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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    • "Relationships among these entraining signals are complicated because lesions of SCN do not diminish the sensitivity of animals to food availability mediated by separate food entrainable oscillators (FEO) located in the dorsomedial (Gooley et al. 2006; Mieda et al. 2006) or ventromedial (Krieger et al. 1977) nucleus of the hypothalamus. Shift work, night work and jet lag are important elements in modern human life, but they can disturb circadian oscillations and have negative health consequences (Puttonen et al. 2010). Epidemiological and clinical studies provide inconclusive results about the negative effects of shift work on cardiovascular diseases (Frost et al. 2009; Wang et al. 2011) and cannot reveal any causal relationship. "

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    • "Shift work is associated with impaired health. For example, it has been shown that working shifts increase the risk of sleep disturbances, gastrointestinal and cardiovascular complaints and possibly also cancer (Akerstedt, 2003; Knutsson & Boggild, 2010; Megdal et al., 2005; Puttonen et al., 2010). Sleep disturbances are considered to be the most common problem, especially in rotational shift work and in night work (Akerstedt, 1998, 2003). "
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    ABSTRACT: The aim of this study was to investigate whether different shift work schedules were associated with nonrapid eye movement (NREM)- and/or REM-related parasomnias. A total of 2198 nurses with different work schedules participated in a longitudinal cohort study. The parasomnia questions were included in the fourth wave of the data collection, with a response rate of 74.1%. Logistic regression analyses with the different parasomnias as dependent variables were conducted. Nurses working two shift (day and evening) and nurses working three shift (day, evening and night) rotational schedules had increased risk of confusional arousal, a NREM-related parasomnia, compared to nurses working daytime only (odds ratios = 2.10 and 1.71, respectively). Similarly, nurses working two and three shift rotational schedules had increased risk of nightmares, a REM-related parasomnia (odds ratios = 1.64 and 1.57, respectively). The other parasomnias were not significantly associated with work schedule. Working night shifts only was not associated with any of the parasomnias. In conclusion, confusional arousal and nightmares were more commonly reported by nurses working rotational shift work schedules compared to nurses working daytime only. This is likely related to the circadian rhythm misalignment and sleep deprivation caused by such shift schedules.
    Chronobiology International 11/2015; DOI:10.3109/07420528.2015.1091354 · 3.34 Impact Factor
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    ABSTRACT: Purpose: The purpose of this review is to summarize the current knowledge from field studies on how many consecutive night shifts are required for adaptation of diurnal rhythms in cortisol, melatonin and heart rate variability (HRV) to night work. Methods: A systematic search of the databases PubMed and Web of Science resulted in 18 studies selected for review. Results: Cortisol was measured in five studies, melatonin in 11 studies and HRV in four studies. Diurnal rhythms were assessed by use of several different measures based on three to eight samples per day for cortisol and melatonin and 24-h recordings for HRV. Most of the studies in the review were small studies with less than 30 participants, and most studies evaluated diurnal rhythms after only two consecutive night shifts whereas only six studies used seven or more consecutive night shifts. The majority of studies found that adaptation to night work had not occurred after two consecutive night shifts, whereas a small number found evidence for full adaptation after seven consecutive night shifts based on diurnal rhythms in cortisol and melatonin. Conclusion: There are methodological differences in the field studies analyzing diurnal rhythms and large diversity in the occupational fields studied. Nevertheless, we conclude that diurnal rhythms in cortisol, melatonin and HRV are not adapted to night work after 1-3 consecutive night shifts. Studies are needed to establish how many consecutive night shifts are needed for full adaptation of diurnal rhythms to night work.
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