{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:42:36Z","timestamp":1790095356774,"version":"4.0.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the predictive, moderating, and combined effects of circadian rhythm types and shift work demands on sleep quality and depressive symptoms among shift-working nurses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross-sectional study was conducted between May 1, 2024, and May 31, 2025. Shift-working nurses were recruited using convenience sampling at a tertiary hospital in Guangxi, China. Circadian rhythm types, sleep quality and depressive symptoms were assessed using the Circadian Type Inventory [CTI; including flexibility\u2013rigidity (FR) and languidness\u2013vigorousness (LV)], the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9). Objective data on shift work demands over a four-week period were extracted from the hospital nursing management system, including number of night shifts, total shift hours, and shift workload exposure. Generalized linear modeling (GLM), nonlinear curve fitting, and Monte Carlo simulation were used for data analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 288 shift nurses were included. The GLMs showed that depressive symptoms (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.245), languidness (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.065), shift work hours (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.093), and body mass index (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f\u22120.056) were significant predictors of poorer sleep quality. Poorer sleep quality (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.314), flexibility (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f\u22120.129), languidness (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.159), and the interaction between sleep quality and flexibility (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.091), between languidness and shift work hours (<jats:italic>\u03b2<\/jats:italic>\u202f=\u202f0.069) significantly predicted depressive symptoms. Nonlinear analysis identified a potential threshold effect, with more than 24 shift work hours in 4\u202fweeks linked to poorer sleep quality. Dynamic simulations demonstrated that the combined effects of circadian rhythm types and shift work demands corresponded to distinct dose\u2013response patterns in sleep quality and depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Circadian rhythm types and shift work demands jointly shape sleep quality and depressive symptoms in shift nurses, with distinct dose\u2013response patterns. These findings highlight the importance of circadian-informed shift scheduling to improve sleep and mental health among shift nurses.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1667778","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T05:31:01Z","timestamp":1758605461000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Circadian rhythm types and shift work demands shape sleep quality and depressive symptoms in shift-working nurses"],"prefix":"10.3389","volume":"13","author":[{"given":"Huihan","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuxia","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiqiao","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feihong","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijuan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoquan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"key":"ref1","year":"2021"},{"key":"ref2","year":"2023"},{"key":"ref3","author":"Berg","year":"2019"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/07487304211064218","article-title":"Disturbance of the circadian system in shift work and its health impact","volume":"37","author":"Boivin","year":"2022","journal-title":"J Biol Rhythm"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2486\/indhealth.SW-1","article-title":"Working time society consensus statements: evidence-based effects of shift work on physical and mental health","volume":"57","author":"Moreno","year":"2019","journal-title":"Ind Health"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1093\/occmed\/kqz063","article-title":"Systematic review of shift work and nurses' health","volume":"69","author":"Rosa","year":"2019","journal-title":"Occup Med (Lond)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"104395","DOI":"10.1016\/j.ijnurstu.2022.104395","article-title":"Shift work organization on nurse injuries: a scoping review","volume":"138","author":"Imes","year":"2023","journal-title":"Int J Nurs Stud"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e22068","DOI":"10.1097\/MD.0000000000022068","article-title":"The fMRI study for acupuncture on shift work sleep disorder: study protocol for a randomized controlled neuroimaging trial","volume":"99","author":"Ning","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ijnurstu.2019.04.013","article-title":"The impact of rotating work schedules, chronotype, and restless legs syndrome\/Willis-Ekbom disease on sleep quality among female hospital nurses and midwives: a cross-sectional survey","volume":"95","author":"Uekata","year":"2019","journal-title":"Int J Nurs Stud"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"926988","DOI":"10.3389\/fpubh.2022.926988","article-title":"Effects of factors related to shift work on depression and anxiety in nurses","volume":"10","author":"Li","year":"2022","journal-title":"Front Public Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"115076","DOI":"10.1016\/j.psychres.2023.115076","article-title":"Shift work schedule and sleep patterns in relation to incident depression: evidence from a prospective cohort study","volume":"321","author":"Liu","year":"2023","journal-title":"Psychiatry Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e12997","DOI":"10.1111\/inr.12997","article-title":"Physical activity patterns, sleep quality, and stress levels among rotating-shift nurses during the COVID-19 pandemic","volume":"72","author":"Chiang","year":"2025","journal-title":"Int Nurs Rev"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.1080\/07420528.2019.1681441","article-title":"Differences in workday sleep fragmentation, rest-activity cycle, sleep quality, and activity level among nurses working different shifts","volume":"36","author":"Chang","year":"2019","journal-title":"Chronobiol Int"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"4507","DOI":"10.26355\/eurrev_201905_17963","article-title":"Can nurses' shift work jeopardize the patient safety? 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