Digital circadian and sleep health in individual hospital shift workers: A cross sectional telemonitoring study
Yiyuan Zhang,
Emilie Cordina-Duverger,
Sandra Komarzynski,
Amal M. Attari,
Qi Huang,
Guillen Aristizabal,
Brice Faraut,
Damien Léger,
René Adam,
Pascal Guénel,
Julia A. Brettschneider,
Bärbel F. Finkenstädt,
Francis Lévi
Affiliations
Yiyuan Zhang
Department of Statistics, University of Warwick, Coventry, United Kingdom
Emilie Cordina-Duverger
Inserm, CESP, Team Exposome and Heredity, University Paris-Saclay, Gustave Roussy, Villejuif, France
Sandra Komarzynski
Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
Amal M. Attari
UPR “Chronothérapie, Cancers, et Transplantation”, Faculté de Médecine, Université Paris-Saclay, Villejuif, France; Cap Gemini, Velizy Villacoublay, France
Qi Huang
Department of Statistics, University of Warwick, Coventry, United Kingdom
Guillen Aristizabal
Inserm, CESP, Team Exposome and Heredity, University Paris-Saclay, Gustave Roussy, Villejuif, France
Brice Faraut
Université de Paris, VIFASOM (EA 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France; Assistance Publique-Hôpitaux de Paris, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
Damien Léger
Université de Paris, VIFASOM (EA 7330 Vigilance Fatigue, Sommeil et Santé Publique), Paris, France; Assistance Publique-Hôpitaux de Paris, APHP-Centre Université de Paris, Hôtel Dieu, Centre du Sommeil et de La Vigilance, Paris, France
René Adam
UPR “Chronothérapie, Cancers, et Transplantation”, Faculté de Médecine, Université Paris-Saclay, Villejuif, France; Hepato-Biliary Center, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
Pascal Guénel
Inserm, CESP, Team Exposome and Heredity, University Paris-Saclay, Gustave Roussy, Villejuif, France
Julia A. Brettschneider
Department of Statistics, University of Warwick, Coventry, United Kingdom
Bärbel F. Finkenstädt
Department of Statistics, University of Warwick, Coventry, United Kingdom
Francis Lévi
Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom; UPR “Chronothérapie, Cancers, et Transplantation”, Faculté de Médecine, Université Paris-Saclay, Villejuif, France; Department of Medical Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France; Corresponding author.
Summary: Background: Telemonitoring of circadian and sleep cycles could identify shift workers at increased risk of poor health, including cancer and cardiovascular diseases, thus supporting personalized prevention. Methods: The Circadiem cross-sectional study aimed at determining early warning signals of risk of health alteration in hospital nightshifters (NS) versus dayshifters (DS, alternating morning and afternoon shifts). Circadian rhythmicity in activity, sleep, and temperature was telemonitored on work and free days for one week. Participants wore a bluetooth low energy thoracic accelerometry and temperature sensor that was wirelessly connected to a GPRS gateway and a health data hub server. Hidden Markov modelling of activity quantified Rhythm Index, rest quality (probability, p1-1, of remaining at rest), and rest duration. Spectral analyses determined periods in body surface temperature and accelerometry. Parameters were compared and predictors of circadian and sleep disruption were identified by multivariate analyses using information criteria-based model selection. Clusters of individual shift work response profiles were recognized. Findings: Of 140 per-protocol participants (133 females), there were 63 NS and 77 DS. Both groups had similar median rest amount, yet NS had significantly worse median rest-activity Rhythm Index (0·38 [IQR, 0·29-0·47] vs. 0·69 [0·60-0·77], p<0·0001) and rest quality p1-1 (0·94 [0·94-0·95] vs 0·96 [0·94-0·97], p<0·0001) over the whole study week. Only 48% of the NS displayed a circadian period in temperature, as compared to 70% of the DS (p=0·026). Poor p1-1 was associated with nightshift work on both work (p<0·0001) and free days (p=0·0098). The number of years of past night work exposure predicted poor rest-activity Rhythm Index jointly with shift type, age and chronotype on workdays (p= 0·0074), and singly on free days (p=0·0005). Interpretation: A dedicated analysis toolbox of streamed data from a wearable device identified circadian and sleep rhythm markers, that constitute surrogate candidate endpoints of poor health risk in shift-workers. Funding: French Agency for Food, Environmental and Occupational Health & Safety (EST-2014/1/064), University of Warwick, Medical Research Council (United Kingdom, MR/M013170), Cancer Research UK(C53561/A19933).
