Sleep duration mediates abdominal and lower-extremity pain after night work in nurses

  • Maria Katsifaraki
  • Kristian Bernhard Nilsen
  • Jan Olav Christensen
  • Morten Wærsted
  • Stein Knardahl
  • Bjørn Bjorvatn
  • Mikko Härmä
  • Dagfinn MatreEmail author
Original Article



The aim of this study was to investigate the association between different working shifts (i.e. morning, evening, night shifts) and headache, musculoskeletal and abdominal pain, and the extent to which reduced sleep duration could account for these associations.


Nurses (N = 679, 649 female, aged 22–53 years) were followed up for a period of 28 consecutive days, responding to a diary about sleep, shift type and pain complaints (measured on a Likert-type scale ranging from 0 to 3). Generalised structural equation modelling mediation analysis (GSEM) was performed to test whether shift type was associated with higher incidence or higher intensity of pain (headache, pain in neck/shoulders/upper back, upper extremity, low back, lower extremity and abdominal pain), and if this effect was mediated by sleep duration (continuous variable), after controlling for age, work and lifestyle factors.


Pain scores in lower extremities were decreased following night shifts in general. However, when night shifts were followed by short sleep duration, the risk of pain in the lower extremities and abdominal pain were increased. Headache and pain in the upper extremity were increased after night shifts, but were not associated with sleep duration. Pain in the neck/shoulder/upper back and lower back was not related to shift work.


Among nurses in a three-shift rotating schedule, night shifts increased the risk of pain in several regions, but only pain in the lower extremities and abdomen was related to reduced sleep duration.


