Effects of shiftwork on sleep and menstrual function in nurses

School of Nursing, University of Washington, Seattle, Washington 98195-7262, USA.
Health Care For Women International (Impact Factor: 0.63). 09/2002; 23(6-7):703-14. DOI: 10.1080/07399330290107449
Source: PubMed


Evidence suggests that shiftwork is associated with menstrual irregularities, reproductive disturbances, risk of adverse pregnancy outcome, and sleep disturbances in women, yet little has been done to evaluate the effects of shiftwork on menstrual function and fertility. The purpose of this study was to evaluate menstrual function, fertility, and pregnancy outcome in nurses working shiftwork, and to examine the relationship of sleep to menstrual function. Sixty-eight nurses < 40 years old completed a survey evaluating sleep, menstrual function, and pregnancy outcome. Fifty-three percent of the women noted menstrual changes when working shiftwork. Women noting menstrual changes reported more physiological symptoms (p < 0.003), slept approximately one hour less when working nights, and reported lengthened time to fall asleep (p < 0.01) when working nights. Findings suggest that sleep disturbances may lead to menstrual irregularities, and changes in menstrual function may be a marker of shiftwork intolerance.

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    • "Disruptions in sleep rhythms can often precipitate episodes of mood instability (Bauer et al., 2006). Self-perceived sleep quality may vary across the menstrual cycle in healthy women (Baker and Driver, 2004), and disruption in circadian rhythms is associated with disruption in menstrual function (Labyak et al., 2002). Thus it is possible that variations in sleep quality across the menstrual cycle could also have bearing on mood stability in women with bipolar disorder. "
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    ABSTRACT: Objectives: To examine the occurrence of menstrually-entrained mood cycling in women with treated bipolar disorder as compared to healthy controls, and to explore whether there is a specific effect of lamotrigine in dampening menstrually-entrained cyclicity of mood. Methods: Observational comparison study of daily self-ratings of mood, sleep, and insomnia obtained over a mean of four menstrual cycles in 42 women with bipolar disorder taking lamotrigine as part of their treatment, 30 women with bipolar disorder receiving mood stabilizing regimens without lamotrigine, and 13 healthy controls, all with physiological menstrual cycles. Additional exploratory analysis of interactions between psychopharmacological regimen and hormonal contraceptive use in the group of women with bipolar disorder, with the addition of 19 women with bipolar disorder who were using hormonal contraceptives. Results: Women treated for bipolar disorder manifested lower average mood, longer average nightly sleep duration, and greater fluctuations in mood and sleep across menstrual cycle phases than healthy controls. Women with bipolar disorder who were taking lamotrigine had less fluctuation in mood both within and across menstrual cycle phases, and were more similar to the control group than to women with bipolar disorder who were not taking lamotrigine in this respect. In addition, medications with GABA-A receptor modulating effects were found to result in improved mood ratings when combined with hormonal contraceptives. Conclusions: Menstrually-entrained mood fluctuation is present in women treated for bipolar disorder to a greater degree than in healthy controls. Lamotrigine may be of use in mitigating this fluctuation. GABA-A receptor modulators in general may act synergistically with hormonal contraceptives to enhance mood in women with bipolar disorder; this hypothesis merits further study.
    Journal of Affective Disorders 04/2015; 175. DOI:10.1016/j.jad.2014.12.040 · 3.38 Impact Factor
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    • "The circadian clock also coordinates seasonal cycles of reproduction in many mammalian species by relaying information regarding day length to neuroendocrine systems regulating reproductive function [2]. In humans, one study found that half of shift-working nurses experience changes in menstrual function [3]. Interestingly, three women involved in the study who were attempting to conceive reported infertility during shift work [3]. "
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    ABSTRACT: The circadian clock has been linked to reproduction at many levels in mammals. Epidemiological studies of female shift workers have reported increased rates of reproductive abnormalities and adverse pregnancy outcomes, although whether the cause is circadian disruption or another factor associated with shift work is unknown. Here we test whether environmental disruption of circadian rhythms, using repeated shifts of the light:dark (LD) cycle, adversely affects reproductive success in mice. Young adult female C57BL/6J (B6) mice were paired with B6 males until copulation was verified by visual identification of vaginal plug formation. Females were then randomly assigned to one of three groups: control, phase-delay or phase-advance. Controls remained on a constant 12-hr light:12-hr dark cycle, whereas phase-delayed and phase-advanced mice were subjected to 6-hr delays or advances in the LD cycle every 5-6 days, respectively. The number of copulations resulting in term pregnancies was determined. Control females had a full-term pregnancy success rate of 90% (11/12), which fell to 50% (9/18; p<0.1) in the phase-delay group and 22% (4/18; p<0.01) in the phase-advance group. Repeated shifting of the LD cycle, which disrupts endogenous circadian timekeeping, dramatically reduces pregnancy success in mice. Advances of the LD cycle have a greater negative impact on pregnancy outcomes and, in non-pregnant female mice, require longer for circadian re-entrainment, suggesting that the magnitude or duration of circadian misalignment may be related to the severity of the adverse impact on pregnancy. These results explicitly link disruptions of circadian entrainment to adverse pregnancy outcomes in mammals, which may have important implications for the reproductive health of female shift workers, women with circadian rhythm sleep disorders and/or women with disturbed circadian rhythms for other reasons.
    PLoS ONE 05/2012; 7(5):e37668. DOI:10.1371/journal.pone.0037668 · 3.23 Impact Factor
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    • "The altered circadian patterns that accompany shift work are known to disrupt reproductive function in women. Female shift workers have more menstrual cycle irregularities than nonshift workers (Labyak et al, 2002) and some report more sleep disturbances. A link between adverse pregnancy outcomes and shift work has also been suggested (Kutson, 2003) although in a recent study no relationship was found between rotating shift work and adverse pregnancy outcomes but an increase in late abortions/still births was reported in women who were working fixed night shifts (Schl√ľnssen et al, 2007). "

    Sleep Disorders, 03/2012; , ISBN: 978-953-51-0293-9
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