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Systematic Review

The Impact of Night Work on the Sleep and Health of Medical Staff—A Review of the Latest Scientific Reports

by
Katarzyna Czyż-Szypenbejl
and
Wioletta Mędrzycka-Dąbrowska
*
Department of Anaesthesiology Nursing & Inte and Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2024, 13(15), 4505; https://doi.org/10.3390/jcm13154505
Submission received: 23 June 2024 / Revised: 17 July 2024 / Accepted: 24 July 2024 / Published: 1 August 2024
(This article belongs to the Special Issue Association between Sleep Disorders and Diabetes)
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Abstract

:
Introduction: Employees working in shifts are exposed to many threats affecting their health, quality of life and safety at work. Those who perform their work only at night are particularly vulnerable. The purpose of the review is to identify risks to the health, quality of life and sleep of shift health workers. Method: A systematic review (SR) was used in the analysis. Electronic databases were searched. The search was limited to the latest studies published in the last five years: 2019–2023. Results: Finally, 36 articles were included in the review. Most authors have shown a link between sleep disturbance or its quality and shift work/night work. Moreover, a three-shift schedule was the most significant factor for poorer subjective sleep quality when compared to other work schedules. Furthermore, many authors have shown a link between shift/night work and health problems, which include cardiometabolic risk, glucose intolerance, breast cancer and immune vulnerability. Conclusions: The research results clearly show a significant impact of night work on the increased risk of sleep disorders and health disturbance. Healthcare workers should be aware of the risks associated with night work in order to take measures preventing sleep/health problems. Shift/night workers should have the opportunity to be screened for disorders linked with their work.

Graphical Abstract

1. Introduction

Circadian rhythms regulate the life functions of a human being. Each of us has our own preferences regarding sleep; on this basis, you can determine your chronotype. Evidence shows that chronotype habits are genetically regulated (approximately 45% of chronotype preferences can be explained by gene polymorphism) [1,2]. Despite its economic and social significance, shift work causes disruption of diurnal rhythms and influences the well-being of shift workers [3]. Employees working in shifts are exposed to many threats affecting their health, quality of life and safety at work. Workers who perform their work only at night are particularly vulnerable [4]. Nurses and midwives employed in inpatient care dominate in this group, which is obvious due to the need to provide patients with round-the-clock care. Both in Poland and other countries around the world, numerous studies were conducted to determine the impact of work in shifts, including night shifts, on various aspects related to the functioning of the body. Nurses are the largest group of healthcare providers who are responsible for providing high quality patient care. Sleep problems can lead to distraction and apathy, interfering with work capacity. Long-term sleep problems can lead to serious effects such as delayed thinking, hypomnesia, slow reaction, fatigue, irritability, increased frequency of depression and suicidal thoughts [4,5,6,7,8,9]. Furthermore, shift work may increase the risk of various diseases, such as cancer, diabetes or cardiovascular diseases [10,11,12,13].

