The current study aims to extend our previous study by using a much larger sample of nurses and investigating the effects of working 8-h rapidly rotating shifts on tiredness and sleepiness and how they affect psychomotor performance. Thus, more consistent evidence and studies using larger samples are necessary. However, in other studies, even though sleepiness and mental tiredness are more pronounced in night shift workers, none of the negative effects have been replicated in PVT performance ( Surani et al., 2015). Studies utilizing the PVT have observed that at the end of a 12-h shift, nurses appear more vulnerable with decreased response speed and increased sleepiness ( Wilson et al., 2019). PVT is considered the most widespread and reliable method to assess the neurocognitive consequences of sleep deprivation and excessive sleepiness on sustained attention ( Dinges et al., 1997). In that study, the psychomotor performance was measured by the psychomotor vigilance task (PVT). Regarding psychological health and performance, in our previous study ( Di Muzio et al., 2019), comparing nighttime and daytime psychomotor performance in a small sample of Italian nurses, night shifts are associated with significantly greater sleepiness, tiredness, and worsened performance, such as reduced reaction time to visual cues. It is crucial to managing shift work so that medical professionals and patients’ safety and health are not negatively affected. Sleepiness is linked to a higher deterioration of cognitive performance in executive skills and concentration-related procedures among Italian medical specialists who worked on rotating shifts compared to those who worked fixed shifts ( Tempesta et al., 2013). Similarly, their ability to perform mental calculations quickly and correctly is impaired compared to those who worked fixed shifts ( Molzof et al., 2019). The altered sleep/wake rhythm of nurses working night shifts is associated with medical errors ( Gold et al., 1992 Fabbian et al., 2016 Di Muzio et al., 2019) and, more generally, with their ability to accurately and rapidly attend to basic and advanced attentional performance tasks ( Behrens et al., 2019). This issue is particularly relevant in the health-care industry, which requires workers to be available in 24-h runs with a rotation of three shifts per day. Due to the intrinsic association between sleep regulation and circadian desynchronization, rotating shift workers with night shift experience more sleep/wake cycle disruptions and nodded off more at work more often than did those who worked early day shifts only ( Gold et al., 1992). Shift work is increasingly common in developed countries about 40% of workers in the European Union care industry are involved in shift work ( Parent-Thirion et al., 2017). The evaluation of sleep quality through PSQI could represent a rapid, inexpensive tool to assess health-care workers assigned to rotating night shifts or to evaluate nurses who coped poorly with night-shift work. The high prevalence of altered sleep quality showed that nurses, and shift workers in general, are at risk for a poor sleep quality. While sex, age, and years on the job did not affect PVT performance after the night shift, lower sleep quality (Pittsburgh Sleep Quality, PSQI > 5) was associated with decreased performance.

These increases were paralleled by lower attentional performance on the psychomotor vigilance task (PVT) after the night shift. Sleepiness, as measured by the Karolinska Sleepiness Scale, and tiredness, as measured by the Tiredness Symptoms Scale, were more pronounced after the night shift. Eighty-six nurses with 8-h-rapidly-rotating-shifts were evaluated at the end of three shifts (morning/afternoon/night) for sleepiness and tiredness. In this study, we examine the effects of the night shift on psychomotor performance, sleepiness, and tiredness in a large sample of shift-working nurses and evaluated if poor sleep quality, sex, age, or years on the job could impact on a better adaptation to shift work. The altered sleep/wake rhythm of night-shift nurses is also associated with deteriorated cognitive efficiency.

In Europe, 40% of health-care employees are involved in shift work.

5Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy.4IRCCS Fondazione Santa Lucia, Rome, Italy.3Department of Psychology, Sapienza University of Rome, Rome, Italy.2Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.1Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.Marco Di Muzio 1 Giulia Diella 1 Emanuele Di Simone 2 Luana Novelli 3 Valentina Alfonsi 4 Serena Scarpelli 4 Ludovica Annarumma 3 Federico Salfi 5 Mariella Pazzaglia 3,4 Anna Maria Giannini 3 Luigi De Gennaro 3*

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