Year: 2026
Type: editorial
Abstract: associated with higher post shift fatigue scores (Profile of Mood States) and increased post-shift sleepiness levels (Karolinska Sleepiness Scale).However, the effects of extended 24-hour shifts may extend beyond the immediate post-shift period and lead to chronic sleep impairment. To explain this, several authors have suggested that night shift induced circadian misalignment and impaired melatonin secretion (2).We hypothesize that work-related stress may act as a key mediator linking extended 24-hour shifts to impaired off-shift sleep quality among physicians. Indeed, in a cross-sectional survey of 218 French intensivists from 38 ICUs, the prevalence of poor sleep quality (Pittsburgh Sleep Quality Index >5) was 58%. In multivariate analysis, poor sleep quality was associated with higher perceived stress intensity at work, as measured by the recently developed PS-ICU scale, which was specifically designed for ICU professionals (3).Shift work leads to the depletion of physiological resources : effects on the cardiovascular system(4), increased stress hormone levels, sympathetic activation, unhealthy diet (rushed eating, inadequate water intake, excessive sugar intake), reduced sleep duration.Shift work also contributes to the depletion of mental resources. Physicians must cope with high emotional and cognitive demands. According to Karasek's job strain model, psychological strain experienced during a shift results from the interaction between high job demands and low job control (5):1-high job demands : uncertainty, task organization and prioritization, increased vigilance, high workload, challenging interactions with patients and their families, fear of clinical errors, ethically challenging situations.2-low job control : limited control over workload, unit organization, difficulties in managing break times, staff shortages, frequent task interruptions.Work-related stress is associated with impaired sleep as it induces increased physiological and psychological activation incompatible with sleep initiation and normal sleep patterns (6). We emphasize that a vicious cycle may develop, whereby stress impairs sleep, while fatigue further increases stress reactivity and individual susceptibility to stress.We believe that it is urgent to reassess work organization for physicians working on-call shifts and to move away from extended 24-hour shifts. Physicians should be able to take a restorative nap during a shift. We owe it to physicians, for their mental and physical health and to patients, in order to ensure safety and quality of care (7). The extended duration of medical shifts often raises concerns among the public. Other high-risk professions such as airline pilots for example are subject to stringent workingtime regulations to ensure passenger safety. Recent guidelines from the French Society of Intensive Care recommend a maximum of 16 hour of consecutive work but they encounter resistance, especially because of concerns about disrupting continuity of care, high frequency of shifts, and changing established practices.A review by Hulsegge showed that limiting shifts to 16 hours increased off-shift sleep duration and reduced sleepiness during shifts (measured by the Karolinska Sleepiness Scale) (8).It may be appropriate to reassess the organization of shift itself : 12-hour shift, expansion of the medical workforce, mandatory rest period between two shifts, protected rest periods during shifts. We must implement a system that ensures continuous medical presence for patients while sustaining the medical workforce in the short, medium and long term. In parallel, strategies aimed at reducing stress among physicians must be implemented.( 629 words )
Source: Frontiers in Public Health
Authors: Thibault Vieille, Gaël Piton
Language: English
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7221503992