Influence of Shift/Night Work on Health and Sleep Quality

Decades of research have identified many biochemical processes involved in the regulation of sleep homeostasis. Sleep plays an important role in our cognitive abilities and is not simply the opposite state of wakefulness, but rather a dynamic process involving changes in neurotransmitter release, immune response and metabolic status. Sleep disorders impact not only circadian patterns, but also mood, perception, memory, stress response and daily functioning. Performing strenuous work at night affects the quality of sleep [14,15]. There are many factors influencing our sleep, i.e., physiological and environmental changes, emotions and cognitive functioning; thus, sleep quality is a very complex matter. Sleep quality influences an individual’s quality of life and health perception. To our knowledge, shift/night work may cause significant sleep disruptions, low sleep quality and daytime sleepiness [16].
In 2019, The International Agency for Research on Cancer (IARC) classified night shift work as probably carcinogenic. It is hypothesised that an altered circadian rhythm can influence the expression of circadian genes. Disruption of the circadian central clock may lead to asynchronous cell proliferation [17]. Night shift work might be associated with breast cancer in women, prostate cancer and chronic lymphocytic leukaemia [18].
Recent studies found that night shift work has an impact on female reproductive health and fertility. Night work affects the circadian rhythm and disrupts hormonal balance. The hypothalamic-pituitary-ovarian axis (responsible for follicular maturation and ovulation) is controlled by the circadian clock; therefore, night work may cause abnormal menstrual cycles. There is a link between melatonin levels and maternal circadian rhythm. Women who work night shifts have lower melatonin levels due to light-at-night exposure. Melatonin is primarily synthesised in the pineal gland and is also found in the ovaries or the placenta. Furthermore, it is thought to play a crucial role in the maintenance of full-term pregnancies [19,20].
It was established that night shift work may influence dietary intake and alter melatonin levels, which regulates metabolism-related hormones, i.e., insulin, cortisol and leptin. Prolonged asynchrony of circadian rhythmicity can affect body weight and lead to adiposity. Moreover, the night shift makes workers eat during resting time, which leads to increased diurnal caloric intake [21,22].
Several epidemiological studies have indicated that shift work increases the risk of developing glucose intolerance or type 2 diabetes. The human circadian system is a complex structure. As previously mentioned, melatonin (which plays a crucial role in circadian rhythms) regulates insulin secretion and insulin sensitivity. Decreased melatonin levels are concomitant with inadequate glycaemic control and increased risk of developing type 2 diabetes [23,24,25].
Elevated blood pressure, dyslipidaemia, increased waist circumference and body mass index are known factors of cardiovascular diseases. Several studies observed that night shift work is correlated with cardiometabolic risk. Atherosclerosis and altered drug intake for hypertension were observed [26,27,28].

2. Methods

2.1. Study Design

The work uses a systematic review (SR), which aims to search, synthesise and assess existing knowledge on a given topic.
The aims of this study were to:
▪
establish an association between night/shift work and health.
▪
identify disorders linked to night/shift work.
▪
identify the incidence of sleep disorders in night/shift workers.
▪
evaluate the impact of night/shift work on sleep quality.

2.2. Search Methods

Medline databases were searched: PubMed, Ebsco, OVID, Scopus and Web of Science. The following words were used for verification: nurse, healthcare workers, shift work, night work, sleep, sleep disorders, sleep quality, health, risk. The search was limited to the latest studies published in English and carried out in the years 2019–2024. Single keywords were introduced, as well as a combination of them with AND, OR and both operators. The number of citations obtained during each search attempt was scanned and reduced according to the inclusion criteria. Only studies on healthcare workers working in medical facilities on shifts that assessed sleep quality and health problems were selected. The last search was performed on 12 July 2024. A total of 403 articles were found in the databases corresponding to the discussed issue. After considering the assumed review criteria; finally, 38 articles were included in the analysis.

2.3. Study Selection

Inclusion criteria
▪
Years of publication: 2019–2024 (research was limited to the latest studies, hence the years of publication).
▪
Publication type: original papers only.
▪
Studies carried out on healthcare workers.
Exclusion criteria
▪
Year of publication earlier than 2019.
▪
Publications type: reviews, meta-analyses, letters, opinions.
▪
Studies carried out on shift/night workers other than healthcare employees.

2.4. Research Variables and Strategy

All papers selected for inclusion in the systematic review were subjected to the appraisal of two independent researchers. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Cross-Sectional Studies was used to assess the methodological quality of the study and the possibility of bias in its design [29].

