DOI QR코드

DOI QR Code

Associations of chronotype and insomnia with menstrual problems in newly employed nurses at university hospitals in the Republic of Korea

  • Han-Na Jung (Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital) ;
  • Dongwhan Suh (Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital) ;
  • Woo Chul Jeong (Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital) ;
  • Jia Ryu (Department of Occupational and Environmental Medicine, Catholic Kwandong University International St. Mary's Hospital) ;
  • Yu-Mi Kim (Department of Preventive Medicine, College of Medicine, Hanyang University) ;
  • Seohyun Yoon (Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Hyunjoo Kim (Department of Occupational and Environmental Medicine, Ewha Womans University Mokdong Hospital)
  • Received : 2023.02.16
  • Accepted : 2023.06.30
  • Published : 2023.12.31

Abstract

Background: Dysmenorrhea and menstrual cycle changes occur in women working shifts. Circadian rhythm disruption and sleep disturbances associated with shift work leads to health problems. We identified chronotypes and the occurrence of insomnia among newly employed university hospital nurses and investigated the association of these factors with menstrual problems. Methods: We conducted pre-placement health examinations for shift workers using self-reported questionnaires between 2018 and 2020. A total of 463 nurses were included in the study. Sociodemographic data, shift work experience, and information on insomnia were collected from health examination data. In addition, details regarding chronotype, dysmenorrhea, irregular and abnormal menstrual cycles, amenorrhea, and contraceptive use were obtained from the questionnaire. Multiple logistic regression analysis was performed to study the association between chronotype, insomnia, and menstrual problems after controlling for age, body mass index, contraceptive use, amenorrhea, and prior shift work. Results: The prevalence rates of dysmenorrhea, irregular menstrual cycles, and longer menstrual cycles were 23.8%, 14.9%, and 4.1%, respectively. The risk of dysmenorrhea increased in the evening-type (odds ratio [OR]: 3.209; 95% confidence interval [CI]: 1.685-6.113) and those with insomnia (OR: 1.871; 95% CI: 1.074-3.261). Additionally, the risk of an irregular menstrual cycle (OR: 2.698; 95% CI: 1.167-6.237) increased in the evening-type, and the risk of a longer menstrual cycle (OR: 4.008; 95% CI: 1.354-11.864) increased in individuals with insomnia. Conclusions: Our findings suggest that dysmenorrhea is promoted in the evening-type and insomnia individuals. There may be an increased risk of irregular menstrual cycles among evening-type nurses and an increased risk of longer menstrual cycles among those with insomnia. Therefore, factors such as evening-type and insomnia should be considered for the prevention of menstrual problems in women performing shift work.

Keywords

Acknowledgement

The authors thank the staff of the Ewha Medical Examination Center of Ewha Womans University Mokdong Hospital for their assistance in this study.

