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  • 1. Ahlström, Christer
    et al.
    Nyström, Marcus
    Holmqvist, Kenneth
    Fors, Carina
    Sandberg, David
    Anund, Anna
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fit-for-duty test for estimation of drivers' sleepiness level: Eye movements improve the sleep/wake predictor2013In: Transportation Research Part C: Emerging Technologies, ISSN 0968-090X, E-ISSN 1879-2359, Vol. 26, p. 20-32Article in journal (Refereed)
    Abstract [en]

    Driver sleepiness contributes to a considerable proportion of road accidents, and a fit-for-duty test able to measure a driver’s sleepiness level might improve traffic safety. The aim of this study was to develop a fit-for-duty test based on eye movement measurements and on the sleep/wake predictor model (SWP, which predicts the sleepiness level) and evaluate the ability to predict severe sleepiness during real road driving. Twenty-four drivers participated in an experimental study which took place partly in the laboratory, where the fit-for-duty data were acquired, and partly on the road, where the drivers sleepiness was assessed. A series of four measurements were conducted over a 24-h period during different stages of sleepiness. Two separate analyses were performed; a variance analysis and a feature selection followed by classification analysis. In the first analysis it was found that the SWP and several eye movement features involving anti-saccades, pro-saccades, smooth pursuit, pupillometry and fixation stability varied significantly with different stages of sleep deprivation. In the second analysis, a feature set was determined based on floating forward selection. The correlation coefficient between a linear combination of the acquired features and subjective sleepiness (Karolinska sleepiness scale, KSS) was found to be R = 0.73 and the correct classification rate of drivers who reached high levels of sleepiness (KSS ⩾ 8) in the subsequent driving session was 82.4% (sensitivity = 80.0%, specificity = 84.2% and AUC = 0.86). Future improvements of a fit-for-duty test should focus on how to account for individual differences and situational/contextual factors in the test, and whether it is possible to maintain high sensitive/specificity with a shorter test that can be used in a real-life environment, e.g. on professional drivers.

  • 2.
    Akerstedt, Torbjörn
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Hallvig, David
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Fors, Carina
    Schwarz, Johanna F A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Having to stop driving at night because of dangerous sleepiness - awareness, physiology and behaviour2013In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 22, no 4, p. 380-388Article in journal (Refereed)
    Abstract [en]

    A large number of accidents are due to the driver falling asleep at the wheel, but details of this link have not been studied on a real road. The purpose of the present study was to describe the development of sleepiness indicators, leading to the drive being terminated prematurely by the onboard expert driving instructor because of imminent danger. Eighteen individuals participated during a day drive and a night drive on a motorway (both 90 min). Eight drivers terminated (N) prematurely (after 43 min) because of sleep-related imminent danger [according to the driving instructor or their own judgement (two cases)]. The results showed very high sleepiness ratings (8.5 units on the Karolinska Sleepiness Scale) immediately before termination (<7 at a similar time interval for those 10 who completed the drive). Group N also showed significantly higher levels of sleep intrusions on the electroencephalography/electro-oculography (EEG/EOG) than those who completed the drive (group C). The sleep intrusions were increased in group N during the first 40 min of the night drive. During the day drive, sleep intrusions were increased significantly in group N. The night drive showed significant increases of all sleepiness indicators compared to the day drive, but also reduced speed and driving to the left in the lane. It was concluded that 44% of drivers during late-night driving became dangerously sleepy, and that this group showed higher perceived sleepiness and more sleep intrusions in the EEG/EOG.

  • 3.
    Albrecht, Sophie C.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Rajaleid, Kristiina
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The longitudinal relationship between control over working hours and depressive symptoms: Results from SLOSH, a population-based cohort study2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 215, p. 143-151Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychosocial work factors can affect depressive moods, but research is inconclusive if flexibility to self-determine working hours (work-time control, WTC) is associated with depressive symptoms over time. We investigated if either sub-dimension of WTC, control over daily hours and control over time off, was related to depressive symptoms over time and examined causal, reversed-causal, and reciprocal pathways.

    METHODS: The study was based on four waves of the Swedish Longitudinal Occupational Survey of Health which is a follow-up of representative samples of the Swedish working population. WTC was measured using a 5-item index. Depressive symptoms were assessed with a brief subscale of the Symptom Checklist. Latent growth curve models and cross-lagged panel models were tested.

    RESULTS: Best fit was found for a model with correlated intercepts (control over daily hours) and both correlated intercepts and slopes (control over time off) between WTC and depressive symptoms, with stronger associations for control over time off. Causal models estimating impacts from WTC to subsequent depressive symptoms were best fitting, with a standardised coefficient between -0.023 and -0.048.

    LIMITATIONS: Results were mainly based on self-report data and mean age in the study sample was relatively high.

    CONCLUSION: Higher WTC was related to fewer depressive symptoms over time albeit small effects. Giving workers control over working hours - especially over taking breaks and vacation - may improve working conditions and buffer against developing depression, potentially by enabling workers to recover more easily and promoting work-life balance.

  • 4.
    Albrecht, Sophie
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Tucker, Philip
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Swansea University, UK.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Investigating the factorial structure and availability of work time control in a representative sample of the Swedish working population2016In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 3, p. 320-328Article in journal (Refereed)
    Abstract [en]

    Aims: Past research has often neglected the sub-dimensions of work time control (WTC). Moreover, differences in levels of WTC with respect to work and demographic characteristics have not yet been examined in a representative sample. We investigated these matters in a recent sample of the Swedish working population. Methods: The study was based on the 2014 data collection of the Swedish Longitudinal Occupational Survey of Health. We assessed the structure of the WTC measure using exploratory and confirmatory factor analysis. Differences in WTC by work and demographic characteristics were examined with independent sample t-tests, one-way ANOVAs and gender-stratified logistic regressions. Results: Best model fit was found for a two-factor structure that distinguished between control over daily hours and control over time off (root mean square error of approximation = 0.06; 95% CI 0.04 to 0.09; Comparative Fit Index (CFI) = 0.99). Women, shift and public-sector workers reported lower control in relation to both factors. Age showed small associations with WTC, while a stronger link was suggested for civil status and family situation. Night, roster and rotating shift work seemed to be the most influential factors on reporting low control over daily hours and time off. Conclusions: Our data confirm the two-dimensional structure underlying WTC, namely the components 'control over daily hours' and 'control over time off'. Women, public-sector and shift workers reported lower levels of control. Future research should examine the public health implications of WTC, in particular whether increased control over daily hours and time off can reduce health problems associated with difficult working-time arrangements.

