Puttonen S, Härmä M, Hublin C. Shift work and cardiovascular disease: pathways from circadian stress to morbidity

Centre of Expertise on Human Factors at Work, Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland.
Scandinavian Journal of Work, Environment & Health (Impact Factor: 3.45). 03/2010; 36(2):96-108. DOI: 10.2307/40967836
Source: PubMed


In order to establish a causal relation between shift work and cardiovascular disease (CVD), we need to verify the pathways from the former to the latter. This paper aims to review the current knowledge of the mechanisms between shift work and CVD. Shift work can increase the risk of CVD by several interrelated psychosocial, behavioral, and physiological mechanisms. The psychosocial mechanisms relate to difficulties in controlling working hours, decreased work-life balance, and poor recovery following work. The most probable behavioral changes are weight gain and smoking. The plausible physiological and biological mechanisms are related to the activation of the autonomic nervous system, inflammation, changed lipid and glucose metabolism, and related changes in the risk for atherosclerosis, metabolic syndrome, and type II diabetes. The data provide evidence for possible disease mechanisms between shift work and CVD, but compelling evidence on any specific mechanism is missing.

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Available from: Sampsa Puttonen, Oct 04, 2015
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    • "Shift work is a key feature of our contemporary 24/7 society, employing several successive work teams to sustain round-the-clock operations (Tucker & Folkard, 2012). However, numerous studies present results that imply, if not indicate, that the long-term experience of frequently shifting the periods of sleep and wakefulness poses a serious threat to the shift worker's physical, mental and psychosocial health (Knutsson, 2003; Matheson et al., 2014; Morris et al., 2012; Puttonen et al., 2010; Rajaratnam et al., 2013; Wang et al., 2011). One of the major issues related to the adverse consequences of shift work concerns the impact of inter-individual differences. "
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    ABSTRACT: Cortisol acts as a critical biological intermediary through which chronic stressors like shift work impact upon multiple physiological, neuro-endocrine and hormonal functions. Therefore, the cortisol awakening response (CAR) is suggested as a prime index of shift work tolerance. Repeated assessments of the CAR (calculated as MnInc) in a group of 25 young novice police officers showed that in the interval between about 4 and 14 months after transitioning from regular day work to rotating shift work, mean values began to rise from baseline to significantly higher levels at about 14 months after they commenced shift work. Visual inspection of the individual trends revealed that a subgroup of 10 subjects followed a monotonically rising trend, whereas another 14 subjects, after an initial rise from about 4-14 months, reverted to a smaller, baseline level cortisol response at about 20 months after the start of shift work. If the initial increase in the cortisol response marks the development of a chronic stress response, the subsequent reversal to baseline levels in the subgroup of 14 participants might be indicative of a process of recovery, possibly the development of shift work tolerance.
    Chronobiology International 08/2015; DOI:10.3109/07420528.2015.1064130 · 3.34 Impact Factor
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    • "Shift work can be burdening to workers due to disturbances of biological and social circadian rhythms, i.e. interference with the day/night rhythm. The adverse effects of shift work are well documented and comprise, amongst others, an increased risk of developing cardiovascular disease, gastrointestinal disease and metabolic syndrome (Knutsson 2003; Puttonen, Härmä, and Hublin 2010; Knutsson and Bøggild 2010; Wang et al. 2011). The most reported problem by shift workers is disturbed sleep (A ˚ kerstedt and Wright 2009). "
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    ABSTRACT: This study examined associations of chronotype and age with shift-specific assessments of main sleep duration, sleep quality and need for recovery in a cross-sectional study among N = 261 industrial shift workers (96.6% male). Logistic regression analyses were used, adjusted for gender, lifestyle, health, nap behaviour, season of assessment and shift schedule. Shift workers with latest versus earliest chronotype reported a shorter sleep duration (OR 11.68, 95% CI 3.31-41.17) and more awakenings complaints (OR 4.84, 95% CI 4.45-11.92) during morning shift periods. No associations were found between chronotype, sleep and need for recovery during evening and night shift periods. For age, no associations were found with any of the shift-specific outcome measures. The results stress the importance of including the concept of chronotype in shift work research and scheduling beyond the concept of age. Longitudinal research using shift-specific assessments of sleep and need for recovery are needed to confirm these results. Practitioner Summary: Chronotype seems to better explain individual differences in sleep than age. In view of ageing societies, it might therefore be worthwhile to further examine the application of chronotype for individualised shift work schedules to facilitate healthy and sustainable employment.
    Ergonomics 08/2015; DOI:10.1080/00140139.2015.1058426 · 1.56 Impact Factor
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    • "Shift work and jet lag induce acute sleep deprivation and chronic sleep restriction, which is associated with deteriorated neurobehavioral performance3552. Furthermore, a misalignment between endogenous circadian rhythms and sleep–wake cycles known as internal desynchronization is thought to cause sleep shortage and circadian rhythm disturbance, leading to elevated risks for autonomic disorders, cardiovascular diseases, metabolic diseases, and mood disorders535455. Therefore, predicting sleep and circadian phenotypes may help develop interventions to improve quality of life and potentially prevent various diseases. "
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    ABSTRACT: A system of self-sustained biological clocks controls the 24-h rhythms of behavioral and physiological processes such as the sleep–wake cycle. The circadian clock system is regulated by transcriptional and translational negative feedback loops of multiple clock genes. Polymorphisms in circadian clock genes have been associated with morningness–eveningness (diurnal) preference, familial advanced sleep phase type (ASPT), and delayed sleep phase type (DSPT). We genotyped single-nucleotide polymorphisms in circadian clock genes in 182 DSPT individuals, 67 free-running type (FRT) individuals, and 925 controls. The clock gene polymorphisms were tested for associations with diurnal preference and circadian rhythm sleep disorder (CRSD) phenotypes. The PER3 polymorphism (rs228697) was significantly associated with diurnal preference and the FRT phenotype. The minor allele of rs228697 was more prevalent in evening types than in morning types (sex-adjusted odds ratio (OR), 2.483, Bonferroni-corrected P = 0.012) and in FRT individuals compared with the controls (age- and sex-adjusted OR, 2.021, permutated P = 0.017). Our findings support the notion that PER3 polymorphisms could be a potential genetic marker for an individual's circadian and sleep phenotypes.
    Scientific Reports 09/2014; 4:6309. DOI:10.1038/srep06309 · 5.58 Impact Factor
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