3. Results

A total of 38 papers that met the inclusion criteria were selected for final analysis. Seven articles described the influence of shift/night work on overall sleep quality, whereas thirty-one studies referred to the link between shift/night work and various health problems. The search strategy is presented in Figure 1.
Healthcare workers who participated in the studies were physicians, nurses, midwives and technicians working in various hospitals. Most studies were cross-sectional in design [30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52]. Only one study did not include any control group—a small study by Imes et al. describing the impact of rotating shifts on health [53]—and some researchers did not give a clear definition of night work [31,40,50,54]. Most studies defined night or shift work exposure as work performed between midnight and 5 a.m. [34,35,39,41,42,49,52,55,56,57,58,59,60,61,62]. Moreover, many of the surveyed employees worked 3-shift rotations (morning, evening and night shifts) [30,33,35,48,50,59,60,61,63]. A few researchers defined night work exposure as at least 2–3 night shifts per month for the last 2 years. Most of the studies were carried out on large cohorts, while 11 studies included small sample groups (less than 100 subjects) [31,32,35,49,50,51,53,64,65,66].
Most authors who investigated the quality of sleep amongst shift/night workers used the Pittsburgh Quality Index questionnaire, and some researchers used their own validated questionnaire. Most authors have shown a link between sleep disturbance or its quality and shift work/night work. The most reported sleep disturbances were difficulty falling asleep and waking up at night, short sleep duration and low subjective sleep quality [30,37,38,39,40,46,51].
Concerning health problems, several authors found evidence of the association between shift/night work and various disorders: increased risk of cardiometabolic and cerebrovascular diseases, DNA damage and increased risk of breast cancer, preterm birth and metabolic and immune disruptions [31,32,33,41,42,43,47,48,51,52,55,56,57,63,64,65,66]. The evaluation of the results is described in Table 1. Study characteristics can be found in the Supplementary Materials in Table S1.

