倒班相关睡眠障碍与倒班耐受性及其环境与遗传交互作用机制的前瞻性研究

Shift work involves unusual or irregular working hours in relation to daytime work, which may cause a misalignment between one’s behavioral timing of sleep/wake and endogenous circadian timing, thereby increasing the risk for shift work sleep disorder (SWSD) and imposing adverse impacts on one’s physical/mental health and psychosocial functioning. As evidenced by epidemiological studies in Western countries, there exists large individual variation in people’s tolerance to shift work; namely, some shift workers adjust very well without developing SWSD, whereas others are less capable of coping with the stresses and circadian challenges generated by shift work and thus more vulnerable to SWSD. Research on the psychosocial, biological and genetic mechanisms underlying the individual variation in shift work tolerance is warranted. A major purpose of this project is to establish a large cohort of Chinese workers with different work schedules and demographic characteristics, to prospectively investigate their sleep problems, physical/mental symptoms and related psychosocial factors. This research project will also employ a nested case-control design, to conduct candidate gene analysis and sleep deprivation experiments. Specific objectives of this research project are: 1) to describe epidemiological characteristics, developmental trajectories and relevant psychosocial risk factors of SWSD among Chinese workers; 2) to explore the candidate genes and gene-environmental interactions implicated in SWSD susceptibility; 3) to examine the detrimental influences of SWSD on cognitive and psychosomatic functioning; and 4) to build upon findings from epidemiological and risk factor studies to develop integrative evaluation systems for shift work tolerance as well as prevention and intervention programs for SWSD. This research project will be of great clinical and practical significance to shift workers’ occupational health care, by providing importance guidance on both individuals’ personal career planning and organizations’ human resource management.

长期倒班易引起生物节律紊乱和心理功能受损，导致倒班相关睡眠障碍，危害心身健康和社会功能。而倒班的易感性和耐受性存在个体差异，这种差异性有心理、社会和生物学基础。本项目拟采取大样本前瞻性研究和套叠式病例对照设计，通过流行病学调查、睡眠剥夺实验，并拟进行易感基因分析，研究倒班相关睡眠障碍的发生率、临床和流行病学特点、变化转归特征，探索其心理社会层面的影响因素和可能的“内表型”及遗传易感性，分析其环境与遗传交互作用机制；并在此基础上研发倒班耐受性的预测指标，以及倒班相关睡眠障碍的预防干预方案。本项目研究对倒班工作人群的职业卫生和心理保健有重要意义，也对职业生涯规划、人员选拔和组织管理有重要的理论和应用价值。

我国目前约有8000万人从事倒班工作，倒班相关睡眠障碍不仅关系到倒班人群的心理健康和社会功能，还关系到全社会的和谐与安全，倒班相关睡眠障碍的发生机制及其预防干预研究不仅重要而且极为迫切。选取从未有倒班经历但是将要进行倒班实习的护士725人作为研究对象，匹配性别年龄的中职学生680人为对照组，对她们进行4波次追踪，主要展开了以下六个方面的研究。第一，对倒班实习护士倒班睡眠障碍（SWSD）的检出率、影响因素及结局进行了分析，结果发现：实习护士在倒班后3个月和6个月时的SWSD检出率分别为22.8%和23.2%，倒班9个月然后恢复正常作息两周后的SWSD检出率为14.8%，实习护士倒班后的失眠和嗜睡症状较为普遍。第二，对SWSD影响因素的分析发现，较为混乱的倒班顺序、高困倦性、高应激失眠反应性、情绪调节困难以及较高的压力感知是重要的风险因素，而倒班期间进行体育锻炼、夜班期间小睡和较高的睡眠灵活性则是保护性因素。第三，考察了睡眠问题及情绪调节困难在失眠易感特质与身心症状之间的纵向中介关系。结果发现，应激失眠反应较小和睡眠灵活性较强的护士在倒班后产生的睡眠问题和情绪问题相对较少，倒班耐受性更强。第四，考察了倒班睡眠障碍组（SWSD）和倒班耐受组（SWT）在倒班前后头发皮质醇水平（ HCC）的变化特点，结果表明，HCC是区分倒班耐受性的重要生物学标记物。第五，选用引导性认知重评任务，考察了SWSD组和SWT组的护士在晚期正成分（LPP）上的差异。结果表明，SWSD组在晚期阶段的认知重评能力上出现异常，这可能与过度关注负性刺激以及失眠所导致的认知控制能力的下降有关。第六，选用Flanker任务，以错误相关负波（Error-related negativity, ERN）和错误正波（Error-positivity, Pe）的波幅作为反映错误监控能力的指标，考察了SWSD和SWT可能的认知神经机制。结果表明，SWSD组的ERN波幅要显著低于SWT组，说明SWSD组在对错误信息的监控和觉察能力上要比SWT组更差。本研究对倒班工作人群的职业卫生和心理保健有重要意义，也对职业生涯规划、人员选拔和组织管理有重要的理论和应用价值。