Study | Design and critical appraisal (see criteria in box 3) | Setting and participants | Summary results | |
↑ = improvement ↓ = worsening ↔ = little change | ||||
Prospective cohort studies | ||||
Stinson & Hazlett, 197540 | One-month follow-up | Hospital, Canada | Tired on the job | ↔ |
Final sample: n = 23Critical appraisal: 1 2 4 7 9 10 | Nurses, mainly femaleFive eight-hour shifts, two days off to three/four 12-hour shifts, four/three days off | Time available for recreationNot feeling overloaded with work | ↑↔ | |
Eaton & Gottselig, 198041 | Six-month follow-upFinal sample: n = 24Critical appraisal: 1 2 7 9 10 | Hospital, CanadaNurses, mainly femaleEight-hour shifts to 12-hour shifts | Personal Health Survey:Health complaintsCardiovascular complaintsAnxietyAnger-frustrationNurses perception questionnaire:FatigueFelt more restedAbsenceAccidents and injuriesMinnesota Satisfaction Questionnaire:Job satisfactionTurnoverIncidents and errors | ↓↓↓↓↓↑↔↔↔↓↔ |
Peacock et al, 198342 | Six-month follow-up | Police Force, Canada | Sleep duration | ↑ |
Final sample: n = 75 | Police officers | Alertness | ↔ | |
Critical appraisal: 1 7 9 10 | Eight eight-hour shifts, four days off to five 12-hour shifts, three days off | |||
Rosa et al, 1989; Lewis & Swaim, 1986; Rosa, 199143–45 | Seven-month follow-upFinal sample: n = 50Critical appraisal: 1 5 9 10 | Processing plant, USAControl room operators, mainly male aged 25–34Five/seven eight-hour shifts, two/four days off to three/four 12-hour shifts, three/six days off | Gastrointestinal state (night)Gastrointestinal state (day)ExerciseNapping after shift (night)Napping after shift (day)StressTotal sleep timeNumber of awakeningsSleep depthSleep qualitySleep latencyAdjust personal routine for workMissed social events | ↑↔↓↑↔↔↔↔↔↔↔↓↔ |
Jansen & Mull, 199046 | Six-month follow-upFinal sample: n = 87Critical appraisal: 1 2 7 9 10 | Confectionary Factory, NetherlandsPackaging department workers, all female, 46 full-time, 41 part-timeFive eight-hour shifts, two days off to three 12-hour shifts, four days off | FatigueGastrointestinal complaintsTime spent with familySatisfaction with leisure time | ↔↔↑↔ |
Slota & Balas-Stevens, 199047 | Three-month follow-up | Hospital, USA | Absence | ↑ |
Final sample: n = 36Critical appraisal: 1 2 9 10 | Nurses, all femaleFive eight-hour shifts, two days off to three 12.5-hour shifts, four days off | Concern about scheduling of vacation timeAbility to request time offIncidents and errorsPersonal productivity | ↔↔↔↔ | |
Pierce & Dunham, 199248 | 12-month follow-upFinal sample: n = 50Critical appraisal: 1 2 4 7 9 10 | Police Force, USAPolice officers, mainly maleSeven/ten eight-hour shifts, two/three days off to four 12-hour shifts, four days off | Physiological distressFatigueSchedule interference with personal activitiesStressSatisfaction with leisure timeLife satisfactionSatisfaction with organisational associationSatisfaction with workloadJob satisfactionOrganisational effectivenessPerformance | ↑↑↑↑↑↑↔↔↑↑↔ |
Williams, 199249 | Six-month follow-upFinal sample: n = 131Critical appraisal: 1 2 4 5 6 7 9 10 | Chemical Plant, USAOperators, mainly white malesSix/seven eight-hour shifts, two/four days off to three/four 12-hour shifts, two to seven days off | DepressionAbsenceAccidentsGeneral life satisfactionConflict between work and non-work timeSocial/community involvementPlanning activities with familyJob satisfaction | ↑↔↔↑↑↔↑↔ |
Rosa & Bonnet, 199350 | Eight-month follow-upFinal sample: n = 10Critical appraisal: 1 7 9 10 | Gas Processing Plant, USAComputer operators, all maleFour/seven eight-hour shifts, two/three days off to two/three 12-hour shifts, two/three days off | Sleepiness (day)Sleepiness (night)Total sleep time (night)Total sleep time (day)Sleep depthSleep latencyNumber of awakeningsExerciseWork-related adjustment of meal timesWork-related adjustment of personal schedules | ↑↔↑↔↓↔↔↔↔↔ |
Todd et al, 199351 | Six-month follow-upFinal sample: n = 150Critical appraisal: 1 2 4 7 9 10 | Hospital, UKNurses, mainly femaleThree/four 12-hour shifts, three/four days off | Dissatisfaction with fatigueDissatisfaction with ease of getting childcareDissatisfaction with amount of time spent with familyDissatisfaction with how personal life is put secondJob satisfaction | ↓↓↓↓↓ |
Williamson et al, 199452 | Seven-month follow-upFinal sample: n = 18Critical appraisal: 1 2 4 7 9 10 | Computer Company, AustraliaComputer operators (80%) and supervisors (20%)Two to five eight-hour shifts, one/two days off to four 12-hour shifts, four days off | Loss of appetiteGastrointestinal symptomsSleep and fatigueHeadachesIrritabilityHeart problemsGHQVisit to doctorConsumption of social drugsJob satisfaction | ↑↑↑↑↑↑↑↔↔↔ |
Freer & Murphy-Black, 199553 | One-month follow-up | Hospital, UK | Stress | ↔ |
