Fatigue, Poor Quality Sleep
Conditions
Brief summary
The overarching goal of this proposal is to address the MedEvac foundation priority of educational techniques and technologies and improve Helicopter Emergency Medical Services (HEMS) safety by determining if overall sleep quality and intra-shift fatigue of HEMS clinicians can be improved with real-time assessment and intervention. Aim 1: To determine the short-term impact of an enhanced SleepTrackTXT intervention on HEMS clinician fatigue reported in real-time during and at the end of shift work. Aim 2: To determine the long-term impact of the SleepTrackTXT intervention on sleep quality and sleep health indicators including hours of sleep and recovery between shift work.
Detailed description
The investigators will examine short term impact by examining self-reported fatigue captured at the start, during, and end of scheduled shifts. The investigators will determine longer-term impact on sleep quality by comparing scores on the Pittsburgh Sleep Quality Index (PSQI) taken at baseline and then again at 4 months.
Interventions
BEHAVIORALSleepTrackTXT2
Participants that report high levels of fatigue, sleepiness, or difficulty with concentration during shift work (intra-shift) will receive tailored text-messages promoting adoption of behaviors that can improve alertness during shift work. Participants will also receive a summary of their sleep debt once a week and suggestions for paying back sleep debt. Participants will also have access to a graphic summary of their sleep hours over previous 30-days.
Sponsors
University of Pittsburgh
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
Yes
Inclusion criteria
* 18 years of age and older * working clinically at a study site * currently working in shifts * has a smart phone and * willing to take part in a research study that requires the sending and receiving of multiple text messages daily over 4-months
Exclusion criteria
* does not meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Sleep Quality | 4 months | Measured by the Pittsburgh Sleep Quality Index (PSQI); Scores range from 0 to 21. Higher scores indicate poorer sleep quality. Scores \>6 indicate poor sleep quality. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fatigue During Shiftwork | Every 4 hours up to 12 hours within work shifts | Single item measure of fatigue taken at beginning, every 4-hours, and at the end of shifts. Scores range from 0 (Not at all) to 5 (Very much); higher scores indicate more fatigue. |
| Sleepiness During Shiftwork | Every 4 hours up to 12 hours within a work shift | Single item measure of sleepiness taken at beginning, every 4-hours, and at the end of shifts. Scores range from 0 (Not at all) to 5 (Very much). Higher scores indicate more sleepiness. |
| Difficulty With Concentration During Shiftwork | Every 4 hours up to 12 hours at end of work shift | Single item measure of difficulty with concentration taken at beginning, every 4-hours, and at the end of shifts. Scores range from 0 (Not at all) to 5 (Very much). Higher scores indicate more difficulty with concentration. |
| Inter-Shift Recovery | 4 months | The Occupational Fatigue Exhaustion Recovery Scale Inter-shift Recovery Subscale. Scores range from 0 to 100. Scores 50-100 imply moderate to high recovery. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SleepTrackTXT2 Participants receive text-message assessment during shift work (intra-shift) and between shifts (inter-shift). Participants in the experimental group that report high levels of fatigue, sleepiness, or difficulty with concentration during shift work (intra-shift) will receive tailored text-messages promoting adoption of behaviors that can improve alertness. Participants will also receive a summary of their sleep debt once a week and suggestions for paying back sleep debt. Participants will also have access to a graphic summary of their sleep hours over previous 30-days. | 39 |
| Text-Message Assessments Only Participants in the non-intervention group/arm will receive text-message based assessment during shift work (intra-shift) and between shifts (inter-shift). The inter-shift assessments will query the participant about his/her sleep hours, fatigue, sleepiness, and difficulty with concentration. No intervention messages sent to this group/arm. | 44 |
| Total | 83 |
Baseline characteristics
| Characteristic | Text-Message Assessments Only | Total | SleepTrackTXT2 |
|---|---|---|---|
| Age, Continuous | 41.8 years STANDARD_DEVIATION 9.8 | 41.4 years STANDARD_DEVIATION 9.7 | 40.9 years STANDARD_DEVIATION 9.5 |
| Most Common Shift Length 12 Hours | 22 Participants | 40 Participants | 18 Participants |
| Most Common Shift Length 24 Hours | 21 Participants | 39 Participants | 18 Participants |
| Most Common Shift Length Other | 0 Participants | 2 Participants | 2 Participants |
| Race and Ethnicity Not Collected | — | 0 Participants | — |
| Sex: Female, Male Female | 15 Participants | 34 Participants | 19 Participants |
| Sex: Female, Male Male | 27 Participants | 46 Participants | 19 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 39 | 0 / 44 |
| other Total, other adverse events | 0 / 39 | 0 / 44 |
| serious Total, serious adverse events | 0 / 39 | 0 / 44 |
Outcome results
Primary
Sleep Quality
Measured by the Pittsburgh Sleep Quality Index (PSQI); Scores range from 0 to 21. Higher scores indicate poorer sleep quality. Scores \>6 indicate poor sleep quality.