References

  1. Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ 2016;355:i5210.
  2. Wickwire EM, Geiger-Brown J, Scharf SM, Drake CL. Shift work and shift work sleep disorder: clinical and organizational perspectives. Chest 2017;151(5):1156-72. https://doi.org/10.1016/j.chest.2016.12.007
  3. Turek FW. From circadian rhythms to clock genes in depression. Int Clin Psychopharmacol 2007;22 Suppl 2:S1-8. https://doi.org/10.1097/01.yic.0000277956.93777.6a
  4. Hurley S, Goldberg D, Von Behren J, Clague DeHart J, Wang S, Reynolds P. Chronotype and postmenopausal breast cancer risk among women in the California Teachers Study. Chronobiol Int 2019;36(11):1504-14. https://doi.org/10.1080/07420528.2019.1658113
  5. Kook SH, Yoon JS, Lee HY. Cross validation of the Korean translation of composite Scale (KtCS) to measure morningness-eveningness. J Korean Neuropsychiatr Assoc 1999;38(2):297-305.
  6. Lee JH, Kim IS, Kim SJ, Wang W, Duffy JF. Change in individual chronotype over a lifetime: a retrospective study. Sleep Med Rev 2011;2(2):48-53. https://doi.org/10.17241/smr.2011.2.2.48
  7. Gentry NW, Ashbrook LH, Fu YH, Ptacek LJ. Human circadian variations. J Clin Invest 2021;131(16):e148282.
  8. Walker HK, Hall WD, Hurst JW. The history, physical, and laboratory examinations. Clinical Methods. 3rd ed. Boston, MA, USA: Butterworths; 1990.
  9. Perkio A, Merikanto I, Kantojarvi K, Paunio T, Sinnott-Armstrong N, Jones SE, et al. Portability of polygenic risk scores for sleep duration, insomnia and chronotype in 33,493 individuals. Clocks Sleep 2022;5(1):10-20. https://doi.org/10.3390/clockssleep5010002
  10. Chang WP, Chang YP. Meta-analysis comparing menstrual regularity and dysmenorrhea of women working rotating shifts and fixed day shifts. J Womens Health (Larchmt) 2021;30(5):722-30. https://doi.org/10.1089/jwh.2020.8517
  11. Szmidt MK, Granda D, Sicinska E, Kaluza J. Primary dysmenorrhea in relation to oxidative stress and antioxidant status: a systematic review of case-control studies. Antioxidants (Basel) 2020;9(10):994.
  12. Draper CF, Duisters K, Weger B, Chakrabarti A, Harms AC, Brennan L, et al. Menstrual cycle rhythmicity: metabolic patterns in healthy women. Sci Rep 2018;8(1):14568.
  13. Pogodina A, Dolgikh O, Astakhova T, Klimkina J, Khramova E, Rychkova L. Health-related quality of life and menstrual problems in adolescents. J Paediatr Child Health 2022;58(6):1028-32. https://doi.org/10.1111/jpc.15895
  14. Shimamoto K, Hirano M, Wada-Hiraike O, Goto R, Osuga Y. Examining the association between menstrual symptoms and health-related quality of life among working women in Japan using the EQ-5D. BMC Womens Health 2021;21(1):325.
  15. Titilayo A, Agunbiade OM, Banjo O, Lawani A. Menstrual discomfort and its influence on daily academic activities and psychosocial relationship among undergraduate female students in Nigeria. Tanzan J Health Res 2009;11(4):181-8.
  16. Sharma A, Taneja DK, Sharma P, Saha R. Problems related to menstruation and their effect on daily routine of students of a medical college in Delhi, India. Asia Pac J Public Health 2008;20(3):234-41. https://doi.org/10.1177/1010539508316939
  17. Small CM, Manatunga AK, Klein M, Dominguez CE, Feigelson HS, McChesney R, et al. Menstrual cycle variability and the likelihood of achieving pregnancy. Rev Environ Health 2010;25(4):369-78. https://doi.org/10.1515/REVEH.2010.25.4.369
  18. Olsson HL, Olsson ML. The menstrual cycle and risk of breast cancer: a review. Front Oncol 2020;10:21.
  19. Solomon CG, Hu FB, Dunaif A, Rich-Edwards J, Willett WC, Hunter DJ, et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. JAMA 2001;286(19):2421-6. https://doi.org/10.1001/jama.286.19.2421
  20. Solomon CG, Hu FB, Dunaif A, Rich-Edwards JE, Stampfer MJ, Willett WC, et al. Menstrual cycle irregularity and risk for future cardiovascular disease. J Clin Endocrinol Metab 2002;87(5):2013-7. https://doi.org/10.1210/jcem.87.5.8471