4. Discussion

Most authors have shown a link between sleep disturbance or its quality and shift work/night work [31,43,46,47,56]; only one study showed no relationship between day or night shifts and the quality of sleep, which was described in line with a previous study by McDowall et al., who concluded that poor sleep quality was present in both shift- and non-shift workers [42,68]. Poor sleep quality was observed in all healthcare workers in a study by Uekata et al.; however, a three-shift schedule was the most significant factor for poorer subjective sleep quality when compared to other work schedules (12.5 or 16 h night shifts) [30]. Most reported sleep disturbances were fragmented sleep, a long sleep latency and short sleep duration [53]. A few studies investigated the level of fatigue during the day [37,46,53,58]. Jaradat et al. found that fatigue was prevalent in more than two-thirds of participants, but it was not investigated whether night shifts were associated with this factor [37]. An earlier study by Gomez-Garcia et al. also revealed a significant level of daytime sleepiness (more than half of respondents), furthermore Roman et al. observed poorer sleep efficiency in night workers, thus fatigue and sleepiness might have been influenced by sleep quality [51,62]. On the other hand, Alshahrani et al. discovered no difference between studied groups (shift work vs. non-shift work) concerning daytime sleepiness; nonetheless, the authors did not ask about naps or drinking caffeinated beverages during shifts. In addition, the research was performed in Saudi Arabia, where the international standards for working time are followed; therefore, the employees must have an appropriate amount of time off from work. This prevents employees from rapid returns and excessive or long working hours [69].
Some authors studied the chronotype of participants to determine the relationship between the type of changes (shifts) and the quality of sleep [30,36,37,41]. Uekata et al. noted that workers with evening chronotype had poor sleep quality on working days, whereas morning chronotype workers experienced poor sleep quality on work-free days [30]. Earlier studies carried out by Lee et al. revealed that nurses with the evening chronotype were more susceptible to emotional disturbances and insomnia [1]. Thus, it can be hypothesised that working shifts following one’s chronotype has a less distressing impact on health and sleep quality, as any sudden changes can be more disturbing than working regular fixed shifts.
Another noteworthy fact is that most of the respondents were women. In addition to professional work, most women also do non-professional work and are burdened with the care of other family members. Some authors asked in their questionnaires about having children or family members dependent on their care (dependents), since the need to combine many occupational and non-occupational duties can contribute to the occurrence of daytime fatigue, shortening of sleep or deterioration of its quality [30,37].
Not only did the studies included in the review show a correlation between shift work and sleep disturbances, but they also found a link between night/ shift work and physical health. Some studies have shown a relationship between night work and the presence of abdominal obesity and metabolic syndrome, which affect the occurrence of coronary heart disease and diabetes [41,47]. Metabolic syndrome is a cluster of disorders that occur simultaneously. These disorders include excess adipose tissue around the waist, high blood pressure, high glucose levels and cholesterol/triglycerides imbalance [70]. Because excess adipose tissue is a result of surplus food intake, it was investigated whether night shift workers were more prone to weight gain. In a few studies, there was a correspondence between night work and increased body weight [50,58,70]. In a previous study by Buchvold et al., night shift work was found to be a far greater risk factor for obesity than working mixed shifts [71]. On the contrary, other studies did not establish the relation of shift work with obesity, which might be a result of some methodological differences [33,72]. Terada et al. established that higher snacking frequency during night shifts was associated with a greater percentage of body fat as well as body mass index and waist circumference. Moreover, snacks consumed by shift-working nurses were mostly unhealthy (chocolate, chips, sweet beverages) [35]. Nonetheless, the researchers did not find any differences between the studied groups regarding metabolic indicators.
Rollin et al. found that more than half of night shift workers gained weight (approximately 8 kg) during the night work period due to snacking and hyperphagia. As it is difficult not to reach for snacks during night shifts, it can be avoided by eating a full meal beforehand [35,72]. In turn, Park et al. reached interesting conclusions regarding meals after a night shift: the sooner nurses ate a high-protein and high-calorie meal, the better the quality of sleep they achieved [73].
Besides weight gain, researchers found that night shift work or rotating shift work was linked with elevated glucose levels/diabetes (or insulin resistance), elevated blood pressure and overall metabolic syndrome [32,41,47]. Multiple studies have shown that insufficient and/or irregular sleep promotes glucose intolerance. Studies investigating women’s health revealed that extended periods of night shift work were linked to a greater risk of developing type 2 diabetes in women [72,73,74,75], which is in line with the latest studies regarding night-working nurses [9,32]. Given the increasing evidence underlying the role of gut microbiota in the development of type 2 diabetes, circadian misalignment could affect microbiota diversity, thus promoting insulin resistance [9]. In line with this evidence, Loef et al. did not find a connection between shift work and metabolic syndrome [33].
