Isaac Nuako, Emmanuel Frimpong, Thien Thanh Dang-Vu
Rotating shift work, including night shifts, disrupts circadian rhythms and the sleep-wake cycle, contributing to sleep disturbances, cognitive impairment, and increased medical errors among healthcare workers. We evaluated associations between sleep quality and quantity, rotating shift work characteristics, cognitive function, and work performance among healthcare workers, and to identify moderating factors influencing these relationships in a systematic review. Six databases (PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and PsycINFO) and Google Scholar were searched from inception to April 30, 2026. Eligible experimental or observational studies were published in English and assessed sleep, cognitive functions, or work performance in rotating shift healthcare workers. Risk of bias was assessed using the Newcastle-Ottawa Scale, RoB 2, and ROBINS-I V2 tools. Findings were synthesized narratively. We included 59 studies involving 17,660 participants. Poor sleep quality affected 52% to 90% of rotating night shift healthcare workers and was associated with impaired attention (50% higher at night vs. day), memory (OR = 1.86), medical errors (OR = 1.78-2.1), and slowed reaction time after 6 to 7 consecutive nights (comparable to BAC 0.05%). Counterclockwise and rapidly rotating schedules were associated with 1.3-hour less sleep, 44% greater attentional problems, and 36% to 50% greater work-life interference than clockwise rotation. Limiting shifts to ≤16 hours reduced attentional failures by 50%, while scheduled 30-minute naps reduced sleepiness (d = 0.43) and improved cognition (d = 0.23-0.33). Overall, rotating shift and night work substantially impair sleep, cognition, and occupational functioning among healthcare workers. Clockwise rotation, slower rotation, scheduled naps, and limiting extended shifts may mitigate these impairments. PROSPERO REGISTRATION: CRD420251128550.