  • 5.
    Andreasson, Anna N.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Schiller, Helena
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Contemplate your symptoms and re-evaluate your health2015In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 49, p. e38-e39Article in journal (Refereed)
    Abstract [en]

    Bodily signals and how these are interpreted affect self-ratings of health. It is thus reasonable that appraisals of health are affected by imminent exposures and disease primes. We aimed to investigate whether self-ratings of health are affected by a symptom rating and if changes are substantiated in persons who report more symptoms. We used data from 813 persons who completed a questionnaire daily for 21 consecutive days. The questionnaire included a one-item self-rating of health (“pre-SRH”; 1 = excellent, 7 = very poor), a subsequent 26-item rating of physical and mental symptoms and thereafter a second (identical) self-rating of health (“post-SRH”). Paired t-tests were used to test for differences between pre-SRH and post-SRH. Mixed effect regression models were used to calculate the interaction effect of pre-SRH and symptom score on post-SRH adjusted for gender, age and if the person had been working that day (13545 observations). SRH worsened significantly (p  <<.0001) after the symptom rating, from 2.72 pre-SRH (95%CI:−2.70–2.74) to 2.77 post-SRH (95%CI:2.75–2.79). There was a significant interaction between pre-SRH and symptoms on post-SRH so that persons who reported more symptoms changed their post-SRH rating to a higher degree than those who reported fewer symptoms, irrespective of their subjective health status. The results support the notion that subjective health perception is affected by focus of attention, and that the effect depends on level of symptoms.

  • 6. Anund, A.
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fors, C.
    Ihlström, J.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Radun, Igor
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Söderström, B.
    Bussförares arbetstider kopplat till trötthet [Bus drivers' working hours and the relationship to fatigue]2014Report (Other (popular science, discussion, etc.))
  • 7. Anund, Anna
    et al.
    Ahlström, Christer
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rumble strips in centre of the lane and the effect on sleepy drivers2011In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 49, no 5, p. 549-558Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the effects of sleep loss on behavioural and subjective indicators of sleepiness on a road containing a milled rumble strip in the centre of the lane. Particular attention was paid to behavioural and subjective indicators of sleepiness when using the centre lane rumble strip, and to possible erratic driving behaviour when hitting a rumble strip. In total 9 regular shift workers drove during the morning hours after a full night shift and after a full night sleep. The order was balanced. The experiment was conducted in a moving base driving simulator on rural roads with a road width of 6.5 and 9 meters. Out of the 1,636 rumble strip hits that occurred during the study, no indications of erratic driving behaviour associated with the jolt caused by making contact with the centre lane rumble strip could be found. Comparing the alert condition with the sleep deprived condition, both the standard deviation of lateral position (SDLP) and the Karolinska Sleepiness Scale (KSS) increased for sleepy drivers. For the two road widths, the drivers drove closer to the centre line on the 6.5-meter road. The KSS and the SDLP increased with time on task. This simulator study indicates that rumble strips in the centre of the lane may be an alternative to centreline and edgeline rumble strips on narrow roads.

  • 8. Anund, Anna
    et al.
    Fors, Carina
    Hallvig, David
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Observer rated sleepiness and real road driving: an explorative study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 5, article id e64782Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to explore if observer rated sleepiness (ORS) is a feasible method for quantification of driver sleepiness in field studies. Two measures of ORS were used: (1) one for behavioural signs based on facial expression, body gestures and body movements labelled B-ORS, and (2) one based on driving performance e.g. if swerving and other indicators of impaired driving occurs, labelled D-ORS. A limited number of observers sitting in the back of an experimental vehicle on a motorway about 2 hours repeatedly 3 times per day (before lunch, after lunch, at night) observed 24 participant's sleepiness level with help of the two observer scales. At the same time the participant reported subjective sleepiness (KSS), EOG was recorded (for calculation of blink duration) and several driving measure were taken and synchronized with the reporting. Based on mixed model Anova and correlation analysis the result showed that observer ratings of sleepiness based on drivers' impaired performance and behavioural signs are sensitive to extend the general pattern of time awake, circadian phase and time of driving. The detailed analysis of the subjective sleepiness and ORS showed weak correspondence on an individual level. Only 16% of the changes in KSS were predicted by the observer. The correlation between the observer ratings based on performance (D-ORS) and behavioural signs (B-ORS) are high (r = .588), and the B-ORS shows a moderately strong association (r = .360) with blink duration. Both ORS measures show an association (r>0.45) with KSS, whereas the association with driving performance is weak. The results show that the ORS-method detects the expected general variations in sleepy driving in field studies, however, sudden changes in driver sleepiness on a detailed level as 5 minutes is usually not detected; this holds true both when taking into account driving behaviour or driver behavioural signs.

  • 9. Anund, Anna
    et al.
    Fors, Carina
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van Leeuwen, Wessel M A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Countermeasures for fatigue in transportation: A review of existing methods for drivers on road, rail, sea and in aviation2015Report (Other academic)
  • 10. Anund, Anna
    et al.
    Ihlström, Jonas
    Fors, Carina
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Filtness, Ashleigh
    Factors associated with self-reported driver sleepiness and incidents in city bus drivers2016In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 54, no 4, p. 337-346Article in journal (Refereed)
    Abstract [en]

    Driver fatigue has received increased attention during recent years and is now considered to be a major contributor to approximately 15-30% of all crashes. However, little is known about fatigue in city bus drivers. It is hypothesized that city bus drivers suffer from sleepiness, which is due to a combination of working conditions, lack of health and reduced sleep quantity and quality. The overall aim with the current study is to investigate if severe driver sleepiness, as indicated by subjective reports of having to fight sleep while driving, is a problem for city based bus drivers in Sweden and if so, to identify the determinants related to working conditions, health and sleep which contribute towards this. The results indicate that driver sleepiness is a problem for city bus drivers, with 19% having to fight to stay awake while driving the bus 2-3 times each week or more and nearly half experiencing this at least 2-4 times per month. In conclusion, severe sleepiness, as indicated by having to fight sleep during driving, was common among the city bus drivers. Severe sleepiness correlated with fatigue related safety risks, such as near crashes.

  • 11. Anund, Anna
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Vadeby, Anna
    Hjälmdahl, Magnus
    Akerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The alerting effect of hitting a rumble strip--a simulator study with sleepy drivers.2008In: Accid Anal Prev, ISSN 1879-2057, Vol. 40, no 6, p. 1970-6Article in journal (Refereed)
    Abstract [en]

    The alerting effect of hitting a rumble strip--a simulator study with sleepy drivers.

    Anund A, Kecklund G, Vadeby A, Hjälmdahl M, Akerstedt T.

