Impact of Shift Work Patterns on Actigraphy-based Sleep Measures among Nurses: Results from the Hong Kong Night Shift Cohort

Introduction: The relationship between sleep quality and shift work schedules among nurses remains unclear. To assess sleep parameters across different shifts, with particular focus on a rapid-rotating shift pattern (completing afternoon→morning→night shifts within 40 hours, termed “PAN pattern”). Methods: Utilizing a cross-sectional design and census sampling, this 7-day actigraphy study included 201 nurses (41.0% PAN pattern) and 100 daytime office workers in Hong Kong (2022.06–2023.02). Mixed-effects models analyzed sleep parameters, adjusting for covariates. Results: PAN pattern nurses were younger (mean age 32.2 years), had fewer years of employment (averagely 9.3 years) compared to non-PAN pattern nurses, along with more disrupted rest-activity circadian rhythms. All shifts, except day shifts, disrupted sleep regularity ( P < 0.001). A 0.25-h decrease ( P = 0.047) in wake after sleep onset was observed on nonworkdays postafternoon shifts compared to other nonworkdays. Notably, PAN pattern nurses experienced a 1.01-h reduction in total sleep time (TST) on morning shifts ( P < 0.001) compared to daytime office workers. However, they showed 21% increased sleep efficiency on nonworkdays postnight shifts ( P = 0.037) compared to other nonworkdays. Non-PAN nurses exhibited a 53-min reduction in TST on the nonworkday postafternoon shifts ( P = 0.014) than on other nonworkdays. Conclusion: Shift work impairs nurses’ sleep quality, with the rapid-rotating PAN pattern compromises workday sleep but shows selective nonworkday recovery benefits, whereas non-PAN pattern incurs sustained sleep deficits on nonworkdays. The findings demonstrated the critical need for tailored shift scheduling that accounted for these differential sleep impacts, providing nurse managers with evidence to optimize shift arrangements.