It was hypothesised that insulin resistance is correlated with disruption of circadian rhythms and cannot be explained solely by anthropometric factors (BMI, WC)/body fat content and was confirmed in a previous study by Hansen et al.; the risk for diabetes was pertinent to all women working night shifts [76,77]. Moreover, Kiranmala et al. linked insulin resistance to altered lipid levels, which suggests that postprandial triglyceride levels play an important role in insulin resistance mechanisms [32]. Worth mentioning is another fact: night shift workers had short periods of fasting time (due to snacking during shifts), which can be a complementary risk factor for insulin resistance.
Another study investigating the association between night work and dyslipidaemia included South Korean workers, in which it was established that men were more susceptible to altered lipid levels [26]. The latest studies showed a correlation between night/shift work to some metabolic changes: van den Langenberg et al. connected shift work with impaired lipid metabolism. Furthermore, Borroni et al. demonstrated altered levels of some metabolites (glycerophospholipids, sphingolipids, serotonin, taurine, aspartic acid) [51,52]. However, there are some limitations to the aforementioned studies; most of them were conducted on a small study group and were cross-sectional in their design.
Most research regarding night/shift work in healthcare is focused on nurses, whose vast majority are women, thus the research produces somewhat greater bias (as there are not enough male participants to compare).
Several studies have shown a correlation between night/shift work and elevated blood pressure. Nascimento et al. concluded that fixed night shift work was related to altered blood pressure during sleep in ambulatory blood pressure monitoring (ABPM), together with Solymanzadeh et al. and Torun et al., whose studies revealed a connection between rotational shift work and hypertension [34,45,65]. These results are in place with another study describing hypertension risk in petrochemical plant shift workers [78]. Hypertension is the most prevalent risk factor for strokes [79]; therefore, night work, which alters blood pressure, may be a risk for cerebrovascular incidences. This hypothesis was confirmed in a large cohort of 30,460 employees by Bigert et al. [63].
Because most of the nursing staff are women, healthcare workers must be familiar with threats related to night/shift work in terms of women’s health. Some studies suggested that demanding and physically intense jobs increase the risk for preterm delivery, miscarriage, low birth weight birth weight, hypertension and preeclampsia, especially when it comes to night shift work [80,81], which is in line with the studied research of this review [55]. On the other hand, Specht et al. did not find night work itself to be a risk factor for preterm birth. Noteworthy is the fact that they found switching from night shifts in the first trimester to day work only during the second trimester was related to an increased risk of preterm birth. It might indicate that not only night work, but any hormonal imbalance may be a risk factor for carrying the pregnancy to term [19]. Another interesting study was conducted by Nehme et al., in which the researchers measured melatonin levels in pregnant women and compared the health status of the newborns. The results indicated that night workers had assisted deliveries and the newborns had lower Apgar scores and trouble breastfeeding [18]. Unfortunately, the study was limited to its numbers—only three women were eligible for the study, so there is no possibility of generalising their results to a larger population.
Furthermore, there is some evidence of a link between night work and breast cancer. Carugno et al. established that there is a link between prolonged exposure to night shifts and molecular changes that may be involved in processes such as the ageing of cells and genome instability, especially TP53 and BRCA1, which encode tumour suppressors. It is in line with another study by Fagundo-Rivera et al., in which not working in shifts or at night was linked with a reduced risk of breast cancer [42,64]. These studies are in accordance with other research, in which night work was found to be damaging to DNA; in participants working overnight, DNA hypermethylation and breaks were increased [31,49,82]. Ahmadi et al. studied the influence of night shifts on DNA methylation of circadian genes, and it appeared that there was a positive correlation. Interestingly, in a study by Lahtinen et al., a break from night work led to changes in DNA methylation, which influenced the activity of the NMDA receptor, which could mean that the risk of breast cancer decreases after the night work is stopped [83]. However, the risk of breast cancer increases with age, so it is not possible to simply hypothesize about the incidence of breast cancer after retiring. On the contrary, Heckmann et al. found that night work was not associated with skin cancer, which is probably due to reduced exposure to sunlight [84].
Only a few studies have explored the possibility of the impact of night/shift work on the immune system. Loef et al. established that shift workers were prone to more severe acute respiratory infections when compared to non-shift workers, whereas Faraut et al. noted that night work may decrease vaccination efficiency due to altered immune patterns (different blood concentrations of total lymphocytes and T-helpers lymphocytes when compared to day shifters) [48,67].
One study described the influence of night work on the incidence of psychiatric disturbances—authors noted that working night shifts for a long period (6 years or more) was associated with mood and neurotic disorders [59]. These findings are consistent with other studies that have shown a correlation between night work and bipolar disorder, depression and neurotic behaviours [85,86,87]. Even in the medical community, the stigma associated with mental health conditions impacts willingness to seek help or disclose a mental health problem, which can result in ostracization from co-workers and an increased risk of suicide. This is also a reason for self-treatment and not seeking help from other medical professionals [88].

