Daejeon, Republic of Korea
                Author information
                http://orcid.org/0000-0003-2624-3257
                Article
                1496
                10.1007/s00420-019-01496-3
                7078139
                31768636
                8c68eb9c-320d-4f9e-89b6-ba3a14c98c4d
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 2 May 2019
                : 19 November 2019
                Funding
                Funded by: National Fire Agency of Korea
                Award ID: MPSS-firefighting safety-2017-87
                Award Recipient :
                Categories
                Original Article
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                Occupational & Environmental medicine
                firefighters,insomnia,shift work,sleep disturbance
                Occupational & Environmental medicine
                firefighters, insomnia, shift work, sleep disturbance

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