Effects of Nocturnal Sleep Quality on Diurnal Cortisol Profiles and Attention in Nurses: A Cross-Sectional Study

Abstract

Objective: Low sleep quality (LSQ) activates the hypothalamic–pituitary–adrenal (HPA) axis and is related to arousal. Nursing staff, who work in shifts, tend to exhibit LSQ, which affects the level of vigor after awakening. This study investigated the effects of nocturnal sleep quality on diurnal cortisol profiles and sustained attention in day-shift nurses. Method: This study adopted a prospective cross-sectional design. Participants were recruited from a university-affiliated hospital in northern Taiwan. In the initial stage of this study, the Chinese Pittsburgh Sleep Quality Index (PSQI) Questionnaire was administered to 199 participants to categorize them as either LSQ (PSQI > 5) or high sleep quality (HSQ; PSQI ≤ 5). Participants were then randomly sampled from the two groups. Nocturnal sleep data and four diurnal saliva samples were collected for each participant. Sustained attention was measured before they started work. A total of 32 and 29 participants in the HSQ and LSQ groups, respectively, completed the data collection process. Results: Compared with the HSQ group, the LSQ group exhibited earlier wake-up times ( p = .02), a flatter cortisol awakening response (CAR) slope ( p < .01), a flatter morning-to-evening slope ( p < .01), and prolonged reaction speed and mean reaction time before starting work ( p < .01). Conclusion: Compared with the HSQ group, the LSQ group exhibited impaired HPA-axis regulation, with a flatter CAR and diurnal cortisol slope and poor sustained attention in the morning. Nursing staff are advised to achieve HSQ to improve attention and performance levels and maintain optimum work safety.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off

“…In physiological circumstances, cortisol levels are elevated in the morning, according to the findings of this study, in which 10.7% of nurses had peak secretion upon awakening, however with values above the reference, which may be indicative of some sleep disorder (30) . Studies have identified that increased cortisol secretion may indicate occupational stress chronification (14,31) with greater activation of the HPA axis (29) , and that, in chronic stress, atypical patterns of cortisol secretion may occur, as the flat pattern, in which the secretion of this hormone remains high during the day (14) .…”

Factors associated with insomnia among Chinese front‐line nurses fighting against COVID‐19 in Wuhan: A cross‐sectional survey

“…Irregular shift work causes nurses' biological clocks to be disturbed, causing the body and mind to be in a state of stress, making them prone to shift work disorder, which is mainly manifested as insomnia and drowsiness (Ai & Guan, 2015). It had also been pointed out that shift nurses tend to show low sleep quality, which has been shown to activate the hypothalamic-pituitary-adrenal axis and was related to sleep arousal (Tsai, Chou, Tsai, Yen, & Niu, 2019). Previous research has shown that more than 5 night shifts per month and long working hours will seriously affect sleep quality.…”

Quality of Life, Sleep Quality, Depression, Anxiety, Stress, Eating Habits, and Social Bounds in Nurses during the Coronavirus Disease 2019 Pandemic in Qatar (The PROTECTOR Study): A Cross-Sectional, Comparative Study

“…Each item has four possible answers (never = 0, sometimes = 1, generally = 2, and always = 3). Total scores are then classified into four groups: non-emotional eater (0-5), low emotional eater (6-10), emotional eater (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), and very emotional eater (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). To analyze factor structure and psychometric properties of Emotional Eater Questionnaire (EEQ), the authors recruited 295 participants, and Exploratory Factor Analysis (EFA) was carried out by using the Unweight Least Squares (ULS) method [41].…”

“…Change in eating habits was another common coping mechanism for nurses; this could be in the form of consuming high energy-dense foods that have a significant correlation with weight gain [16][17][18][19].…”