5. Implications for Practice

  • All staff members should be aware of the risks related to night/shift work.
  • Night work should be a personal choice.
  • If possible, staff members should be able to switch to day shifts when they feel that night shifts are causing any distress.
  • Screening for disorders linked to night/shift work should be done regularly.
  • If possible, the work schedule should be adjusted to individual chronotypes.
  • Shift/night workers should be able to consult with a sleep specialist when they feel their job interferes with daytime fatigue.
  • Shift-working healthcare professionals may require a more specific dietary program to improve their health.

6. Conclusions

Limitations of this study include the study design; the self-report method (night work exposure) might have influenced the results. Some studies were too small to objectively generalise the results on the whole population. Nevertheless, the research results clearly show a significant impact of night work on sleep quality, but also on health in general.
Healthcare workers should be aware of the risks associated with night work to take measures to prevent sleep/health problems. Shift/night workers should have the opportunity to be screened for disorders linked with their work.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/jcm13154505/s1, Table S1. Study characteristics.

Author Contributions

Conceptualization, K.C.-S. and W.M.-D.; methodology, K.C.-S. and W.M.-D.; formal analysis, K.C.-S. and W.M.-D.; writing—original draft preparation, K.C.-S. and W.M.-D.; writing—review and editing, W.M.-D.; visualisation, W.M.-D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

