title: Caffeine for the prevention of injuries and errors in shift workers.
abstract: BACKGROUND
  Sleepiness leads to a deterioration in performance and attention, and is associated with an increased risk of injury. Jet lag and shift work disorder are circadian rhythm sleep disorders which result in sleepiness and can elevate injury risk. They create a need for individuals to operate at times which are different to those dictated by their circadian rhythms. Consequently there is also a need for interventions to help ensure that these persons can do so safely. Caffeine has a potential role in promoting alertness during times of desired wakefulness in persons with jet lag or shift work disorder, however its effects on injury and error are unclear.
  
  
  OBJECTIVE
  To assess the effects of caffeine for preventing injuries caused by impaired alertness in persons with jet lag or shift work disorder.
  
  
  METHODS
  We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL, TRANSPORT (to July 2008); and PubMed databases (to April 2010). We also searched the Internet and checked reference lists of relevant papers.
  
  
  METHODS
  Randomised controlled trials investigating the effects of caffeine on injury, error or cognitive performance in people with jet lag or shift work disorder.
  
  
  METHODS
  Two authors independently screened search results and assessed full texts for inclusion. Data were extracted and risk of bias was assessed. Estimates of treatment effect (odds ratio and standardised mean difference (SMD)) and 95% confidence intervals (CI) were calculated and pooled using the fixed-effect model.
  
  
  RESULTS
  Thirteen trials were included. None measured an injury outcome. Two trials measured error, and the remaining trials used neuropsychological tests to assess cognitive performance. The trials assessing the impact on errors found that caffeine significantly reduced the number of errors compared to placebo. The pooled effect estimates on performance by cognitive domain suggest that, when compared to placebo, caffeine improved concept formation and reasoning (SMD -0.41; 95% CI -1.04 to 0.23), memory (SMD -1.08; 95% CI -2.07 to -0.09), orientation and attention (SMD -0.55; 95% CI -0.83 to -0.27) and perception (SMD -0.77; 95% CI -1.73 to 0.20); although there was no beneficial effect on verbal functioning and language skills (SMD 0.18; 95% CI -0.50 to 0.87). One trial comparing the effects of caffeine with a nap found that there were significantly less errors made in the caffeine group. Other trials comparing caffeine with other active interventions (for example nap, bright light, modafinil) found no significant differences. There is a high risk of bias for the adequacy of allocation concealment and presence of selective outcome reporting amongst the trials.
  
  
  CONCLUSIONS
  Caffeine may be an effective intervention for improving performance in shift workers however, there are no trials from which we can assess its effect on injuries. The results largely originate from studies involving young participants under simulated conditions, and the extent to which the findings are generalisable to older workers and real world shift work is unclear. Based on the current evidence, there is no reason for healthy individuals who already use caffeine within recommended levels to improve their alertness to stop doing so. The assessment of the relative effects of caffeine to other potential countermeasures should be a focus of future research.
authors.affiliation: Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, Room 280, North Courtyard, Keppel Street, London, UK, WC1E 7HT.
authors.forename: Katharine
authors.initials: K
authors.lastname: Ker
authors.forename: Philip James
authors.initials: PJ
authors.lastname: Edwards
authors.forename: Lambert M
authors.initials: LM
authors.lastname: Felix
authors.forename: Karen
authors.initials: K
authors.lastname: Blackhall
authors.forename: Ian
authors.initials: I
authors.lastname: Roberts
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control*; D002110:Caffeine / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000517:prevention & control*; D006801:Humans; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D016032:Randomized Controlled Trials as Topic; D020178:Sleep Disorders, Circadian Rhythm / Q000188:drug therapy; D014940:Work Schedule Tolerance / Q000502:physiology*
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine
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