Insomnia in shift work disorder relates to occupational and neurophysiological impairment
Abstract
Study objectives: To determine whether occupational and neurophysiological decrements within shift work disorder (SWD) are differentially related to its two diagnostic symptoms, insomnia and excessive sleepiness.
Methods: Thirty-four permanent night workers participated in an overnight lab protocol including a multiple sleep latency test (MSLT) and an event-related brain potential (ERP) task testing auditory target detection (P3a and P3b). At 16:00, each subject completed an Endicott Work Productivity Scale (EWPS), two Insomnia Severity Indices (ISI-Day, ISI-Night), and an Epworth Sleepiness Scale (ESS). Subjects were grouped by ISI and ESS scores into clinical phenotypes. This study compared EWPS and ERP results between alert insomniacs ("AI," reporting insomnia without sleepiness), sleepy insomniacs ("SI," reporting both insomnia and sleepiness), and controls.
Results: The AI group was most impaired on the EWPS, significantly more impaired than controls (25.8 ± 14.8 vs. 12.3 ± 9.4, p 0.05). Compared to controls, AI showed significantly attenuated P3a response (Fcz, Czp, Cpz, mean difference [MD] 1.62-1.77, p 0.10), and P3a was only different at one electrode site (Cpz, MD 1.43, p 0.10). However, the mean of the ISI measurements correlated with the EWPS (r = 0.409, p < 0.01) and the attention-to-novelty P3a (r = -0.410, p < 0.01).
Conclusions: Among shift work disorder patients, insomnia is linked to functional and cognitive impairments. Insomniacs with normal sleepiness…
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