Final sample: n = 13Critical appraisal: 1 4 5 6 9 | Nurses and midwives12-hour flexible shifts | Enjoyment at workMorale at work | ↑↑ | |
Campolo et al, 199854 | 12-month follow-upFinal sample: n = 20Critical appraisal: 1 2 4 9 | Hospital, AustraliaNurses, all femaleSix-hour morning shifts, eight-hour afternoon shifts, 9.5-hour night shifts to four 12-hour shifts, three days off | FatigueGastrointestinal symptomsAbsenceSleep lengthSleep qualityWork demandsTime spent on hobbiesTime with family and friendsPerformance | ↑↓↔↔↔↓↑↔↔ |
Di Milia, 199855 | Two-, three-, four- and five-month follow-upsFinal sample: n = 3Critical appraisal: 1 5 9 10 | Coal mine, AustraliaElectricians, all maleSeven eight-hour shifts, two/four days off to four 12-hour shifts, two/eight days off | Sleep duration | ↔ |
Paley et al, 1994a; 1994b; 199856–58 | 16-month follow-upFinal sample: n = 15Critical appraisal: 1 2 4 5 9 10 | Fire Department, USAFire fighters, all maleFive/seven eight-hour shifts, two/three days off to two 10-hour day shifts, two 14-hour night shifts, four days off | Sleep length (night)Sleep length (day)Sleepiness | ↑↔↔ |
Heslegrave et al, 200059 | One-month follow-upFinal sample: n = 120Critical appraisal: 1 2 7 9 10 | Metal Mine, CanadaMining operatives, mostly maleFive eight-hour shifts, two days off (weekends) to two/three/four 10-hour shifts, two/three days off | Sleep duration (day)Sleep duration (night)Sleep duration (rest)Tiredness (day)Tiredness (rest)Tiredness (night)Gastrointestinal problemsHeadachesPerformance (day)Performance (night) | ↓↔↔↓↓↔↑↑↓↑ |
Johnson & Sharit, 200160 | 11-month and 8-year follow-upsFinal sample: n = 104Critical appraisal: 1 4 7 8 9 10 | Manufacturing Company, USAProduction workersEight-hour rotating shifts to 12-hour rotating shifts | Sleep between shiftsSleep difficultiesHealth disordersSatisfaction with systemProductivityProduction quality | ↑↑↑↑↑↑ |
Von Borkenhagen-Chandler, 200461 | One-month follow-upFinal sample: n = 121Critical appraisal: 1 7 9 | Aerospace Manufacturing Company, USAFinal assembly and flight test workersFive eight-hour shifts, two days off to four 10-hour shifts (Mon–Thurs) with three days off or three 12-hour shifts (Fri-Sun) with four days off | AbsenceJob satisfaction | ↑↑* |
Prospective repeat cross-section studies with control group | ||||
Duchon et al, 1994, 1997; Keran et al, 1994†62–64 | 10-month follow-upFinal sample: n = 22 (17 intervention, 5 control)Critical appraisal: 1 4 5 7 9 | Metal mine, CanadaMinersSeven eight-hour shifts, two/three days off to four 12-hour shifts, four days off | Health problemsEating habitsSleep difficulties after night shiftMinor aches and painsStressStanford Sleepiness Scale:SleepinessSleep lengthFamily lifeMorale | ↔↑↓↓↔↔↔↑↑ |
Smith et al, 199865 | Six-month follow-upFinal sample: n = 62 (47 intervention, 15 control)Critical appraisal: 1 2 4 5 7 8 9 10 | Sewage treatment plant, AustraliaSewage workersSeven eight-hour shifts, two/days off to two/three 12-hour shifts, two/four days off | GHQ-12:Psychological complaintsMinor health complaintsCircadian malaiseMuscular complaintsMinor infectionsDay sleep qualityNight sleep qualityTirednessFatiguePhysical healthMental healthInterference of work with home lifeInterference of work with social lifeWork-life satisfactionWork performance | ↑↔↔↔↔↔↔↔↔↔↔↑↑↔↔ |
Cydulka et al, 199466 | One- and six-month follow-upsFinal sample: n = 140 (27 intervention, 113 control)Critical appraisal: 1 2 4 5 7 8 9 10 | Hospital, USAAmbulance workers and paramedicsSix eight-hour shifts, two days off to three 12 -hour shifts, two days off | Somatic distressOrganisational stressJob dissatisfaction | ↔↔↔ |
Prospective repeat cross-section studies | ||||
Heslegrave et al, 200067 | 12-month follow-upFinal sample: n = 66Critical appraisal: 1 2 4 5 7 9 10 | Nuclear Power Plant, CanadaPower plant operators, mainly maleThree/four/seven nine-hour shifts, two/six days off to four 12.5-hour shifts, four days off | FatigueSleepPerformance | ↓↔↓ |
Mitchell & Williamson, 200068 | Six-month follow-upFinal sample: n = 12Critical appraisal: 1 2 4 5 7 9 10 | Electrical Power Station, AustraliaPower station workers (supervisors, fire fighters, turbine operators), all maleSeven eight-hour shifts, one/two/four days off to five/six 12-hour shifts, two/three/seven days off | Health complaintsAlcohol consumptionSleep qualityAbsenceSleep disturbanceSleep lengthChronic fatiguePhysical healthGHQSomatic anxietyFeeling stressedSocial lifeDomestic lifeCoping with social lifeCoping with home lifeWork performance | ↑↑↑↓↔↔↔↔↔↔↔↑↑↑↑↔ |
Effect sizes have been added to the text where appropriate and the detailed results are available in online table E2.
†Results only presented for the intervention group.
*Amongst some workers only.