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Jcm 13 04505 g001
Figure 1. Search strategy for eligible articles.
Figure 1. Search strategy for eligible articles.
Jcm 13 04505 g001
Table 1. PICOS (Population, Investigated condition, Control group, Outcome, Study design) evaluation.
Table 1. PICOS (Population, Investigated condition, Control group, Outcome, Study design) evaluation.
Author/DatePopulationInvestigated ConditionComparison/Control GroupOutcomeStudy Design
Imes et al., 2019 [53]NursesImpact of rotating shifts on healthNo control groupShift work was associated with sleep-related impairment, fatigue, emotional distress (anger), and worse memory and concentrationA within-subject study
Uekata et al., 2019 [30]Nurses, midwivesImpact of rotating shift schedule on sleep qualityDay-only workers vs. rotating shift workersPoor sleep quality was high among all nurses and midwives, especially those engaged in three-shift rotationsA cross-sectional study
Carugno et al., 2019 [64]NursesAssociation between night work and DNA methylation of tumour suppressorNight shift workers vs. non-shift workersThere was an association between night shift work and DNA alterations potentially related to a higher carcinogenic riskA cohort study
Begtrup et al., 2019 [55]Hospital employees: nurses, physicians, midwives, nurses’ assistants, otherInfluence of night work on miscarriageNight shift workers vs. no-night+ workersThere was an increased risk of miscarriage among women who had night work the previous week, and among women with cumulated numbers of night shiftsA cohort study
Cheung et al., 2019 [31]PhysiciansInfluence of night work on DNA disruptionNight shift workers vs. no-night workersAcute sleep deprivation and a frequently disrupted sleep cycle were associated with DNA damageA cross-sectional observational study
Kiranmala et al., 2019 [32]Nurses, physicians, other healthcare workersInfluence of rotational shift work on postprandial triglyceride levels and insulin resistanceNon-shift workers vs. shift workersRotational night shift work might negatively impact on metabolic parametersA cross-sectional study
Loef et al., 2019 [33]Healthcare workers (75% nurses, 25% other)Influence of shift work on metabolic risk factorsNon-shift workers vs. shift workersNo evidence was observed that could underlie a link between shift work and cardiometabolic diseasesA cross-sectional study
Loef et al., 2019 [56]Healthcare workers (75% nurses, 25% other)Influence of shift work on respiratory infectionsNon-shift workers vs. shift workersShift workers had more acute respiratory illnesses and more severe symptoms than non-shift workersA prospective cohort study
Loef et al., 2019 [67]Healthcare workers (74% nurses, 26% other)Immunological effects of shift workNight shift workers vs. non-shift workersChronic exposure to night shift work as well as recent night shift work may influence workers’ immune statusA prospective cohort study
Nascimento et al., 2019 [34]Nurses (44.2%), nursing assistants (55.8)Influence of shift work on blood pressure, the presence of burnout and common mental disordersShift workers vs. non-shift workersShift work was associated with a higher prevalence of work-related inadequate habits and lifestyles and altered (elevated) sleep blood pressureA cross-sectional study
Terada et al., 2019 [35]NursesAssociation between shift work, dietary habits and mood disturbanceNon-shift workers vs. shift workersShift-working nurses exhibited shorter fasting duration, larger diurnal energy intake and higher total mood disturbance scoreA cross-sectional study
Rizza et al., 2019 [57]Healthcare workersAssociation between shift work and occurrence of thyroid nodulesDay workers vs. rotating night shift workersAlteration in the molecular clocks typical of rotating night shift workers harbours a higher risk of thyroid nodule developmentA retrospective cohort study
Bani Issa et al., 2020 [36]NursesInfluence of rotating night shift work on sleep qualityFixed day workers vs. rotating night shift workersRotating night shift nurses had better sleep than working fixed day shifts. Proper shift assignment and chronotype alignment with shift work were related to better sleep quality.A cross-sectional study
Jaradat et al., 2020 [37]PhysiciansSleep quality and health-related problems of shift workOn-call shift workers vs. no on-call shift workersThe majority (90%) reported poor sleep quality; residents having six on-calls or more per month had significantly poorer sleep quality, as well as higher anxiety and depression scores compared to their counterpartsA cross-sectional study
Ljevak et al., 2020 [38]NursesInfluence of shift work on psychological functioning and quality of lifeRotating shift workers (51%) vs. day workers (49%)Increased anxiety, stress, psychosomatic symptoms and sleep disturbances were more common in shift workersA cross-sectional study
Brum et al., 2020 [58]Hospital workers (direct patient care, administration support, maintenance)Association between night shift work and obesityDay vs. night workersNight work was a determining risk factor for abdominal obesityA cross-sectional study
Feng et al., 2021 [39]NursesAssociation between night shift and sleep quality and healthDay shift vs. night shift workersNight shift work was significantly associated with poor sleep quality and poor healthA cross-sectional study
Qanash et al., 2021 [40]Nurses, physicians, other healthcare providersImpact of night shifts on sleeping patterns, psychosocial and physical well-beingNight shift workers (272) vs. day workers (80)Night shift workers were more likely to have sleep disturbances, particularly in terms of initiating sleep, staying asleep and duration of sleep compared with day shift workersA cross-sectional study
Aslam et al., 2021 [65]Nurses, physicians, other healthcare personnelEffects of rotational night shift work on expression of circadian genes and its association with postprandial triglyceride levelsNight shift workers vs. no-night shift workersThe study showed altered expression of several circadian genes with postprandial triglyceride and insulin resistance parameters in rotational night shift workersA cross-sectional study
Cheng et al., 2021 [41]Nurses, medical technicians, administrative clerks, pharmacistsInfluence of night shift work on the risk of metabolic syndromeNight workers vs. day workersNight shift work was associated with metabolic risk factorsA retrospective cohort study