  21. Wang YX, Arvizu M, Rich-Edwards JW, Stuart JJ, Manson JE, Missmer SA, et al. Menstrual cycle regularity and length across the reproductive lifespan and risk of premature mortality: prospective cohort study. BMJ 2020;371:m3464.
  22. Rosa D, Terzoni S, Dellafiore F, Destrebecq A. Systematic review of shift work and nurses' health. Occup Med (Lond) 2019;69(4):237-43. https://doi.org/10.1093/occmed/kqz063
  23. Negriff S, Dorn LD. Morningness/eveningness and menstrual symptoms in adolescent females. J Psychosom Res 2009;67(2):169-72. https://doi.org/10.1016/j.jpsychores.2009.01.011
  24. Xing X, Xue P, Li SX, Zhou J, Tang X. Sleep disturbance is associated with an increased risk of menstrual problems in female Chinese university students. Sleep Breath 2020;24(4):1719-27. https://doi.org/10.1007/s11325-020-02105-1
  25. Nam GE, Han K, Lee G. Association between sleep duration and menstrual cycle irregularity in Korean female adolescents. Sleep Med 2017;35:62-6. https://doi.org/10.1016/j.sleep.2017.04.009
  26. Chung FF, Yao CC, Wan GH. The associations between menstrual function and life style/working conditions among nurses in Taiwan. J Occup Health 2005;47(2):149-56. https://doi.org/10.1539/joh.47.149
  27. Uehata T, Sasakawa N. The fatigue and maternity disturbances of night workwomen. J Hum Ergol (Tokyo) 1982;11 Suppl:465-74.
  28. Toffol E, Merikanto I, Lahti T, Luoto R, Heikinheimo O, Partonen T. Evidence for a relationship between chronotype and reproductive function in women. Chronobiol Int 2013;30(6):756-65. https://doi.org/10.3109/07420528.2012.763043
  29. Michels KA, Mendola P, Schliep KC, Yeung EH, Ye A, Dunietz GL, et al. The influences of sleep duration, chronotype, and nightwork on the ovarian cycle. Chronobiol Int 2020;37(2):260-71. https://doi.org/10.1080/07420528.2019.1694938
  30. Yun JA, Ahn YS, Jeong KS, Joo EJ, Choi KS. The relationship between chronotype and sleep quality in Korean firefighters. Clin Psychopharmacol Neurosci 2015;13(2):201-8. https://doi.org/10.9758/cpn.2015.13.2.201
  31. McDowell I. Measuring Health: A Guide to Rating Scales and Questionnaires. 3rd ed. Oxford, UK: Oxford University Press; 2006.
  32. Bastien CH, Vallieres A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001;2(4):297-307. https://doi.org/10.1016/S1389-9457(00)00065-4
  33. Chun MY. Validity and reliability of Korean version of international physical activity questionnaire short form in the elderly. Korean J Fam Med 2012;33(3):144-51. https://doi.org/10.4082/kjfm.2012.33.3.144
  34. Ju H, Jones M, Mishra G. The prevalence and risk factors of dysmenorrhea. Epidemiol Rev 2014;36(1):104-13. https://doi.org/10.1093/epirev/mxt009
  35. Bae J, Park S, Kwon JW. Factors associated with menstrual cycle irregularity and menopause. BMC Womens Health 2018;18(1):36.
  36. Takeuchi H, Oishi T, Harada T. Association between moringness-eveningness preference and mental/physical premenstrual symptoms in Japanese females 12 to 31 years of age. Chronobiol Int 2005;22(6):1055-68. https://doi.org/10.1080/07420520500398007
  37. Labyak S, Lava S, Turek F, Zee P. Effects of shiftwork on sleep and menstrual function in nurses. Health Care Women Int 2002;23(6-7):703-14. https://doi.org/10.1080/07399330290107449
  38. Baker FC, Driver HS, Rogers GG, Paiker J, Mitchell D. High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea. Am J Physiol 1999;277(6):E1013-21. https://doi.org/10.1152/ajpendo.1999.277.6.E1013
  39. Harlow SD, Park M. A longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women. Br J Obstet Gynaecol 1996;103(11):1134-42. https://doi.org/10.1111/j.1471-0528.1996.tb09597.x
  40. Teperi J, Rimpela M. Menstrual pain, health and behaviour in girls. Soc Sci Med 1989;29(2):163-9. https://doi.org/10.1016/0277-9536(89)90164-0
  41. Giannotti F, Cortesi F, Sebastiani T, Ottaviano S. Circadian preference, sleep and daytime behaviour in adolescence. J Sleep Res 2002;11(3):191-9. https://doi.org/10.1046/j.1365-2869.2002.00302.x
