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上夜班損害哪些人的身心健康?

Is working at night bad for you?
上夜班損害哪些人的身心健康?

In some jobs, working the night shift is unavoidable. There are hospitals to run, planes to fly and shops to keep open as we move towards a 24-hour society. With careful planning and a bit of peace during the daytime, it is possible to work all night and still get eight hours sleep the follow day. Some people will even tell you they don’t mind and that they get used to working in this way. But can their bodies ever become fully accustomed to working to a clock turned upside down? And, more worryingly, is nocturnal labour bad for your health?

對有些工作而言,上夜班在所難免。隨著人類社會朝著24小時連軸轉的方向發展,這意味著,在夜晚,醫院要正常運轉,航班要正常飛行,商店要照常營業。其實只要安排周密,白天片享片刻安靜,人們可以在徹夜工作后,第二天再補足8小時睡眠。有些人甚至會說,他們不介意夜班,而且也已經適應了這種工作方式了。但是他們的身體真的能完全適應晝夜顛倒的作息時間么?更令人擔憂的是,夜間工作會不會帶來一些對健康不利的影響呢?

There are two elements to these questions. One is about how we feel – our mental wellbeing. People are right to say they get used to shift work. There’s evidence that we cope with subsequent night shifts better than the first of a series, but some people find it much harder than others.

這些問題可以分成兩方面來回答。一方面是人們自身感受如何,也就是心理健康狀況。一些人說自己習慣上夜班,他們這么說是有道理的,因為證據表明,上完一段時間的夜班后,接下來的夜班就比較可以輕松應對,但是另外也有一些人的很難習慣上夜班。
 

A Canadian study monitored the timing of the sleep, the light levels and the quantity of the sleep hormone melatonin produce by a small group of police officers as they embarked on a week of night shifts. Usually we release melatonin late in the evening when we start feeling tired and ready for bed. If you’ve adapted well to working nights, the peak will move to daytime instead. In this study, those whose pattern of melatonin production showed they had made that adjustment felt happier and more alert, as well as showing faster reaction times – but only 40% managed to make the switch.

加拿大的一項科學調查針對一小部分警察進行了研究。在警察連續值一周夜班的期間,研究人員持續對他們的睡眠時間、環境的光強度和體內分泌的睡眠荷爾蒙褪黑素的水平進行了監測。深夜,人們開始感覺疲倦并打算上床睡覺,人體通常會在這時分泌褪黑素。如果一個人已經很適應晚上工作,褪黑素的峰值就會出現在白天。研究中,褪黑素分泌模式已經轉變的警察感覺更開心,值夜班時也更警惕,而且反應時間也更短,不過調查發現只有40%的警察褪黑素的分泌模式發生了轉變。

In a larger study of more than 3,000 police officers working shifts in Canada and the US, the consequences for those who were unable to adjust were clear, with 40% diagnosed with some kind of sleep disorder.

另外一項規模更大的研究涵蓋了加拿大和美國的3,000多名夜班警察,對于無法適應夜班的警察來說,后果很明確,他們中有40%確診出現了某種睡眠紊亂癥狀。

Even if you do feel OK, there’s also the question of whether your body could be suffering in the long-term. When it comes to assessing the physiological effects, one of the problems is differentiating between the impact that shift work might have on your lifestyle from the direct impact of working during the night. It is harder to eat healthily or to exercise regularly if you’re working shifts. Not only is a salad harder to obtain during the night, but it’s probably not what you feel like when you’re trying to keep yourself awake. This tempts people towards snacks and takeaways. Pizza and curry may be convenient and make you feel better, but of course eating them every night isn’t very healthy. There’s also less opportunity for exercise. While you might manage to drag yourself to the gym at the end of a day’s work, it’s that much harder to do that at the end of your shift if you’re already been up all night and are yearning for a nap.

即便你的心理感覺狀況良好,但是長時間的夜班生活會不會對你的身體造成傷害也是一個問題。研究熬夜對人體生理造成的影響時,科學家面臨一些難題,其中之一就是,如何區分夜班導致生活方式改變而產生的間接影響,和夜間工作產生的直接影響。上夜班的人更難保持飲食健康和規律運動。這不僅是因為大半夜色拉不好找,而且當一個人想努力保持清醒的時候,恐怕也不太想吃色拉。這讓人們在晚上更愿意吃快餐和外賣。匹薩和咖喱吃起來方便,而且吃完也能讓人感覺更開心,不過每天晚上都吃這個肯定不怎么利于健康。上夜班也會導致運動機會減少。忙活了一個白天之后,你也許還能逼自己去健身房運動一下,但若是你已經熬了一個通宵,下班之后哈欠連天,再去健身房練練就要難多了。

Airline pilots were found to be happier on the days they were resting compared with those where they worked early or late shifts. Of course it’s not unusual to prefer your day off to the days you have to get up and go to work, regardless of the time. But the researchers also found that when the pilots worked the early shift they had higher levels of the stress hormone cortisol on waking and produced more cortisol throughout the day. In the long-term, high levels are thought to be associated with an increased the risk of heart problems and high blood pressure.

