Shiftwork, sleep habits, and metabolic disparities: results from the Survey of the Health of Wisconsin



      With the expanding demand for a 24-hour society, the prevalence of sleep deprivation and other sleep-related health problems is increasing. Shiftwork is an occupational health risk of growing significance because of its high prevalence and because of its potential role as a determinant of socioeconomic-related health disparities.


      The aim of this study was to examine the associations of shiftwork with overweight status and type 2 diabetes and explore whether a history of sleep problems mediates or modifies these associations.

      Participants and methods

      A cross-sectional study was conducted among 1593 participants in the Survey of the Health of Wisconsin (2008-2012) who were employed and reported work characteristics (traditional schedule or shiftwork), sleep habits and history of sleep problems (insomnia, insufficient sleep, and wake time sleepiness). Objective measures of body mass index and type 2 diabetes were used.


      Shiftworkers were more overweight than traditional schedule workers (83% vs 71% with body mass index ≥25) and reported more sleep problems, such as insomnia symptoms (24% vs 16%), insufficient sleep (53% vs 43%), and sleepiness (32% vs 24%). The associations between shiftwork and being overweight or diabetic were stronger among those reporting insufficient sleep, but the interaction was not statistically significant.


      Shiftworkers face disparities in metabolic health, particularly those with insufficient sleep. Improved understanding of the relationship between sleep and metabolic states can inform health care providers' and employers' efforts to screen high-risk individuals and intervene with workplace wellness initiatives to address these disparities.


