Acute effects of night work and meals on blood glucose levels.

Employees working at night are at increased risk of diabetes. A possible mechanism is related to differences in glucose regulation at night. Laboratory simulated night work studies show regulation of blood glucose is impaired at night. Regular exposure to high glucose levels at night may explain the observed relationship between night work and diabetes. We performed a field study of 19 nonsmoking women from the health-care sector to investigate how night work and the composition of meals affect post-prandial blood glucose levels. Blood glucose levels were self-assessed by finger-prick blood sampling using the Beurer blood glucose monitoring system. Measurements were done before and 15, 30, 60, and 120 min after different test meals: a nighttime high sugar meal during a night shift and during a day shift, and a reference (low sugar) meal under these same two conditions. There was a statistically significant difference in blood glucose concentration between the four test meal conditions (P = .0086). Post-meal blood glucose levels following the night-shift meals, compared to following daytime meals, rose faster and remained elevated for longer a duration of time. At the 15 min time point following the high sugar test meal, the blood glucose concentration was 8.3 mmol/L when consumed at night vs. 7.3 mmol/L when consumed during the day. We found no difference in area under the blood glucose concentration-time curve (AUC) after consumption of the high or low sugar test meals during the night shift compared with consumption of them during the day. Our findings indicate the glucose levels in response to food intake by female night working healthcare assistants are higher following the nighttime compared with daytime consumption of a high sugar content meal. However, we did not find a difference in total glucose exposure across time (assessed as AUC) after eating a high vs. low sugar meal during the night shift.

Diurnal urinary 6-sulfatoxymelatonin levels among healthy Danish nurses during work and leisure time.

The present study aims to examine the influence of evening and night shift work, compared to day shift work, on melatonin secretion in nurses in a field setting. Effects were examined during a workday and during a day off. Both fixed schedules and mixed or rotating schedules were studied. In total, 170 nurses were studied: 89 nurses worked fixed schedules, 27 nurses worked the day shift, 12 nurses worked the evening shift, 50 nurses worked the night shift, and 82 nurses worked mixed schedules, with data collected during a day (n = 17), evening (n = 14), or night shift (n = 50). All spot urine samples were collected during 24 h from the participants on a work day and on a day off and were analyzed for 6-sulphatoxymelatonin. On the day of urine sampling, participants filled in the Karolinska Sleep Diary. Additional information was collected through a telephone interview. Data were analyzed using a mixed procedure with autoregressive covariance structure. The present study showed that shift work affected the concentrations of 6-sulphatoxymelatonin in the short term by lower excretion in urine from nurses working the night compared to day shift on a workday and on a day off as well. No significant differences were observed between a workday and a day off when doing day and evening shifts, irrespective of mixed and fixed schedules. Sleep length was reduced workdays (from 6.1-6.8 h) among all nurses, compared to days off (from 7.8-8.7 h).

Building-site camps and extended work hours: A two-week monitoring of self-reported physical exertion, fatigue, and daytime sleepiness.

Large-scale construction work often requires people to work longer daily hours and more than the ordinary five days in a row. In order to minimize transportation times and optimize the use of personnel, workers are sometimes asked to live in temporary building-site camps in the proximity of the work site. However, little is known about the biological and psychological effects of this experience. The objective of the present study was to investigate whether exposure to long work hours and extended workweeks while living in building-site camps in between work shifts was associated with a build-up of increased complaints of poor sleep, daytime sleepiness, physical exertion, and fatigue across a two-week work cycle. Two groups of construction workers were examined. The camp group of 13 participants (mean age: 42+/-11 S.D. yrs) lived in building-site camps and worked extended hours (between 07:00 and 18:00 h) and extended workweeks (six days in a row, one day off, five days in a row, nine days off). The home group of 16 participants (mean age 40+/-9 yrs) worked ordinary hours between 07:00 and 15:00 h and returned home after each workday. Self-ratings of daytime sleepiness (Karolinska Sleepiness Scale), physical exertion (Borg CR-10), and mood were obtained six or seven times daily during two workweeks. Fatigue ratings were obtained once daily in the evening, and ratings of sleep disturbances were obtained once daily in the morning with the Karolinska Sleep Diary. Data were evaluated in a repeated measures design. The results showed that both groups reported a similar level of daytime sleepiness, physical exertion, and mood across workdays and time points within a workday (all three-way interactions had p>0.898). Although the home group reported earlier wake-up times, the pattern of sleep disturbance ratings across the workdays did not differ between the groups. Both groups reported few sleep disturbances and good mood. However, the camp group reported higher physical exertion already at the start of work and showed a more gentle increase in ratings during the work shift and a smaller decline between the end of work and bedtime. The camp group also reported higher fatigue scores than the home group. However, none of the groups showed signs of increasing ratings in the progress of the two workweeks. For both groups, the ratings of daytime sleepiness formed a U-shaped pattern, with the highest scores at awakening and at bedtime. Yet, the camp group reported higher daytime sleepiness than the home group at lunch break and at the second break in the afternoon. In conclusion, there were no signs of fatigue build-up or accumulation of daytime sleepiness, physical exertion, or sleep disturbances in either group. Despite the fact that the camp group showed some signs of having trouble in recuperating in between work shifts, as indicated by the higher physical exertion ratings at the start of work, higher fatigue scores, and higher daytime sleepiness, the results constitute no real foundation for altering the camp group's current work schedule and living arrangements.

Diurnal cortisol rhythm: Associated with anxiety and depression, or just an indication of lack of energy?

Dysregulation of hypothalamus-pituitary-adrenal-activity has been associated with low back pain (LBP). The underlying mechanisms are not fully explained, but psychological mechanisms are considered important. In this study we examine the association between psychiatric disorders/symptoms measured with different instruments, and cortisol in a population with LBP. Participants (n=305) sick-listed 2-10 months due to non-specific LBP were included in the study. The screening instruments were the MINI-interview, HADS and HSCL-25. Saliva cortisol were measured on 2 consecutive days; at awakening, 30min later, at 15:00h and 22:00h. Results showed no associations between any of the main diagnostic categories from the MINI-interview, or anxiety/depression measured with HADS or HSCL-25 and cortisol. However, significant associations were found between low cortisol awakening response, low cortisol slope during the day and the somatization scale from HSCL-25 (dizziness or lack of energy, lack of sexual interest, the feeling that everything requires substantial efforts, difficulties to fall asleep, headache). The results indicate that cortisol, may not be directly associated with psychopathology, such as anxiety and depression, but instead are associated with one dimension of the psychopathology, namely lack of energy. This could help explain the inconsistency in the literature, and it should be explored further.

Determination of cortisol in human saliva using liquid chromatography-electrospray tandem mass spectrometry.

The aim of this work was to develop a method for determination of cortisol in saliva by liquid chromatography-tandem mass spectrometry (LC-MS-MS). Saliva was sampled on Salivette tubes. These were centrifuged, deuterium-labeled cortisol was added as internal standard and the proteins precipitated by acetonitrile. The supernatant was evaporated, dissolved in methanol acidified with acetic acid and analyzed by LC-MS-MS. The with-in run precision, tested by pooling saliva samples from volunteers and then analyzing these in a single run, was found to be 7% at 0.7 microgram l(-1). The between-run precision was tested by analysis of the same samples at different days and found to be 11% at 2.5 microgram l(-1). The limit of quantification was 0.5 microgram l(-1). The method was applied for analysis of saliva samples from three volunteers during their last week before vacation and the first and second week on vacation. In addition, the method was compared to analysis by an immunological method. The values from the immunological method were 2.7 times higher than the LC-MS-MS results.