Time frame: 4 months
Population: Individuals with outcome measured at 4 months.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SleepTrackTXT2 | Sleep Quality | 7.9 score on a scale | Standard Deviation 3.6 |
| Text-Message Assessments Only | Sleep Quality | 6.5 score on a scale | Standard Deviation 4 |
p-value: 0.76t-test, 2 sided
Secondary
Difficulty With Concentration During Shiftwork
Single item measure of difficulty with concentration taken at beginning, every 4-hours, and at the end of shifts. Scores range from 0 (Not at all) to 5 (Very much). Higher scores indicate more difficulty with concentration.
Time frame: Every 4 hours up to 12 hours at end of work shift
Population: Number with shift data at 30 days
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) |
|---|---|---|---|
| SleepTrackTXT2 | Difficulty With Concentration During Shiftwork | Start of shift | 0.52 score on a scale |
| SleepTrackTXT2 | Difficulty With Concentration During Shiftwork | 4 hours | 0.68 score on a scale |
| SleepTrackTXT2 | Difficulty With Concentration During Shiftwork | 8 hours | 1.12 score on a scale |
| SleepTrackTXT2 | Difficulty With Concentration During Shiftwork | 12 hours end of shift | 1.12 score on a scale |
| Text-Message Assessments Only | Difficulty With Concentration During Shiftwork | 12 hours end of shift | 1.76 score on a scale |
| Text-Message Assessments Only | Difficulty With Concentration During Shiftwork | Start of shift | 0.46 score on a scale |
| Text-Message Assessments Only | Difficulty With Concentration During Shiftwork | 8 hours | 1.27 score on a scale |
| Text-Message Assessments Only | Difficulty With Concentration During Shiftwork | 4 hours | 0.71 score on a scale |
p-value: <0.0001Mixed Models Analysis
Secondary
Fatigue During Shiftwork
Single item measure of fatigue taken at beginning, every 4-hours, and at the end of shifts. Scores range from 0 (Not at all) to 5 (Very much); higher scores indicate more fatigue.
Time frame: Every 4 hours up to 12 hours within work shifts
Population: Participants with at least some intra-shift data on fatigue.
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) |
|---|---|---|---|
| SleepTrackTXT2 | Fatigue During Shiftwork | Start of Shift | 0.71 score on a scale |
| SleepTrackTXT2 | Fatigue During Shiftwork | 4 hours | 0.96 score on a scale |
| SleepTrackTXT2 | Fatigue During Shiftwork | 8 hours | 1.45 score on a scale |
| SleepTrackTXT2 | Fatigue During Shiftwork | 12 hours (end of shift) | 1.5 score on a scale |
| Text-Message Assessments Only | Fatigue During Shiftwork | 12 hours (end of shift) | 2.19 score on a scale |
| Text-Message Assessments Only | Fatigue During Shiftwork | Start of Shift | 0.79 score on a scale |
| Text-Message Assessments Only | Fatigue During Shiftwork | 8 hours | 1.79 score on a scale |
| Text-Message Assessments Only | Fatigue During Shiftwork | 4 hours | 1.10 score on a scale |
p-value: <0.0001Mixed Models Analysis
Secondary
Inter-Shift Recovery
The Occupational Fatigue Exhaustion Recovery Scale Inter-shift Recovery Subscale. Scores range from 0 to 100. Scores 50-100 imply moderate to high recovery.
Time frame: 4 months
Population: Participants with survey data at 4 months.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| SleepTrackTXT2 | Inter-Shift Recovery | 51.7 score on a scale | Standard Deviation 20 |
| Text-Message Assessments Only | Inter-Shift Recovery | 56.3 score on a scale | Standard Deviation 18.8 |
p-value: 0.91t-test, 2 sided
Secondary
Sleepiness During Shiftwork
Single item measure of sleepiness taken at beginning, every 4-hours, and at the end of shifts. Scores range from 0 (Not at all) to 5 (Very much). Higher scores indicate more sleepiness.
Time frame: Every 4 hours up to 12 hours within a work shift
Population: Individuals with shift data up to 30 days
| Arm | Measure | Group | Value (LEAST_SQUARES_MEAN) |
|---|---|---|---|
| SleepTrackTXT2 | Sleepiness During Shiftwork | Start of shift | 0.84 score on a scale |
| SleepTrackTXT2 | Sleepiness During Shiftwork | 4 hours | 1.01 score on a scale |
| SleepTrackTXT2 | Sleepiness During Shiftwork | 8 hours | 1.48 score on a scale |
| SleepTrackTXT2 | Sleepiness During Shiftwork | 12 hours at shift end | 1.62 score on a scale |
| Text-Message Assessments Only | Sleepiness During Shiftwork | 12 hours at shift end | 2.50 score on a scale |
| Text-Message Assessments Only | Sleepiness During Shiftwork | Start of shift | 0.82 score on a scale |
| Text-Message Assessments Only | Sleepiness During Shiftwork | 8 hours | 2.01 score on a scale |
| Text-Message Assessments Only | Sleepiness During Shiftwork | 4 hours | 1.29 score on a scale |
p-value: <0.0001Mixed Models Analysis