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        • Iskra-Golec I.
        • Fafrowicz M.
        • Marek T.
        • et al.
        The effect of a change in sleep-wakefulness timing, bright light and physical exercise interventions on 24-hour patterns of performance, mood and body temperature.
        J Hum Ergol (Tokyo). 2001; 30: 261-266
        • Costa G.
        Shift work and occupational medicine: an overview.
        Occup Med (Lond). 2003; 53: 83-88
        • Puttonen S.
        • Harma M.
        • Hublin C.
        Shift work and cardiovascular disease—pathways from circadian stress to morbidity.
        Scand J Work Environ Health. 2010; 36: 96-108
        • Dibner C.
        • Schibler U.
        • Albrecht U.
        The mammalian circadian timing system: organization and coordination of central and peripheral clocks.
        Annu Rev Physiol. 2010;
        • Duez H.
        • Staels B.
        Nuclear receptors linking circadian rhythms and cardiometabolic control.
        Arterioscler Thromb Vasc Biol. 2010; 30: 1529-1534
        • Eckel-Mahan K.
        • Sassone-Corsi P.
        Metabolism control by the circadian clock and vice versa.
        Nat Struct Mol Biol. 2009; 16: 462-467
        • Sookoian S.
        • Gemma C.
        • Fernandez Gianotti T.
        • et al.
        Effects of rotating shift work on biomarkers of metabolic syndrome and inflammation.
        J Intern Med. 2007; 261: 285-292
        • Knutsson A.
        Health disorders of shift workers.
        Occup Med (Lond). 2003; 53: 103-108
        • De Bacquer D.
        • Van Risseghem M.
        • Clays E.
        • Kittel F.
        • De Backer G.
        • Braeckman L.
        Rotating shift work and the metabolic syndrome: a prospective study.
        Int J Epidemiol. 2009; 38: 848-854
        • Kolstad H.A.
        Nightshift work and risk of breast cancer and other cancers—a critical review of the epidemiologic evidence.
        Scand J Work Environ Health. 2008; 34: 5-22
        • Biggi N.
        • Consonni D.
        • Galluzzo V.
        • Sogliani M.
        • Costa G.
        Metabolic syndrome in permanent night workers.
        Chronobiol Int. 2008; 25: 443-454
        • Karlsson B.
        • Knutsson A.
        • Lindahl B.
        Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people.
        Occup Environ Med. 2001; 58: 747-752
        • Puttonen S.
        • Kivimaki M.
        • Elovainio M.
        • et al.
        Shift work in young adults and carotid artery intima-media thickness: the Cardiovascular Risk in Young Finns study.
        Atherosclerosis. 2009; 205: 608-613
        • Centers for Disease Control and Prevention (U.S.)
        Short sleep duration among workers—United States, 2010. Morbidity and mortality weekly report.
        Centers for Disease Control and Prevention, Atlanta, GA2012
        • Spiegel K.
        • Tasali E.
        • Penev P.
        • Van Cauter E.
        Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite.
        Ann Intern Med. 2004; 141: 846-850
        • Nieto F.J.
        • Peppard P.E.
        • Engelman C.D.
        • et al.
        The Survey of the Health of Wisconsin (SHOW), a novel infrastructure for population health research: rationale and methods.
        BMC public health. 2010; 10: 785
        • Centers for Disease Control and Prevention
        Division of Nutrition PA, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Overweight and obesity: data and statistics.
        ([Accessed November, 2011])
        • American Diabetes Association
        Diagnosis and classification of diabetes mellitus.
        Diabetes Care. 2010; 33: S62-S69
        • Young T.
        Rationale, design and findings from the Wisconsin Sleep Cohort Study: toward understanding the total societal burden of sleep disordered breathing.
        Sleep Med Clin. 2009; 4: 37-46
        • Szklo-Coxe M.
        • Young T.
        • Peppard P.E.
        • Finn L.A.
        • Benca R.M.
        Prospective associations of insomnia markers and symptoms with depression.
        Am J Epidemiol. 2010; 171: 709-720
        • Roenneberg T.
        • Kuehnle T.
        • Juda M.
        • et al.
        Epidemiology of the human circadian clock.
        Sleep Med Rev. 2007; 11: 429-438
        • Gander P.H.
        • Marshall N.S.
        • Harris R.
        • Reid P.
        The Epworth Sleepiness Scale: influence of age, ethnicity, and socioeconomic deprivation. Epworth Sleepiness scores of adults in New Zealand.
        Sleep. 2005; 28: 249-253
        • O'Connor G.T.
        • Caffo B.
        • Newman A.B.
        • et al.
        Prospective study of sleep-disordered breathing and hypertension: the Sleep Heart Health Study.
        Am J Respir Crit Care Med. 2009; 179: 1159-1164
        • Knutson K.L.
        Sleep duration and cardiometabolic risk: a review of the epidemiologic evidence.
        Best Pract Res Clin Endocrinol Metab. 2010; 24: 731-743
        • Bøggild H.
        • Knutsson A.
        Shift work, risk factors and cardiovascular disease.
        Scand J Work Environ Health. 1999; 25: 85-99
        • Szosland D.
        Shift work and metabolic syndrome, diabetes mellitus and ischaemic heart disease.
        Int J Occup Med Environ Health. 2010; 23: 287-291
        • Wang X.S.
        • Armstrong M.E.
        • Cairns B.J.
        • Key T.J.
        • Travis R.C.
        Shift work and chronic disease: the epidemiological evidence.
        Occup Med (Lond). 2011; 61: 78-89
        • Nagaya T.
        • Yoshida H.
        • Takahashi H.
        • Kawai M.
        Markers of insulin resistance in day and shift workers aged 30-59 years.
        Int Arch Occup Environ Health. 2002; 75: 562-568
        • Pan A.
        • Schernhammer E.S.
        • Sun Q.
        • Hu F.B.
        Rotating night shift work and risk of type 2 diabetes: two prospective cohort studies in women.
        PLoS Med. 2011; 8: e1001141
        • Charles L.E.