    Clinical Neuroscience, Karolinska Institutet, SE-177 71 Stockholm, Sweden. anna.anund@vti.se

    A moving base driving simulator experiment was carried out in order to investigate the effects of milled rumble strips on driver fatigue. There were rumble strips both at the edge line and centre line. Four different physical designs of milled rumble strips (yielding noise values from 1.5 to 16 dBA) and two placements on shoulder were used in the experiment. Sound and vibrations from real milled rumble strips were reproduced in the simulator. In total 35 regular shift workers drove during the morning hours after a full night shift. The main results showed an increase in sleepiness indicators (EEG alpha/theta activity, eye closure duration, standard deviation of lateral position, subjective sleepiness) from start to before hitting the rumble strip, an alerting effect in most parameters (not subjective sleepiness) after hitting the strip. The alertness enhancing effect was, however, short and the sleepiness signs returned 5 min after the rumble strip hit. Essentially no effects were seen due to type of strip. It was concluded that various aspects of sleepiness are increased before hitting a rumble strip and that the effect is very short-lived. Type of strip, as used in the present study did not have any effect.

  • 12. Axelsson, J
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Gustavsson, P
    Rudman, A
    Selection into shift and night work2013Conference paper (Refereed)
  • 13.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sömn och fysisk aktivitet2016In: FYSS 2017: fysisk aktivitet i sjukdomsprevention och sjukdomsbehandling, Stockholm: Läkartidningen förlag AB , 2016, 3, p. 171-183Chapter in book (Other academic)
  • 14.
    Axelsson, John
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Tigerström, L
    Does rapid eye movement (REM) sleep prepare the brain for wakening?2014In: Journal of sleep research, Special issue: 22nd Congress of the European Sleep Research Society, 16-20 September, 2014, Tallinn, Estonia, 2014Conference paper (Other academic)
  • 15. Beckers, Debby G J
    et al.
    Kompier, Michiel A J
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Härmä, Mikko
    Worktime control: theoretical conceptualization, current empirical knowledge, and research agenda2012In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 38, no 4, p. 291-297Article in journal (Refereed)
  • 16. Dahlgren, A.
    et al.
    van Leeuwen, Wessel M. A.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kircher, A.
    Lüthöft, M.
    Barnett, M.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fatiqueat sea: a simulator study of sleepiness, sleep and neurobehavioural performance during different watch schedules2013Conference paper (Refereed)
  • 17.
    Dahlgren, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. National Institute for Psychosocial Medicine, Stockholm.
    Kecklund, Göran
    National Institute for Psychosocial Medicine, Stockholm.
    Åkerstedt, Torbjörn
    National Institute for Psychosocial Medicine, Stockholm.
    Overtime work and its effects on sleep, sleepiness, cortisol and blood pressure in an experimental field study2006In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 32, no 4, p. 318-327Article in journal (Refereed)
    Abstract [en]

    Objectives Previous studies of long workhours and their effects on stress, sleep, and health show inconclusive results. This inconclusiveness may be partly due to methodological problems such as the use of between-group designs or comparisons before and after reorganizations. In addition, stress is usually a confounder. A within-person design was used to examine the effects of working 8- or 12-hour shifts in the absence of additional stress. Methods In an experimental field study, 16 white-collar workers [9 women, mean age 45.9 (SD 15) years] undertook one workweek with normal workhours (8 hours) and 1 week of overtime with 4 extra hours of regular worktasks (12 hours). The participants wore actigraphs, rated sleepiness (Karolinska Sleepiness Scale) and stress throughout the day, and rated workload and how exhausted they felt. Saliva samples were collected on Mondays and Thursdays for cortisol analysis. On these days, ambulatory heart rate and blood pressure were also measured for 24 hours. Results Overtime was associated with higher levels of exhaustion. Sleepiness showed a significant interaction between conditions, with higher levels at the end of the workweek featuring overtime. Total sleep time was shorter in the overtime week. There were no significant differences between ratings of stress and workload. Cortisol showed a circadian variation but no main effect of condition. Conclusions One week of overtime work with a moderate workload produced no main effects on physiological stress markers. Nevertheless, sleep was negatively affected, with shorter sleeps during overtime work and greater problems with fatigue and sleepiness.

  • 18.
    Dahlgren, Anna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology. National Institute for Psychosocial Medicine.
    Åkerstedt, Torbjörn
    National Institute for Psychosocial Medicine.
    Kecklund, Göran
    National Institute for Psychosocial Medicine.
    Individual differences in the diurnal cortisol response to stress2004In: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 21, no 6, p. 913-922Article in journal (Refereed)
    Abstract [en]

    The objectives of this study were to explore individual differences associated with diverse reactions in cortisol secretion under different stress levels. This study was part of a larger project concerning working hours and health. Thirty-four whitecollar workers participated under two different conditions; one work week with a high stress level (H) and one with a lower stress level (L) as measured through self-rated stress during workdays. Based on the morning cortisol concentration during a workday subjects were divided into two groups. One group consisted of subjects whose morning level of cortisol increased in response to the high-stress week, compared to their morning levels in the low-stress condition (Group 1). The other group consisted of subjects whose morning cortisol response was the opposite, with a lower level under the high stress condition (Group 2). Subjects wore actiwatches, completed a sleep diary, and rated their sleepiness and stress for one work week in each condition, i.e., high and low stress. Saliva samples for measures of cortisol were collected on a Wednesday. Group 2 reported higher workload, fatigue, and exhaustion during both weeks. Since there were no differences in perceived stress, neither within nor between groups, the data indicate that there are other factors influencing morning cortisol. The results suggest that one component modulating the cortisol response might be the level of exhaustion, probably related to work overload. Higher levels of stress in exhausted individuals might suppress morning cortisol levels.

  • 19. Di Milia, Lee
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The distribution of sleepiness, sleep and work hours during a long distance morning trip: A comparison between night- and non-night workers2013In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 53, p. 17-22Article in journal (Refereed)
    Abstract [en]

    Few studies have examined the extent of driver sleepiness during a long distance morning trip. Sleepiness at this time may be high because of night work, waking early to commence work or travel, sleep disorders and the monotony of driving long distances. The objective of this study was to estimate the prevalence of chronic sleepiness (Epworth sleepiness score ≥10) and sleep restriction (≤5h) in a sample of 649 drivers. Participants driving between 08:00 and 10:00 on three highways in regional Australia participated in a telephone interview. Approximately 18% of drivers reported chronic sleepiness. The proportions of night workers (NW) and non-night workers (NNW) with chronic sleepiness were not significantly different but males reported a significantly greater proportion of chronic sleepiness than females. The NW group had a significantly greater proportion of drivers with ≤5h of sleep in the previous 24 and 48h, fewer nights of full sleep (≤4), acute sleepiness and longer weekly work hours. The NW group reported driving a significantly longer distance at Time 1 (Mean=140.29±72.17km, versus 117.55±89.74km) and an additional longer distance to complete the journey (Mean=89.33±95.23km, versus 64.77±94.07km). The high proportions of sleep restriction and acute sleepiness among the NW group, and the amount of chronic sleepiness in the NW and NNW groups reported during a long distance morning trip may be of concern for driver safety.