Fagundo-Rivera et al., 2021 [42]NursesA risk of breast cancer in shift workersNurses diagnosed with breast cancer vs. cancer-free controlsThe estimated risk for breast cancer was higher amongst night shifters who had more than 3 nights/ month and worked more than 16 yearsA cross-sectional study
Jordakieva et al., 2021 [43]Hospital employees (nursing staff, administrative personnel)Quality of life and cardiovascular risk markers in ageing night shift workersNight vs. day workersQuality of life and cardiovascular markers did not significantly differ between rotating night shift and day workersA cross-sectional study
Jørgensen et al., 2021 [59]NursesShift work and incidence of psychiatric disordersShift (37.8%) vs. day workers (62.2%)Night shift work was associated with an increased risk of mood and neurotic disorders, as well as substance useA retrospective cohort study
Ljevak et al., 2021 [44]NursesInfluence of shift work on overall health statusRotating shift workers (51%) vs. day workers (49%)Shift employees are significantly more burdened with appetite loss, nausea, heartburn and weight gain. Differences in the severity of cardiovascular disorders were not statistically significant between the two groupsA comparative cross-sectional study
Kader et al., 2021 [60]Nurses, nursing assistantsNight and shift work characteristics and incident ischemic heart disease and atrial fibrillation among healthcare employeesRotating night or night shift workers vs. no-night workersAn excess risk of incident ischaemic heart disease among employees who during the preceding year worked permanent night shifts, compared to permanent day workersA prospective cohort study
Solymanzadeh et al., 2021 [45]NursesA relationship between rotating shift work and blood pressureRotating shift workers (50%) vs. no-night workers (50%)Rotating shift work was associated with a greater increase in BMI and increased risk of high BP compared to day workersA cross-sectional study
Chang et al., 2022 [46]NursesInfluence of shift work on sleep quality and fatigueDay shift (42.5%) vs. shift workers (57.5%)Shift workers had poorer sleep quality, which was found to impact their fatigueA cross-sectional study
Ahmadi et al., 2022 [66]Hospital employeesDNA methylation of circadian genes and markers of cardiometabolic riskDay shift (51%) vs. night shift workers (49%)Night shift work influenced DNA methylation of circadian genes, which may contribute to increased cardiometabolic riskA cross-sectional study
Bahinipati et al., 2022 [47]Hospital employeesEffect of night shifts on the development of metabolic syndromeDay shift (44%) vs. night shift workers (56%)Night shift work is associated with an increase in pro-inflammatory markers and the development of risk factors leading to metabolic syndromeA cross-sectional study
Bigert et al., 2022 [63]Nurses, nursing assistantsNight and shift work and incidence of cerebrovascular diseaseShift or night workers vs. no-night workersNight shift work was associated with a higher risk of cerebrovascular diseaseA prospective cohort study
Faraut et al., 2022 [48]Nurses, nursing assistantsEffects of circadian and sleep disruptions on immune biomarkers among rotating night shift healthcare workersPermanent night shifters vs. day shifters rotating between morning and afternoon shiftsDisrupted pattern expression of immune cells in hospital night workers could increase vulnerability to infections and reduce vaccination efficiency in night workersA cross-sectional study
Ritonja et al., 2022 [49]NursesRelationship between melatonin secretion patterns and circadian gene methylation among day and night shift workersFixed day shifters vs. night shiftersMelatonin was associated with changes in DNA methylation of circadian genes among night shift workersA cross-sectional study
Sooriyaarachchi et al., 2022 [50]Nurses, patient care assistants, administrative personnel, security personnelComparison of the body composition parameters between shift workers and non-shift workersDay workers vs. shift workersProlonged exposure to shift work was associated with a higher body fat percentage. BMI and waist circumference were significantly higher among shift-working womenA cross-sectional study
Borroni et al., 2023 [51]NursesComparison of metabolomic profiles between night shift and non-night shift workersNight workers vs. no-night workersThe study shows altered levels of some metabolites in night shift workersA cross-sectional study
Roman et al., 2023 [54]NursesAssociation between rotating night shifts and healthFixed shift workers vs. rotating shift workersNurses who worked rotating shifts more often reported poor sleep efficiency, abdominal pain and anxiety.An observational, comparative study
Van den Langenberg et al., 2023 [52]Female Nurses and Paramedic StaffImpact of shift work on metabolic biomarkersNight shift vs. day shift workersNight shifts were associated with unfavourable patterns in fatty acid profilesA cross-sectional study
Viklund et al., 2023 [61]Nurses and Nursing assistantsEffects of night and shift work on type 2 diabetes and hypertensionNight shift vs. mixed shift vs. day workersThe night shift was associated with an increased risk of type 2 diabetes but not hypertensionA longitudinal study
Torun et al., 2024 [62]Physicians, nurses and other healthcare workersEffect of night work on blood pressureNight shift vs. no-night shift workersStatistically significant differences were noted between the groups in the daylight-night
ratios of systolic and diastolic pressures		An observational, comparative study
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Czyż-Szypenbejl, K.; Mędrzycka-Dąbrowska, W. The Impact of Night Work on the Sleep and Health of Medical Staff—A Review of the Latest Scientific Reports. J. Clin. Med. 2024, 13, 4505. https://doi.org/10.3390/jcm13154505

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Czyż-Szypenbejl K, Mędrzycka-Dąbrowska W. The Impact of Night Work on the Sleep and Health of Medical Staff—A Review of the Latest Scientific Reports. Journal of Clinical Medicine. 2024; 13(15):4505. https://doi.org/10.3390/jcm13154505

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Czyż-Szypenbejl, Katarzyna, and Wioletta Mędrzycka-Dąbrowska. 2024. "The Impact of Night Work on the Sleep and Health of Medical Staff—A Review of the Latest Scientific Reports" Journal of Clinical Medicine 13, no. 15: 4505. https://doi.org/10.3390/jcm13154505

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