        • Gu J.K.
        • Andrew M.E.
        • Violanti J.M.
        • Fekedulegn D.
        • Burchfiel C.M.
        Sleep duration and biomarkers of metabolic function among police officers.
        J Occup Environ Med. 2011; 53: 831-837
        • Rajaratnam S.M.
        • Barger L.K.
        • Lockley S.W.
        • et al.
        Sleep disorders, health, and safety in police officers.
        JAMA. 2011; 306: 2567-2578
        • Itani O.
        • Kaneita Y.
        • Murata A.
        • Yokoyama E.
        • Ohida T.
        Association of onset of obesity with sleep duration and shift work among Japanese adults.
        Sleep Med. 2011; 12: 341-345
        • Ayas N.T.
        • White D.P.
        • Al-Delaimy W.K.
        • et al.
        A prospective study of self-reported sleep duration and incident diabetes in women.
        Diabetes Care. 2003; 26: 380-384
        • Tasali E.
        • Leproult R.
        • Ehrmann D.A.
        • Van Cauter E.
        Slow-wave sleep and the risk of type 2 diabetes in humans.
        Proc Natl Acad Sci U S A. 2008; 105: 1044-1049
        • Cappuccio F.P.
        • Taggart F.M.
        • Kandala N.B.
        • et al.
        Meta-analysis of short sleep duration and obesity in children and adults.
        Sleep. 2008; 31: 619-626
        • Taheri S.
        • Lin L.
        • Austin D.
        • Young T.
        • Mignot E.
        Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index.
        PLoS Med. 2004; 1: e62
        • van den Berg J.F.
        • Miedema H.M.
        • Tulen J.H.
        • et al.
        Long sleep duration is associated with serum cholesterol in the elderly: the Rotterdam Study.
        Psychosom Med. 2008; 70: 1005-1011
        • Buscemi D.
        • Kumar A.
        • Nugent R.
        • Nugent K.
        Short sleep times predict obesity in internal medicine clinic patients.
        J Clin Sleep Med. 2007; 3: 681-688
        • Knutson K.L.
        • Ryden A.M.
        • Mander B.A.
        • Van Cauter E.
        Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus.
        Arch Intern Med. 2006; 166: 1768-1774
        • Knutson K.L.
        • Van Cauter E.
        Associations between sleep loss and increased risk of obesity and diabetes.
        Ann N Y Acad Sci. 2008; 1129: 287-304
        • Knutson K.L.
        • Van Cauter E.
        • Zee P.
        • Liu K.
        • Lauderdale D.S.
        Cross-sectional associations between measures of sleep and markers of glucose metabolism among subjects with and without diabetes: the Coronary Artery Risk Development in Young Adults (CARDIA) Sleep Study.
        Diabetes Care. 2011; 34: 1171-1176
        • Spiegel K.
        • Knutson K.
        • Leproult R.
        • Tasali E.
        • Van Cauter E.
        Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes.
        J Appl Physiol. 2005; 99: 2008-2019
        • Hancox R.J.
        • Landhuis C.E.
        Association between sleep duration and haemoglobin A1c in young adults.
        J Epidemiol Community Health. 2012; 66: 957-961
        • Zizi F.
        • Jean-Louis G.
        • Brown C.D.
        • Ogedegbe G.
        • Boutin-Foster C.
        • McFarlane S.I.
        Sleep duration and the risk of diabetes mellitus: epidemiologic evidence and pathophysiologic insights.
        Curr Diab Rep. 2010; 10: 43-47
        • Knutson K.L.
        • Turek F.W.
        The U-shaped association between sleep and health: the 2 peaks do not mean the same thing.
        Sleep. 2006; 29: 878-879
        • Bray M.S.
        • Young M.E.
        The role of cell-specific circadian clocks in metabolism and disease.
        Obes Rev. 2009; 10: 6-13
        • Turek F.W.
        • Joshu C.
        • Kohsaka A.
        • et al.
        Obesity and metabolic syndrome in circadian clock mutant mice.
        Science. 2005; 308: 1043-1045
        • Gale J.E.
        • Cox H.I.
        • Qian J.
        • Block G.D.
        • Colwell C.S.
        • Matveyenko A.V.
        Disruption of circadian rhythms accelerates development of diabetes through pancreatic beta-cell loss and dysfunction.
        J Biol Rhythms. 2011; 26: 423-433
        • Lowden A.
        • Moreno C.
        • Holmback U.
        • Lennernas M.
        • Tucker P.
        Eating and shift work—effects on habits, metabolism and performance.
        Scand J Work Environ Health. 2010; 36: 150-162
        • Fonken L.K.
        • Workman J.L.
        • Walton J.C.
        • et al.
        Light at night increases body mass by shifting the time of food intake.
        Proceedings of the National Academy of Sciences of the United States of America. 2010; 107: 18664-18669
        • Allebrandt K.V.
        • Teder-Laving M.
        • Kantermann T.
        • et al.
        Chronotype and sleep duration: the influence of season of assessment.
        Chronobiol Int. 2014; 31: 731-740
        • Parsons M.J.
        • Moffitt T.E.
        • Gregory A.M.
        • et al.
        Social jetlag, obesity and metabolic disorder: investigation in a cohort study.
        Int J Obes (Lond). 2014; : 20151-20157
        • Garde A.H.
        • Hansen A.M.
        • Hansen J.
        Sleep length and quality, sleepiness and urinary melatonin among healthy Danish nurses with shift work during work and leisure time.
        Int Arch Occup Environ Health. 2009; 82: 1219-1228
        • Scheer F.A.
        • Hilton M.F.
        • Mantzoros C.S.
        • Shea S.A.
        Adverse metabolic and cardiovascular consequences of circadian misalignment.
        Proc Natl Acad Sci U S A. 2009; 106: 4453-4458
        • Lauderdale D.S.
        • Knutson K.L.
        • Yan L.L.
        • Liu K.
        • Rathouz P.J.
        Self-reported and measured sleep duration: how similar are they?.
        Epidemiology. 2008; 19: 838-845
        • Patel S.R.
        • Malhotra A.
        • Gottlieb D.J.
        • White D.P.
        • Hu F.B.
        Correlates of long sleep duration.
        Sleep. 2006; 29: 881-889