  • 20. Filtness, Ashleigh J.
    et al.
    Anund, Anna
    Fors, Carina
    Ahlström, Christer
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University Nijmegen, Netherlands.
    Sleep-related eye symptoms and their potential for identifying driver sleepiness2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no 5, p. 568-575Article in journal (Refereed)
    Abstract [en]

    The majority of individuals appear to have insight into their own sleepiness, but there is some evidence that this does not hold true for all, for example treated patients with obstructive sleep apnoea. Identification of sleep-related symptoms may help drivers determine their sleepiness, eye symptoms in particular show promise. Sixteen participants completed four motorway drives on two separate occasions. Drives were completed during daytime and night-time in both a driving simulator and on the real road. Ten eye symptoms were rated at the end of each drive, and compared with driving performance and subjective and objective sleep metrics recorded during driving. 'Eye strain', 'difficulty focusing', 'heavy eyelids' and 'difficulty keeping the eyes open' were identified as the four key sleep-related eye symptoms. Drives resulting in these eye symptoms were more likely to have high subjective sleepiness and more line crossings than drives where similar eye discomfort was not reported. Furthermore, drivers having unintentional line crossings were likely to have 'heavy eyelids' and 'difficulty keeping the eyes open'. Results suggest that drivers struggling to identify sleepiness could be assisted with the advice 'stop driving if you feel sleepy and/or have heavy eyelids or difficulty keeping your eyes open'.

  • 21.
    Garefelt, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Work and sleep – a prospective study of psychosocial work factors, physical work factors and work scheduling2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 218-218, article id P706Article in journal (Refereed)
  • 22.
    Garefelt, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Work and sleep – the effects of stress, physical work environment and work hours: A prospective study using the SLOSH database2013Conference paper (Other academic)
    Abstract [en]

    METHODS: Data was derived from two waves of SLOSH (The Swedish Longitudinal Occupational Survey of Health), a representative sample of the working population in Sweden. Respondents in the present study sample were gainfully employed in both 2008 (T1) and in 2010 (T2), and without sleep disturbances at T1 (n=5741, 54 % women, 46 % men, aged 24-72 years). Between T1 and T2 a total number of 441 people (8 %) developed sleep disturbances. Logistic regression was made in five hierarchical models with new cases of disturbed sleep as the dependent variable. Factors studied were changes in physical work environment, work hours, demands, control, support and stress between T1 and T2; increased or decreased levels of exposure, as well as consistently high or low levels. RESULTS: In the fully adjusted model, stress showed the strongest association with new cases of disturbed sleep. Increased stress levels had an OR of 2.9 (95% CI 2.0-4.3) and consistently high levels of stress had an OR of 2.8 (1.9-4.2). Increased levels of demands showed a weaker association, OR=1.8 (1.2-2.6), whereas consistently high levels of demands did not show significant results. Decreased levels of social support showed an increased OR of 2.3 (1.6-3.3), as did consistently low levels of social support with an OR of 1.6 (1.1-2.3). Neither changes in control nor changes in work hours showed any significant results. Increased exposure to excessive heat, cold or draught showed a OR of 1.7 (1.1-2.8) whereas changes in heavy physical labour, noise at work, and poor or excessively bright light did not show an association with new cases of sleep disturbances in the fully adjusted model.

  • 23.
    Gerhardsson, Andreas
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Emotional working memory in older adults after total sleep deprivation2017In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 40, no Suppl. 1, p. e110-e110Article in journal (Refereed)
    Abstract [en]

    Introduction: Even though the occurrence of sleep problems increases with age, few studies have focused on the cognitive effects of acute sleep deprivation in elderly. Most previous research indicate that, compared to young, older adults show less impairment in e.g. attention after sleep deprivation. However, little is known of whether the same pattern holds for higher cognitive functions. In addition, while old age is usually related to a general decrease in working memory abilities, performance on working memory tasks may differ depending on the emotional valence of the stimuli, where positive stimuli seem to be beneficial for working memory performance in older adults. The aim of the present study was to investigate the effect of sleep deprivation on emotional working memory in older adults using two levels of working memory load.

    Materials and methods: A healthy sample of 48 old adults (MAge=66.69 years, SDAge=3.44 years) was randomized into a total sleep deprivation group (TSD; n=24) or a sleep control group (SC; n=24). They performed a working memory task (n-back) containing positive, negative and neutral pictures in a low (1-back) and a high (3-back) working memory load condition. Performance was measured as Accuracy (d'), Omissions and Reaction Time (RT).

    Results: For the d' and Omissions we performed two separate 2x2x3 (sleep, working memory load, valence) repeated measures analyses of variance (rmANOVA). For the RTs, we applied a mixed-effects model. For both d' and RT we found no effect of sleep deprivation (Ps > .05). For valence, we found main effects on both d' (F1,46 = 5.56, P=.005) and RT (F1,95.7 = 4.84, P=.01). d' did not differ for positive and neutral pictures, but was in both cases significantly better than for negative pictures. RTs were significantly faster for positive pictures. However, a working memory loadvalence interaction (F1,95.7 = 4.50, P=.01) further revealed an effect of valence in the low, but not in the high load condition. In the low load condition, RTs were faster for positive than for neutral pictures and faster for neutral than for negative pictures. There was no significant effect of Omissions.

    Conclusions: Our results showed that emotional working memory performance was not significantly affected by one night of sleep deprivation in older adults, which contrast what we found in a sample of young adults from the same project. In line with previous research, our results indicate a beneficial effect of positive stimuli on working memory in older adults. This effect was present in both groups and most pronounced for reaction times in the condition with a lower cognitive demand. We can conclude that, among older adults, the working memory performance is not impaired by sleep deprivation and that the benefits of positive stimuli on working memory seem intact. These findings contribute to a better understanding of older adults' cognitive functioning after sleep deprivation.