Sleep Pain Shift work Nurses Musculoskeletal disorders Night work 

Supplementary material

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  1. Andersen LL, Clausen T, Mortensen OS, Burr H, Holtermann A (2012) A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare. Int Arch Occup Environ Health 85(6):615–622CrossRefGoogle Scholar
  2. Attarchi M, Raeisi S, Namvar M, Golabadi M (2014) Association between shift working and musculoskeletal symptoms among nursing personnel. Iran J Nurs Midwifery Res 19(3):309Google Scholar
  3. Bergström G, Bodin L, Bertilsson H, Jensen IB (2007) Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up. Occup Environ Med 64(4):279–287CrossRefGoogle Scholar
  4. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefGoogle Scholar
  5. Carney CE et al (2012) The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 35(2):287–302. CrossRefGoogle Scholar
  6. Dallner M (2000) Validation of the General Nordic Questionnaire (QPSNordic) for psychological and social factors at work. Nordic Council of Ministers [Nordiska ministerrådet]Google Scholar
  7. Dzierzewski JM et al (2010) Daily variations in objective nighttime sleep and subjective morning pain in older adults with insomnia: evidence of covariation over time. J Am Geriatr Soc 58(5):925–930. CrossRefGoogle Scholar
  8. Edwards RR, Almeida DM, Klick B, Haythornthwaite JA, Smith MT (2008) Duration of sleep contributes to next-day pain report in the general population. Pain 137(1):202–207. CrossRefGoogle Scholar
  9. Eriksen W (2003) The prevalence of musculoskeletal pain in Norwegian nurses’ aides. Int Arch Occup Environ Health 76(8):625–630CrossRefGoogle Scholar
  10. Eriksen W, Bruusgaard D, Knardahl S (2004) Work factors as predictors of intense or disabling low back pain; a prospective study of nurses’ aides. Occup Environ Med 61(5):398–404CrossRefGoogle Scholar
  11. Faraut B, Leger D, Medkour T, Dubois A, Bayon V, Chennaoui M, Perrot S (2015) Napping reverses increased pain sensitivity due to sleep restriction. PloS One 10:e0117425CrossRefGoogle Scholar
  12. Geiger-Brown J, Trinkoff A, Rogers VE (2011) The impact of work schedules, home, and work demands on self-reported sleep in registered nurses. J Occup Environ Med 53(3):303–307. CrossRefGoogle Scholar
  13. Haack M, Sanchez E, Mullington JM (2007) Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep 30:1145–1152CrossRefGoogle Scholar
  14. Haack M, Lee E, Cohen DA, Mullington JM (2009) Activation of the prostaglandin system in response to sleep loss in healthy humans: potential mediator of increased spontaneous pain. Pain 145:136–141CrossRefGoogle Scholar
  15. Härmä M, Sallinen M, Ranta R, Mutanen P, Müller K (2002) The effect of an irregular shift system on sleepiness at work in train drivers and railway traffic controllers. J Sleep Res 11(2):141–151CrossRefGoogle Scholar
  16. Holmberg SA, Thelin AG (2006) Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population. BMC Musculoskelet Disord 7(1):1CrossRefGoogle Scholar
  17. Horne JA, Ostberg O (1975) A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol 4(2):97–110Google Scholar
  18. Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB (2012) Stress and sleep duration predict headache severity in chronic headache sufferers. Pain 153(12):2432–2440. CrossRefGoogle Scholar
  19. Huntley ED, Campo JV, Dahl RE, Lewin DS (2007) Sleep characteristics of youth with functional abdominal pain and a healthy comparison group. J Pediatr Psychol 32(8):938–949CrossRefGoogle Scholar
  20. Ihlebæk C, Eriksen HR, Ursin H (2002) Prevalence of subjective health complaints (SHC) in Norway. Scandinavian J Publ Health 30(1):20–29CrossRefGoogle Scholar
  21. Jakobsen GS, Timm AM, Hansen ÅM, Garde AH, Nabe-Nielsen K (2017) The association between shift work and treatment-seeking migraine in Denmark. Ergonomics:1–11Google Scholar
  22. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545CrossRefGoogle Scholar
  23. Joksimovic L, Starke D, vd Knesebeck O, Siegrist J (2002) Perceived work stress, overcommitment, and self-reported musculoskeletal pain: Across-sectional investigation. Int J Behav Med 9(2):122–138CrossRefGoogle Scholar
  24. Keefer L, Stepanski E, Ranjbaran Z, Benson L, Keshavarzian A (2006) An initial report of sleep disturbance in inactive inflammatory bowel disease. J Clin Sleep Med 2(4):409–416Google Scholar
  25. Kelly GA, Blake C, Power CK, O’keeffe D, Fullen BM (2011) The association between chronic low back pain and sleep: a systematic review. Clin J Pain 27(2):169–181CrossRefGoogle Scholar
  26. Knutsson A (2003) Health disorders of shift workers. Occup Med (Lond) 53(2):103–108CrossRefGoogle Scholar
