title: The effect of shift rotation on employee cortisol profile, sleep quality, fatigue, and attention level: a systematic review.
abstract: BACKGROUND
  Disrupted circadian rhythm, especially working night duty together with irregular sleep patterns, sleep deprivation, and fatigue, creates an occupational health risk associated with diminished vigilance and work performance.
  
  
  OBJECTIVE
  This study reviewed the effect of shift rotations on employee cortisol profile, sleep quality, fatigue, and attention level.
  
  
  METHODS
  Researchers conducted a systematic review of relevant articles published between 1996 and 2008 that were listed on the following databases: SCOPUS, OVID, Blackwell Science, EBSCO Host, PsycINFO, Cochrane Controlled Trials Register, and CEPS. A total of 28 articles were included in the review.
  
  
  RESULTS
  Previous research into the effects of shift work on cortisol profiles, sleep quality, fatigue, and attention used data assessed at evidence Levels II to IV. Our systematic review confirmed a conflict between sleep-wake cycle and light-dark cycle in night work. Consequences of circadian rhythm disturbance include disruption of sleep, decreased vigilance, general feeling of malaise, and decreased mental efficiency. Shift workers who sleep during the day (day sleepers) experience cortisol secretion increases, which diminish the healing power of sleep and enjoy 1 to 4 hours less sleep on average than night sleepers. Sleep debt accumulation results in chronic fatigue. Prolonged fatigue and inadequate recovery result in decreased work performance and more incidents. Rotation from day shift to night shift and its effect on shift workers was a special focus of the articles retained for review.
  
  
  CONCLUSIONS
  Disturbed circadian rhythm in humans has been associated with a variety of mental and physical disorders and may negatively impact on work safety, performance, and productivity.
authors.affiliation: Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan, ROC.
authors.forename: Shu-Fen
authors.initials: SF
authors.lastname: Niu
authors.forename: Min-Huey
authors.initials: MH
authors.lastname: Chung
authors.forename: Chiung-Hua
authors.initials: CH
authors.lastname: Chen
authors.forename: Desley
authors.initials: D
authors.lastname: Hegney
authors.forename: Anthony
authors.initials: A
authors.lastname: O'Brien
authors.forename: Kuei-Ru
authors.initials: KR
authors.lastname: Chou
mesh_terms: D001288:Attention; D005221:Fatigue; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D012890:Sleep; D014940:Work Schedule Tolerance
chemical_list: D006854:Hydrocortisone