  • 24.
    Gerhardsson, Andreas
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet.
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet.
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Schwarz, Johanna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet.
    The effect of sleep loss on emotional working memory2016In: Abstracts of the 23rd Congress of the European Sleep Research Society, 13–16 September 2016, Bologna, Italy. Journal of Sleep Research, 25(S1), 17-18., 2016, Vol. 25(S1), p. 17-18Conference paper (Other academic)
    Abstract [en]

    Objectives: Emotional stimuli differently affect working memory (WM) performance. As sleep deprivation has a known impact on both emotion and WM our aim was to investigate how one night without sleep affects emotional WM performance. Methods: Healthy subjects (n = 56; age 18–30 years) were randomized to a total sleep deprivation (TSD) or a rested control (RC) condition. Subjects rated their affective state and performed a 1 and a 3-back WM task consisting of neutral, positive and negative pictures at 3 pm or 6 pm (balanced) the day after sleep manipulation. Accuracy (d’) and target response time (RT) were used as outcomes. Results: In the TSD condition, subjects rated themselves as less positive (P = 0.006) but not more negative than in the RC condition. In the WM task, TSD had a detrimental effect on accuracy (P = 0.03) regardless of difficulty. Moreover, accuracy was higher in the 1-back than in the 3-back (P < 0.001) and higher for neutral compared to both negative and positive stimuli (Ps < 0.05). RT was faster for positive compared to negative and neutral stimuli (Ps < 0.05). The latter effect was particularly pronounced in the TSD condition as shown by a condition*valence interaction (P < 0.03). Conclusions: One night of total sleep loss impaired emotional WM accuracy. Noticeable, RT was faster for positive stimuli compared to negative and neutral stimuli. This effect was particularly pronounced after sleep loss. This suggests that sleep loss strengthens the opposing effects of positive and negative stimuli on WM performance, possibly due to increased emotion reactivity.

  • 25. Greubel, Jana
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    The impact of organizational changes on work stress, sleep, recovery and health2011In: Industrial Health, ISSN 0019-8366, E-ISSN 1880-8026, Vol. 49, no 3, p. 353-364Article in journal (Refereed)
    Abstract [en]

    The study objective was to investigate the impact of different kinds of organizational changes, as well as anticipation of such changes, on work-related stress, sleep, recovery and health. It was hypothesized that impaired sleep and recovery increase the adverse health consequences of organizational changes. The data consisted of cross sectional questionnaire data from a random sample of 1,523 employees in the Swedish police force. It could be shown that extensive organizational changes including downsizing or a change in job tasks were associated with a small increase in work stress, disturbed sleep, incomplete recovery and health complaints. However, less extensive organizational changes like relocation did not affect these outcome variables. Anticipation of extensive organizational changes had almost the same effect as actual changes. Furthermore a moderating effect of sleep and work stress on gastrointestinal complaints and depressive symptoms was found. Thus, like former studies already suggested, extensive organizational changes resulted in increased stress levels, poorer health and impaired sleep and recovery. Furthermore, organizational instability due to anticipation of changes was as negative as actual changes. There was also some evidence that disturbed sleep increased these adverse health effects, in particular with respect to anticipation of organizational changes.

  • 26.
    Hallvig, David
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Fors, Carina
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karlsson, Johan G.
    Wahde, Mattias
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sleepy driving on the real road and in the simulator-A comparison2012In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 50, p. 44-50Article in journal (Refereed)
    Abstract [en]

    Sleepiness has been identified as one of the most important factors contributing to road crashes. However, almost all work on the detailed changes in behavior and physiology leading up to sleep related crashes has been carried out in driving simulators. It is not clear, however, to what extent simulator results can be generalized to real driving. This study compared real driving with driving in a high fidelity, moving base, driving simulator with respect to driving performance, sleep related physiology (using electroencephalography and electrooculography) and subjective sleepiness during night and day driving for 10 participants. The real road was emulated in the simulator. The results show that the simulator was associated with higher levels of subjective and physiological sleepiness than real driving. However, both for real and simulated driving, the response to night driving appears to be rather similar for subjective sleepiness and sleep physiology. Lateral variability was more responsive to night driving in the simulator, while real driving at night involved a movement to the left in the lane and a reduction of speed, both of which effects were absent in the simulator. It was concluded that the relative validity of simulators is acceptable for many variables, but that in absolute terms simulators cause higher sleepiness levels than real driving. Thus, generalizations from simulators to real driving must be made with great caution.

  • 27.
    Hallvig, David
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Fors, Carina
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University Nijmegen, The Netherlands.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Real driving at night - predicting lane departures from physiological and subjective sleepiness2014In: Biological Psychology, ISSN 0301-0511, E-ISSN 1873-6246, Vol. 101, p. 18-23Article in journal (Refereed)
    Abstract [en]

    Only limited information is available on how driving performance relates to physiological and subjective sleepiness on real roads. This relation was the focus of the present study. 33 volunteers drove for 90min on a rural road during the afternoon and night in an instrumented car, while electroencephalography and electrooculography and lane departures were recorded continuously and subjective ratings of sleepiness were made every 5min (Karolinska Sleepiness Scale - KSS). Data was analyzed using Bayesian multilevel modeling. Unintentional LDs increased during night driving, as did KSS and long blink durations(LBD). Lateral position moved to the left . LDs were predicted by self-reported sleepiness and LBDs across time and were significantly higher in individuals with high sleepiness. Removal of intentional LDs, enhanced the KSS/LD relation. It was concluded that LDs, KSS, and LBDs are strongly increased during night driving and that KSS predicts LDs.

  • 28.
    Hellgren, Johnny
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Psychosocial risk assessment and prevention in Sweden2013In: International Yearbook on Psychosocial Risk Prevention and Quality of Life at Work / [ed] J.M. Peirò & C. Molina, Secretary of Labour Health and Environment UGT-CEC , 2013, p. 171-192Chapter in book (Other academic)
    Abstract [en]

    Modern working life involves higher demands on individual responsibility, blurrier lines between work and private life, increasing flexibility as regards the scheduling of work hours including a high variability from week-to-week or day-today, temporary employment contracts and job insecurity, and unstable organizational conditions. This development has raised concerns regarding job-related stress in Sweden, as well as in other countries, and underscored the need to create sustainable psychosocial work conditions for economic competitiveness and occupational health and safety. This chapter aims to provide an overview of psychosocial risk factors characterizing the contemporary Swedish working life, to describe the institutional frameworks that regulate work environment issues, and to describe how various actors work to prevent psychosocial risk factors. The following section outlines work environment trends and the Swedish system in terms of legislation, various actors on the labor market and so on. Drawing on this, we highlight four sets of psychosocial risk factors (flexible work, working hours, new demands at work, and organizational restructuring) before describing activities related to prevention, health promotion at work and healthy work practices.