  42. Srinivasan V, Spence WD, Pandi-Perumal SR, Zakharia R, Bhatnagar KP, Brzezinski A. Melatonin and human reproduction: shedding light on the darkness hormone. Gynecol Endocrinol 2009;25(12):779-85 https://doi.org/10.3109/09513590903159649
  43. Hertz-Eshel M, Rahamimoff R. Effect of melatonin on uterine contractility. Life Sci 1965;4(14):1367-72. https://doi.org/10.1016/0024-3205(65)90014-7
  44. Barron ML. Light exposure, melatonin secretion, and menstrual cycle parameters: an integrative review. Biol Res Nurs 2007;9(1):49-69. https://doi.org/10.1177/1099800407303337
  45. Arafa A, Mahmoud O, Abu Salem E, Mohamed A. Association of sleep duration and insomnia with menstrual symptoms among young women in Upper Egypt. Middle East Current Psychiatry 2020;27(1):2.
  46. Woosley JA, Lichstein KL. Dysmenorrhea, the menstrual cycle, and sleep. Behav Med 2014;40(1):14-21. https://doi.org/10.1080/08964289.2013.829020
  47. Driver HS, Werth E, Dijk DJ, Borbely AA. The menstrual cycle effects on sleep. Sleep Med Clin 2008;3(1):1-11. https://doi.org/10.1016/j.jsmc.2007.10.003
  48. LeRoux A, Wright L, Perrot T, Rusak B. Impact of menstrual cycle phase on endocrine effects of partial sleep restriction in healthy women. Psychoneuroendocrinology 2014;49:34-46. https://doi.org/10.1016/j.psyneuen.2014.06.002
  49. Sveum K. Delayed sleep phase syndrome linked to irregular menstrual cycles, premenstrual symptoms in women. https://aasm.org/delayed-sleep-phase-syndrome-linked-to-irregular-menstrual-cycles-premenstrual-symptoms-in-women/#$%. Updated 2012. Accessed June 10, 2008.
  50. Roenneberg T, Wirz-Justice A, Merrow M. Life between clocks: daily temporal patterns of human chronotypes. J Biol Rhythms 2003;18(1):80-90. https://doi.org/10.1177/0748730402239679
  51. Kivela A, Kauppila A, Ylostalo P, Vakkuri O, Leppaluoto J. Seasonal, menstrual and circadian secretions of melatonin, gonadotropins and prolactin in women. Acta Physiol Scand 1988;132(3):321-7. https://doi.org/10.1111/j.1748-1716.1988.tb08335.x
  52. Emens JS, Lewy AJ, Lefler BJ, Sack RL. Relative coordination to unknown "weak zeitgebers" in free-running blind individuals. J Biol Rhythms 2005;20(2):159-67. https://doi.org/10.1177/0748730404273294
  53. Kang W, Jang KH, Lim HM, Ahn JS, Park WJ. The menstrual cycle associated with insomnia in newly employed nurses performing shift work: a 12-month follow-up study. Int Arch Occup Environ Health 2019;92(2):227-35. https://doi.org/10.1007/s00420-018-1371-y
  54. Baumgartner A, Dietzel M, Saletu B, Wolf R, Campos-Barros A, Graf KJ, et al. Influence of partial sleep deprivation on the secretion of thyrotropin, thyroid hormones, growth hormone, prolactin, luteinizing hormone, follicle stimulating hormone, and estradiol in healthy young women. Psychiatry Res 1993;48(2):153-78. https://doi.org/10.1016/0165-1781(93)90039-J
  55. Merklinger-Gruchala A, Ellison PT, Lipson SF, Thune I, Jasienska G. Low estradiol levels in women of reproductive age having low sleep variation. Eur J Cancer Prev 2008;17(5):467-72. https://doi.org/10.1097/CEJ.0b013e3282f75f67
  56. Hall JE, Sullivan JP, Richardson GS. Brief wake episodes modulate sleep-inhibited luteinizing hormone secretion in the early follicular phase. J Clin Endocrinol Metab 2005;90(4):2050-5. https://doi.org/10.1210/jc.2004-2033
  57. Sequeira ME, Lewis SJ, Bonilla C, Smith GD, Joinson C. Association of timing of menarche with depressive symptoms and depression in adolescence: Mendelian randomisation study. Br J Psychiatry 2017;210(1):39-46. https://doi.org/10.1192/bjp.bp.115.168617
  58. Li SX, Chan NY, Man Yu MW, Lam SP, Zhang J, Yan Chan JW, et al. Eveningness chronotype, insomnia symptoms, and emotional and behavioural problems in adolescents. Sleep Med 2018;47:93-9. https://doi.org/10.1016/j.sleep.2018.03.025
  59. Chan NY, Zhang J, Tsang CC, Li AM, Chan JW, Wing YK, et al. The associations of insomnia symptoms and chronotype with daytime sleepiness, mood symptoms and suicide risk in adolescents. Sleep Med 2020;74:124-31. https://doi.org/10.1016/j.sleep.2020.05.035