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. 2019 Mar 15;9:4635. doi: 10.1038/s41598-019-40914-x

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Alertness and performance of intensive care workers relative to aMT6s acrophase on a day (left), first (middle) and final (3^rd–5^th) night shift (right) shown by the (a) Karolinska Sleepiness Scale, (b) PVT mean reaction time, (c) number of PVT lapses. Zero on the x-axis indicates time of acrophase, positive values represent tests before acrophase (day shift: 0–6 h, 6–12 h, 12–18 h; night shift: −12 to −5 h, −5–0 h, 0–5 h) Grey curves represent aMT6s rhythms averaged for all individuals. Striped horizontal bars represent the average main sleep prior to the start of a shift. Right panel (d) presents combined graphs of the changes in KSS, PVT mean reaction time and PVT lapses across the day, first and final night shift.