  27. Lipscomb JA, Trinkoff AM, Geiger-Brown J, Brady B (2002) Work-schedule characteristics and reported musculoskeletal disorders of registered nurses. Scandinavian J Work Environ Health 28(6):394–401CrossRefGoogle Scholar
  28. Lötters F, Burdorf A (2006) Prognostic factors for duration of sickness absence due to musculoskeletal disorders. Clin J Pain 22(2):212–221CrossRefGoogle Scholar
  29. Matre D, Hu L, Viken LA, Hjelle IB, Wigemyr M, Knardahl S, Sand T, Nilsen KB (2015) Experimental sleep restriction facilitates pain and electrically induced cortical responses. Sleep 38:1607–1617CrossRefGoogle Scholar
  30. Matsumoto K (1978) Sleep patterns in hospital nurses due to shift work: an EEG study. Waking SleepingGoogle Scholar
  31. Nojkov B, Rubenstein JH, Chey WD, Hoogerwerf WA (2010) The impact of rotating shift work on the prevalence of irritable bowel syndrome in nurses. Am J Gastroenterol 105(4):842CrossRefGoogle Scholar
  32. Ohayon MM, Smolensky MH, Roth T (2010) Consequences of shiftworking on sleep duration, sleepiness, and sleep attacks. Chronobiol Int 27(3):575–589CrossRefGoogle Scholar
  33. Pallesen S, Bjorvatn B, Nordhus IH, Sivertsen B, Hjørnevik M, Morin CM (2008) A new scale for measuring insomnia: the Bergen Insomnia Scale. Percept Mot Skills 107(3):691–706CrossRefGoogle Scholar
  34. Park YM, Matsumoto K, Seo YJ, Cho YR, Noh TJ (2000) Sleep–wake behavior of shift workers using wrist actigraph. Psychiatry Clin Neurosci 54(3):359–360CrossRefGoogle Scholar
  35. Picavet H, Schouten J (2003) Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC 3-study. Pain 102(1):167–178CrossRefGoogle Scholar
  36. Pilcher JJ, Lambert BJ, Huffcutt AI (2000) Differential effects of permanent and rotating shifts on self-report sleep length: a meta-analytic review. Journal of Sleep Research & Sleep Medicine, SleepGoogle Scholar
  37. Ranjbaran Z, Keefer L, Farhadi A, Stepanski E, Sedghi S, Keshavarzian A (2007) Impact of sleep disturbances in inflammatory bowel disease. J Gastroenterol Hepatol 22(11):1748–1753CrossRefGoogle Scholar
  38. Roehrs TA, Harris E, Randall S, Roth T (2012) Pain sensitivity and recovery from mild chronic sleep loss. Sleep 35(12):1667–1672. Google Scholar
  39. Sallinen M, Härmä M, Mutanen P, Ranta R, Virkkala J, Müller K (2003) Sleep–wake rhythm in an irregular shift system. J Sleep Res 12(2):103–112CrossRefGoogle Scholar
  40. Smith MT, Edwards RR, McCann UD, Haythornthwaite JA (2007) The effects of sleep deprivation on pain inhibition and spontaneous pain in women. Sleep 30:494–505CrossRefGoogle Scholar
  41. Steingrimsdottir OA, Vollestad NK, Roe C, Knardahl S (2004) Variation in reporting of pain and other subjective health complaints in a working population and limitations of single sample measurements. Pain 110(1–2):130–139. CrossRefGoogle Scholar
  42. Trinkoff AM, Le R, Geiger-Brown J, Lipscomb J, Lang G (2006) Longitudinal relationship of work hours, mandatory overtime, and on-call to musculoskeletal problems in nurses. Am J Ind Med 49(11):964–971. CrossRefGoogle Scholar
  43. Vanini G (2016) Sleep deprivation and recovery sleep prior to a noxious inflammatory insult influence characteristics and duration of pain. Sleep 39:133–142CrossRefGoogle Scholar
  44. Wang Y et al (2015) The prevalence of primary headache disorders and their associated factors among nursing staff in North China. J Headache Pain 16(1):4CrossRefGoogle Scholar
  45. Yoon CS, Lee SH (1999) Symptom prevalence and related factors of upper limb musculoskeletal symptoms in automobile related job workers. Korean J Occup Environ Med 11(4):439–448Google Scholar
  46. Zhao I, Bogossian F, Turner C (2012) The effects of shift work and interaction between shift work and overweight/obesity on low back pain in nurses: results from a longitudinal study. J Occup Environ Med 54(7):820–825. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maria Katsifaraki
    • 1
  • Kristian Bernhard Nilsen
    • 1
    • 2
    • 3
  • Jan Olav Christensen
    • 1
  • Morten Wærsted
    • 1
  • Stein Knardahl
    • 1
  • Bjørn Bjorvatn
    • 4
    • 5
  • Mikko Härmä
    • 6
  • Dagfinn Matre
    • 1
    Email author
  1. 1.Department of Work Psychology and PhysiologyNational Institute of Occupational HealthOsloNorway
  2. 2.Department of NeuroscienceNorwegian University of Science and TechnologyTrondheimNorway
  3. 3.Section for Clinical Neurophysiology, Department of NeurologyOslo University Hospital-UllevålOsloNorway
  4. 4.Norwegian Competence Center for Sleep DisordersHaukeland University HospitalBergenNorway
  5. 5.Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
  6. 6.Finnish Institute of Occupational HealthHelsinkiFinland

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