  • 29. Ihlström, Jonas
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Anund, Anna
    Split-shift work in relation to stress, health and psychosocial work factors among bus drivers2017In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 56, no 4, p. 531-538Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Shift work has been associated with poor health, sleep and fatigue problems and low satisfaction with working hours. However, one type of shift working, namely split shifts, have received little attention.

    OBJECTIVE: This study examined stress, health and psychosocial aspects of split-shift schedules among bus drivers in urban transport.

    METHODS: A questionnaire was distributed to drivers working more than 70% of full time which 235 drivers in total answered.

    RESULTS: In general, drivers working split-shift schedules (n = 146) did not differ from drivers not working such shifts (n = 83) as regards any of the outcome variables that were studied. However, when individual perceptions towards split-shift schedules were taken into account, a different picture appeared. Bus drivers who reported problems working split shifts (36%) reported poorer health, higher perceived stress, working hours interfering with social life, lower sleep quality, more persistent fatigue and lower general work satisfaction than those who did not view split shifts as a problem. Moreover, drivers who reported problems with split shifts also perceived lower possibilities to influence working hours, indicating lower work time control.

    CONCLUSIONS: This study indicates that split shifts were not associated with increased stress, poorer health and adverse psychosocial work factors for the entire study sample. However, the results showed that individual differences were important and approximately one third of the drivers reported problems with split shifts, which in turn was associated with stress, poor health and negative psychosocial work conditions. More research is needed to understand the individual and organizational determinants of tolerance to split shifts.

  • 30.
    Ingre, Michael
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van Leeuwen, Wessel M A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Second generation three process model (TMP) of alertness for better assessment of individual risks2013Conference paper (Refereed)
  • 31.
    Ingre, Michael
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van Leeuwen, Wessel M A
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Klemets, T
    Ullvetter, C
    Hough, S
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karlsson, D
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Validating and extending the three process model (TPM) of alertness in airline operations.2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, no S1, p. 264-264, article id P836Article in journal (Other academic)
  • 32.
    Ingre, Michael
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    van Leeuwen, Wessel M. A.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Klemets, Tomas
    Ullvetter, Christer
    Hough, Stephen
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karlsson, David
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Validating and Extending the Three Process Model of Alertness in Airline Operations.2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 10, p. e108679-Article in journal (Refereed)
    Abstract [en]

    Sleepiness and fatigue are important risk factors in the transport sector and bio-mathematical sleepiness, sleep and fatigue modeling is increasingly becoming a valuable tool for assessing safety of work schedules and rosters in Fatigue Risk Management Systems (FRMS). The present study sought to validate the inner workings of one such model, Three Process Model (TPM), on aircrews and extend the model with functions to model jetlag and to directly assess the risk of any sleepiness level in any shift schedule or roster with and without knowledge of sleep timings. We collected sleep and sleepiness data from 136 aircrews in a real life situation by means of an application running on a handheld touch screen computer device (iPhone, iPod or iPad) and used the TPM to predict sleepiness with varying level of complexity of model equations and data. The results based on multilevel linear and non-linear mixed effects models showed that the TPM predictions correlated with observed ratings of sleepiness, but explorative analyses suggest that the default model can be improved and reduced to include only two-processes (S+C), with adjusted phases of the circadian process based on a single question of circadian type. We also extended the model with a function to model jetlag acclimatization and with estimates of individual differences including reference limits accounting for 50%, 75% and 90% of the population as well as functions for predicting the probability of any level of sleepiness for ecological assessment of absolute and relative risk of sleepiness in shift systems for safety applications.

  • 33.
    Ingre, Michael
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ekstedt, Mirjam
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Periodic self-rostering in shift work: correspondence between objective work hours, work hour preferences (personal fit), and work schedule satisfaction2012In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 38, no 4, p. 327-336Article in journal (Refereed)
    Abstract [en]

    Objectives The main objective of the present study was to investigate relative personal fit as the association between rated needs and preferences for work hours, on the one hand, and actual work hours, on the other hand, in three groups (hospital, call-center, and police) working with periodic self-rostering. We also examined the association between personal fit and satisfaction with the work schedule and preference for a fixed and regular shift schedule, respectively. Methods We collected questionnaire data and objective work hour data over 6-12 months from the computerized self-rostering system. The response rate of the questionnaire was 69% at the hospital and call-center and 98% among the police. In total, 29 433 shifts for 285 shift workers were included in the study. Data was analyzed by means of mixed ANOVA, Kendal tau correlations and ordinal (proportional odds) logistic regression. Results The results show that evening types worked relatively more hours during the evening and night hours compared to morning types as an indication of relative personal fit. Relative personal fit was also found for long shift, short rest, and morning-, evening- and night-shift frequency, but only personal fit related to morning, evening and night-shift was associated with satisfaction with work hours. Reported conflicts at the workplace about work hours and problems with lack of predictability of time for family/leisure activities, was associated with poor satisfaction and a preference for a fixed shift schedule. Conclusions The present study shows that periodic self-rostering is associated with relative personal fit, in particular with respect to night, evening, and morning work. Personal fit seems to be associated with satisfaction with work hours and may be a moderator of tolerance to shift work exposure.

  • 34. Jansson, Catarina
    et al.
    Alexanderson, Kristina
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Clinically diagnosed insomnia and risk of all-cause and diagnosis-specific sickness absence: a nationwide Swedish prospective cohort study.2013In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 7, p. 712-721Article in journal (Refereed)
    Abstract [en]

    Aims: Insomnia is a large health problem. In some prior studies, positive associations between insomnia symptoms and sickness absence have been observed. There is, however, no previous nationwide cohort study of clinically diagnosed insomnia and risk of incident sickness absence. Methods: Prospective nationwide cohort study based on Swedish population-based registers including all 4,956,358 individuals registered as living in Sweden on 31 December 2004/2005, aged 17-64 years, not on disability pension, old-age pension or on-going sickness absence. Those having insomnia inpatient or outpatient care, defined as having at least one admission/specialist visit with a main or secondary diagnosis of disorders of initiating and maintaining sleep [insomnias] (ICD-10: G47.0) during 2000/2001-2005, were compared to those with no such care. All-cause and diagnosis-specific incident sickness absence were followed during 2006-2010. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression. Results: In models adjusted for prior sickness absence, socio-demographic factors and inpatient and specialized outpatient care, associations between insomnia and increased risks of all-cause sickness absence (IRR 1.18, 95% CI 1.04-1.35) and sickness absence due to mental diagnoses (IRR 1.75, 95% CI 1.36-2.25) were observed. After further adjustment for insomnia medications these associations disappeared. No associations between insomnia and risk of sickness absence due to cancer, circulatory or musculoskeletal diagnoses, or injuries, were observed. Conclusions: In this nationwide cohort study, we observed increased risks of all-cause sickness absence and sickness absence due to mental diagnoses after adjustment for several potential confounders that disappeared after further adjustment for insomnia medications.