研究發現,與早班或晚班飛行任務相比,航空公司的飛行員在休息日的時候心情更好。不論是飛早班或飛晚班,一般人肯定更喜歡休息而不是從床上爬起來去工作。但是,研究人員同時發現,飛早班的飛行員醒來時體內的壓力激素皮質醇水平更高,而且一整天都會分泌更多皮質醇。人們認為,長期皮質醇水平偏高可能導致患心臟疾病和高血壓的風險提高。

There could be other consequences too. One study found that a single overnight shift is enough to increase your blood pressure.

不良后果不止于此。一項研究表明,上一個夜班就足以讓人血壓升高。 

Add to this research from the University of Surrey published earlier this year: it demonstrated that after just three days of night shifts, the expression of genes was disrupted, meaning that they began to be active at the wrong time of day. Around 6% of our genes are set to work at specific times, but after just a few days keeping strange hours this pattern was easily disturbed. And a different study found that, after five weeks, people who stayed awake at night and slept during the day showed impaired glucose regulation and changes in metabolism which could increase the risk of type 2 diabetes and obesity in the long-term.

此外,今年早些時候,薩里大學(University of Surrey)發表了一項研究,結果表明,上三個夜班之后,人體的基因表達會出現紊亂,也就是說,基因開始在錯誤的時間被激活。人體約6%的基因會在特定的時間被激活,但是經過幾天的顛倒作息,這種模式很容易就被打亂了。另一項研究發現,經歷5周晝伏夜出的作息后,人體血糖調節能力受損,人體新陳代謝也發生了變化,長期來看,這會導致II型糖尿病和肥胖癥風險上升。

Of course these studies were all short-term, raising the possibility that perhaps our bodies adjust in the long-term, but results of epidemiological studies conducted over many years are on the whole discouraging. There has been some debate about the impact of shift work on the risk of cardiovascular disease, with many studies finding it raises the risk and a few finding it doesn’t. But the largest synthesis of the research to date, published in 2012, did show an increased risk of heart attacks in people working shifts. Even when lifestyle was controlled for, people doing shifts were still put at higher risk.

當然,這些都是短期研究,時間拉長之后人體可能會出現相應的調節機制,但是多年的流行病學研究結果總體上并不支持這種觀點。關于輪班制工作對心血管疾病風險的影響,學界有諸多爭論。許多研究結果發現上夜班會增加患病風險,而少數研究則發現不增加患病風險。但是發表于2012年的至今最長的一篇綜述表明,輪班制工作的人群患心臟病的風險較高。即便將生活方式加以控制,倒班人群仍舊有較高的患病風險。

But when it comes to metabolic syndrome – an umbrella term including obesity, raised glucose levels, increased blood pressure, and high cholesterol levels – it was lifestyle that seemed to be key. If people worked night shifts, but succeeded in exercising regularly, eating healthily and not smoking, there was less evidence of an increased risk, despite their unsocial hours.

代謝綜合征是對肥胖、高血糖、高血壓、高膽固醇等疾病的總稱。對于代謝綜合征來說,生活方式反而似乎是最重要的風險因素。如果上夜班的人能夠保證規律運動、飲食健康和遠離香煙,盡管工作時間不正常,但患代謝綜合征的風險提高并不明顯。

There’s also evidence of increased risk of breast cancer in those who work night shifts, with a greater impact in those who are ‘larks’, who spring out of bed early in the morning, but find it hard to stay up late at night.

上夜班的人也有較高的患乳腺癌風險,尤其對于習慣早睡早起的人來說,上夜班所產生的影響更大。

What these large scale epidemiological studies can’t tell us is which individuals are most likely to be affected. Is it the case that as with the short-term studies, some people adapt and that those people won’t suffer long-term effects? Or are there risks for everyone working shifts?

但是這些大規模的流行病學研究無法告訴人們,哪類人更容易受夜班影響。是不是就像短期研究顯示的那樣,有些人的生理能夠適應,而那些生理上無法調整的人就會受到長期影響?還是說所有上夜班的人都會面臨風險?

Research is complicated by the many forms of shift work people undertake. Working late every so often is likely to have different effects on the body from having the clock turned upside down by working several overnight shifts a week.

人們的夜間工作形式多樣,提高了相關研究的難度。與一周只有幾天晝夜顛倒地上夜班相比,頻繁的夜班工作可能會對人體產生不同的影響。

Still, until we know more about exactly who is at risk, those who work at night would be wise to take every opportunity they can to eat healthily, to exercise and to look out for early signs of these diseases.

不過,在人們能準確地知道什么樣的人上夜班有損健康之前,從事夜間工作的人應該盡量保證飲食健康、規律運動,并且留意有沒有出現這些疾病的早期癥狀。
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