Sleep check before shift work: The effectiveness of a sleep education, screening, and management approach to prevent road trauma in Australia’s young adults.

The purpose of this study is to determine if sleep disorder education combined with an in-laboratory shift work simulation experience will improve help seeking for sleep problems in young Australians before they are required to work regular shift work in the healthcare industry. Participants who screen positive for a sleep disorder will be randomised to one of three study arms including 1) sleep education only arm, 2) sleep education + simulated night shift arm or 3) sleep education + simulated night shift + personalised performance feedback. In all three of the study arms participants will be invited to the Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health sleep laboratory to perform an overnight level one diagnostic sleep study in line with best clinical practice. Clinical interviews will be conducted by a sleep physician and/or sleep psychologist as required to confirm sleep diagnoses. The same education module (~15min) will be provided to all 3 arms prior to their overnight laboratory stay. The sleep study will commence at the participant's habitual bedtime derived from sleep diary reports during the baseline sleep monitoring period. The extended wakefulness protocol will commence 9hrs after each participant's lights off time on the sleep study night. Following the in-laboratory sleep study, participants in arms 2 and 3 will undergo their respective shift work simulation protocols (intervention) while participants in arm one, who represent the control arm, will not undertake further laboratory testing. They will be informed of their sleep disorder diagnosis, and recommended to seek appropriate health care (see 'Diagnostic Appointments' below). Adherence to the shift work simulation (extended wakefulness) will be monitored by research technician staff on shift. The extended wakefulness period will include repeated cognitive testing batteries assessing cognitive capabilities and reaction time. Circadian rhythms from melatonin and core body temperature will also be monitored. The extended wakefulness period will include simulated driving tests to monitor driving performance across the extended wake period. Immediately post completion of the simulated shift work arm, study participants in Arms 2 & 3 will undertake a second sleep study as a recovery sleep in the sleep laboratory before leaving the laboratory. Intervention arms Intervention arm 2 Immediately after the overnight sleep study, participants in arm 2 of the study will undertake a ~30-hour period of extended wakefulness to simulate shift work. Participants will undergo a range of tasks to assess their cognitive performance and mood at unpredictable times throughout the extended wakefulness period. Tasks will include driving in a simulator, reaction time tasks and eye movement assessments using a virtual reality headset. Physiological information on core body temperature using e-Celcius BodyCaps will be collected to assess circadian phase throughout the laboratory stay. Intervention arm 3 The third intervention arm will follow the same procedures as arm 2 with the addition of tailored driving and cognitive performance feedback for each participant. Specifically, an independent feedback session on performance and road risk and safety indicators measured during the simulated shift will be provided to participants. Feedback will be provided by key research personnel (PhD candidates, Research Associate or Investigators) and will be standardised to report their level of impairment during their shift simulation, with metrics such as percentage of road incidents and average lane deviation on simulated driving tasks, and performance on test batteries. This will be reported for each individual relative to their own performance when not sleep deprived. This feedback will be provided during a 30-60 minute individual consultation between the participant and researcher(s). Diagnostic appointments After completion of either the overnight sleep study (Arm 1) or the laboratory component with recovery sleep (arms 2 and 3), participants from all study arms will have a scheduled sleep disorder diagnostic appointment booked with a sleep physician and/or sleep psychologist at the Flinders Health and Medical Research Institute sleep clinic. During the appointments, clinicians will provide participants with information about how to access gold standard evidence-based treatment options for potential sleep disorders including sleep apnea, cognitive behavioural therapy for insomnia (CBTi) or related behavioural sleep difficulties or pharmacological management for other sleep disorders as appropriate to the individual. Participants will be offered gap-free treatment if a subsequent referral is via the Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health sleep clinic. There will be no obligation for participants to engage in these sleep health services, should they prefer an alternative health professional. Participants will be followed up monthly by text, call and/or email to determine the date of any subsequent appointment(s) with a health professional for sleep. Participants will have a follow-up interview and complete questionnaires relating to their sleep quality, mental health, driving behaviours and reporting of any road incidents at 3, 6,9 and 12 months after their diagnostic appointment.