  • 35. Kaida, Kosuke
    et al.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Takahashi, Masaya
    Vestergren, Peter
    Gillberg, Mats
    Lowden, Arne
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Portin, Christian
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Performance prediction by sleepiness-related subjective symptoms during 26-hour sleep deprivation2008In: Sleep and Biological Rhythms, Vol. 6, p. 234-241Article in journal (Refereed)
    Abstract [en]

    Performance prediction by sleepiness-related subjective symptoms during 26-hour sleep deprivation

    Sleepiness is a major cause of lower productivity and higher risk of accidents in various work situation. Developing sleepiness monitoring techniques is important to important to improve work efficiency and to reduce accident risk, so that people can take a rest/break in appropriate timing before an accident or a mistake occurs. The aim of the present study are (1) to explain subjective sleepiness using sleep-related symptoms, and (2) to examine which symptoms are useful to predict performance errors. Participants were healthy paid volunteers (six males, six females; mean ± SD, 31.5 ± 10.74 years). Participants took part in 26-h sleep deprivation. During sleep deprivation, they carried out several performance tasks every 3 h and an hourly rating of questionnaires to evaluate subjective symptoms including two types of Karolinska Sleepiness Scale (KSS). The present study confirmed that performance errors can be predicted by subjective symptoms. While mental fatigue was correlated to KSS scores linearly, eye-related subjective symptoms showed quadratic correlation to KSS. By taking into consideration this noteworthy relationskap between subjective symptoms and sleepiness, more accurate introspection of sleepiness and performance errors prediction (detection) may be possible.

  • 36.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Är det farligt att jobba natt?2016In: När ni andra sover / [ed] Ingrid Sjökvist, Södertälje: Liv i Sverige , 2016, p. 134-151Chapter in book (Other academic)
  • 37.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, Netherlands.
    Axelsson, John
    Health consequences of shift work and insufficient sleep2016In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 355, article id i5210Article, review/survey (Refereed)
    Abstract [en]

    This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause accidents and adverse health. Evidence shows that the effect of shift work on sleep mainly concerns acute sleep loss in connection with night shifts and early morning shifts. A link also exists between shift work and accidents, type 2 diabetes (relative risk range 1.09-1.40), weight gain, coronary heart disease (relative risk 1.23), stroke (relative risk 1.05), and cancer (relative risk range 1.01-1.32), although the original studies showed mixed results. The relations of shift work to cardiometabolic diseases and accidents mimic those with insufficient sleep. Laboratory studies indicate that cardiometabolic stress and cognitive impairments are increased by shift work, as well as by sleep loss. Given that the health and safety consequences of shift work and insufficient sleep are very similar, they are likely to share common mechanisms. However, additional research is needed to determine whether insufficient sleep is a causal pathway for the adverse health effects associated with shift work.

  • 38.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    What characterizes good and bad shift schedules?2013Conference paper (Refereed)
  • 39.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Milia, Lee Di
    Axelsson, John
    Lowden, Arne
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    20th International Symposium on Shiftwork and Working Time: Biological Mechanisms, Recovery, and Risk Management in the 24-h Society2012In: Chronobiology International, ISSN 0742-0528, E-ISSN 1525-6073, Vol. 29, no 5, p. 531-536Article in journal (Refereed)
    Abstract [en]

    This dedicated issue of Chronobiology International is devoted to the selected proceedings of the 20th International Symposium on Shift Work and Working Time held in Stockholm, Sweden, 28 June to 1 July 2011. It constitutes the fifth such issue of the journal since 2004 dedicated to the selected proceedings to the meetings of the Working Time Society. The key theme of the 20th Symposium was "Biological Mechanisms, Recovery, and Risk Management in the 24-h Society." The collection of papers of this dedicated issue represents the best of contemporary research on the effects of night and rotating shift schedules on worker health and safety. The contents cover such topics as sleep restriction, injuries, health, and performance of night work and rotating shiftwork, plus light treatment as a countermeasure against the circadian disruption of shiftwork. The majority of the papers are observational field studies, including some of large sample size, and three studies are well-designed laboratory experiments. (Author correspondence: goran.kecklund@stress.su.se ).

  • 40.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Radun, Igor
    Stockholm University.
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ihlström, J
    Anund, A
    Bus drivers’ working hours and their effects on sleep and fatigue2014Conference paper (Other academic)
  • 41.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sallinen, Mikael
    Axelsson, John
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Optimizing Shift Scheduling2016In: Principles and Practice of Sleep Medicine / [ed] Meir H. Kryger, Thomas Roth, William C. Dement, Elsevier, 2016, 6 uppl., p. 742-749Chapter in book (Refereed)
  • 42.
    Kecklund, Göran
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Söderström, Marie
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Att motverka sömnstörning: orsaker och behandling2008In: Preventiv medicin: Teori och praktik, Studentlitteratur, Lund , 2008, p. 115-126Chapter in book (Other academic)
  • 43.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Radboud University, The Netherlands.
    Lindfors, Petra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Change in Work-Time Control and Work-Home Interference Among Swedish Working Men and Women: Findings from the SLOSH Cohort Study2016In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 23, no 6, p. 670-678Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim is to study the influence of change in work-time control (WTC) on work-home interference (WHI) while adjusting for other work-related factors, demographics, changes at work and WHI at baseline among women and men. An additional aim was to explore sex differences in the relation between change in WTC and WHI.

    METHODS: The study included working participants of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study of the third (2010) and fourth (2012) waves (n = 5440). Based on a seven-item index, four groups of WTC were formed: stable high (40 %), stable low (42 %), increasing (9 %), or decreasing (9 %) WTC over the 2 years. WHI was measured by four items and individuals were categorised in whether suffering or not suffering of WHI. Sex-stratified logistic regression analyses with 95 % confidence intervals (CI) were used to estimate the odds of experiencing WHI by change in WTC.

    RESULTS: Controlling for demographics and work-related factors, women with stable low (OR = 1.46; 95 % CI 1.14-1.88) and women and men with decreasing WTC (women OR = 1.99; 95 % CI 1.38-2.85; men OR = 1.80; 95 % CI 1.18-2.73) had higher odds of WHI than those with a stable high WTC. Additionally, adjusting for changes at work and WHI at baseline did not alter the results substantially. Interaction analysis did not reveal any significant sex difference in the relation between WTC and WHI.

    CONCLUSIONS: For both women and men decreased and for women only, low control over working hours resulted in WHI also after adjusting for work-related factors and demographics.

