European Heart Journal Advance Access originally published online on July 14, 2009
European Heart Journal 2009 30(21):2606-2613; doi:10.1093/eurheartj/ehp268
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Arrhythmias and increased neuro-endocrine stress response during physicians' night shifts: a randomized cross-over trial
1 Department of Pediatrics, Medical University Innsbruck, A-6020 Innsbruck, Austria
2 Department of Internal Medicine I, Medical Intensive Care Unit, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
3 Department of Internal Medicine III (Cardiology), Medical University Innsbruck, A-6020 Innsbruck, Austria
4 Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, A-6020 Innsbruck, Austria
Received 15 April 2009; accepted 10 June 2009; online publish-ahead-of-print 14 July 2009.
* Corresponding author. Tel.: +43 512 504 24180, Fax: +43 512 504 24199, Email: michael.joannidis{at}i-med.ac.at
See page 2560 for the editorial comment on this article (doi:10.1093/eurheartj/ehp310)
Aims: To evaluate the effects of a 24 h (h) physicians on-call duty (OCD) (‘night shift’) on 24 h electrocardiogram (ECG), heart rate variability, blood pressure (BP), and various biochemical serum and urine ‘stress markers’ compared with a ‘regular’ day at work.
Methods and results: The study was designed as a prospective randomized cross-over trial with each physician completing a 24 h (h) OCD and a 24 h control period including a regular 8 h non-OCD. Thirty healthy physicians with a median age of 33.5 years (range 29.0–45.0) were analysed. Twenty-four hours ECG and BP monitoring were performed and participants were instructed to fill out an event diary and perform a 24 h urine collection. Furthermore, blood was drawn before and after OCD and control day. Twenty-four hours ECG showed a higher rate of ventricular premature beats (VPB) during early morning hours (VPB 0–6 h, 0.5 vs. 0.0, P = 0.047) and increased low-frequency normalized units (29.3 vs. 25.5, P = 0.050) during night shift when compared with respective control night at home. During OCD, BP monitoring revealed a greater diastolic BP throughout 24 h (83.5 vs. 80.2 mmHg, P = 0.025) as well as during night-time (75.4 vs. 73.0, P = 0.028) associated with a higher rate of systolic BP more than 125 mmHg during sleep time. Tumour necrosis factor alpha concentrations increased significantly during night shift (0.76 vs. 0.05 pg/mL, P = 0.045). Urinary noradrenaline excretion was greater during OCD when compared with control day (46.0 vs. 36.0 µg/24 h, P = 0.007).
Conclusion: Our results highlight the association of OCD with an increased risk profile for cardiovascular disease. In addition to the acute effects observed, frequent night-calls over a longer period possibly elicit sustained alterations in cardiovascular homeostasis.
Key Words: Night shift • Cardiovascular disease • Stress response • Arrhythmias • Hypertension
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