  • 44.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Theorell, Töres
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjörn
    Alexanderson, Kristina
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Inflytande över arbetstiden och sjuknärvaro/sjukfrånvaro2013In: Arbetsmarknad & Arbetsliv, ISSN 1400-9692, no 4, p. 87-99Article in journal (Other academic)
  • 45.
    Leineweber, Constanze
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Change in work-time control and work-home interference among Swedish working men and women2014In: Looking at the past – planning for the future: capitalizing on Occupational Health Psychology / [ed] Nicholas John Artin Andreou et al, Nottingham: EAOHP , 2014Conference paper (Refereed)
  • 46.
    Lekander, Mats
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute.
    Andreasson, Anna Nixon
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ekman, Rolf
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjorn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Axelsson, John
    Subjective health perception in healthy young men changes in response to experimentally restricted sleep and subsequent recovery sleep2013In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 34, p. 43-46Article in journal (Refereed)
    Abstract [en]

    Sleep and subjective health are both prospectively related to objective indices of health and health care use. Here, we tested whether five days with restricted sleep and subsequent recovery days affect subjective health and is related to increased levels of circulating IL-6 and TNF-α and fatigue. Nine healthy men (23-28years) went through a 6-week sleep protocol with subjects as their own controls in a repeated measures design with a total of 11 nights in a sleep laboratory. The experimental part of the protocol included three baseline days (sleep 23-07h), five days with sleep restriction (03-07h) and three recovery days (23-07h) in the sleep laboratory. Subjective health and fatigue was recorded daily. Eight blood samples were drawn each day (every third hour) on 8days of the protocol and analyzed with respect to IL-6 and TNF-α. Subjective health deteriorated gradually during restricted sleep (p=.002) and returned to baseline levels after three days of recovery. IL-6 and TNF-α did not change significantly. Fatigue increased gradually during sleep restriction (p=.001), which significantly contributed to the association between restricted sleep and subjective health. The study is the first to show that subjective health is directly responsive to changes in sleep length and related to increased fatigue. Thus, subjective health is differently appraised after manipulation of one of its presumed determinants. Larger experimental studies would be beneficial to further distinguish causation from association regarding the underpinnings of subjective health.

  • 47.
    Lindfors, Petra
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Falkenberg, Helena
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Sverke, Magnus
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    A meta-review of job demands and job resources as related to various health-related outcomes among women and men with different occupations2017Conference paper (Refereed)
    Abstract [en]

    Purpose: This systematic meta-review uses the job demands-resources (JD-R) model to investigate the associations between various psychosocial factors at work and a range of health-related outcomes. Specifically, this study investigated how job demands and resources are linked to health-related outcomes such as depressive symptoms, cardiovascular disease and musculoskeletal complaints and whether the linkages varied between genders and occupations.

    Design/Methodology: This meta-review focuses on meta-analyses and systematic literature reviews published during the past 10 years. These secondary studies were identified through combined searches in different international databases. Search terms were selected to identify a range of psychosocial factors and to retrieve published journal articles, and systematic reports linking such factors to health-related outcomes.

    Results: In total, 14 job demands and 7 job resources were identified. Lining these to outcomes resulted in the identification of 273 potential associations. Taken together, the findings show what is known from previous research, namely that job demands are related to poorer health. As expected resources typically relate to better health outcomes that are beneficial for organizations and individual employees. Separating findings for women and men suggest that the overall linkages between psychosocial factors and health-related outcomes hold for both women and men. However, less is know regarding occupational variations.

    Limitations: A meta-review restricts specificity and detail.

    Research/Practical Implications: Adds to the systematic knowledge of health-related consequences of psychosocial factors at work, for research as well as practice.

    Originality/Value: The use of a meta-approach that discusses issues relating to gender and occupation.

  • 48.
    Linton, Steven J
    et al.
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Kecklund, Göran
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Franklin, Karl A
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Leissner, Lena C
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Sivertsen, Børge
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Lindberg, Eva
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Svensson, Anna C
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Hansson, Sven O
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Sundin, Örjan
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Hetta, Jerker
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Björkelund, Cecilia
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    Hall, Charlotte
    Swedish Council on Health Technology Assessment, Stockholm, Sweden.
    The effect of the work environment on future sleep disturbances: a systematic review.2015In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, no 23, p. 10-19Article in journal (Refereed)
    Abstract [en]

    Workers often attribute poor sleep to factors at work. Despite the large number of workers with sleep disturbances, there is a lack of consensus on the relationship between the work environment and sleep. The purpose of this systematic review therefore was to conduct a comprehensive evaluation. To this end, we employed standardized methods to systematically locate, review, and tabulate the results of prospective or randomized studies of the impact of work factors on sleep disturbances. From the 7981 articles located in five databases, 24 fulfilled our inclusion criteria and formed the base of the review including meta-analyses of the effect sizes. Results showed that the psychosocial work variables of social support at work, control, and organizational justice were related to fewer sleep disturbances, while high work demands, job strain, bullying, and effort-reward imbalance were related to more future sleep disturbances. Moreover, working a steady shift was associated with disturbances while exiting shift work was associated with less disturbed sleep. We conclude that psychosocial work factors and the scheduling of work have an impact on sleep disturbances and this might be utilized in the clinic as well as for planning work environments. Future research needs to employ better methodology and focus on underlying mechanisms.

  • 49.
    Lowden, Arne
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Åkerstedt, Torbjorn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Daylight exposure in the in-door working population in Sweden, relation to sleep, wakefulness and health2013Conference paper (Refereed)
  • 50. Malmberg, Birgitta
    et al.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Karlson, Björn
    Persson, Roger
    Flisberg, Per
    Orbaek, Palle
    Sleep and recovery in physicians on night call: a longitudinal field study2010In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 10, p. 239-Article in journal (Refereed)
    Abstract [en]

    Background: It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call.

    Methods: Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons.

    Results: Recovery patterns over the days after night call did not differ between groups, but between days. Mean night sleep for all physicians was 3 hours when on call, 7 h both nights post-call and Saturday, and 6 h after daytime work (p < 0.001). Scores for mental fatigue and feeling well rested were poorer post-call, but returned to Sunday morning levels after two nights' sleep.

    Conclusions: Despite considerable sleep loss during work on night call, and unexpectedly short sleep after ordinary day work, the physicians' self-reports indicate full recovery after two nights' sleep. We conclude that these 16-hour night duties were compatible with a short-term recovery in both physician groups, but the limited sleep duration in general still implies a long-term health concern. These results may contribute to the establishment of safe working hours for night-call duty in physicians and other health-care workers.

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