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Increased night duty loading of physicians caused elevated blood pressure and sympathetic tones in a dose-dependent manner

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Abstract

Purpose

Night duty has been recognized as a significantly harmful stressor for physicians. However, the relationship between various levels of duty loading and stress response is unknown. This study examined whether duty load increases cardiovascular stress indicators in a dose-dependent manner.

Methods

An unallocated prospective observational study was conducted among physicians performing various levels of duties in a secondary referral medical center between 2011 and 2012. Heart rate variability (HRV), blood pressure (BP), and other stress markers of 12 attending physicians were compared during different duty loads: non-duty day (NDD), duty day with one duty area and three wards (1DD), and duty day with two duty areas and six wards (2DD).

Results

During the regular sleep time (i.e., 11 p.m. to 5 a.m.), the relative sympathetic modulations measured using the HRV were 59.0 ± 9.3, 61.6 ± 10.4, and 64.4 ± 8.9 for NDD, 1DD, and 2DD, respectively (p = 0.0012); those for relative parasympathetic modulations were 37.4 ± 9.4, 34.8 ± 9.8, and 32.0 ± 8.8 for NDD, 1DD, and 2DD, respectively (p = 0.0015). The percentages of abnormal systolic BPs were 9.7 ± 13.2 %, 25.3 ± 21.8 %, and 31.5 ± 21.0 % for NDD, 1DD, and 2DD, respectively (p = 0.003), and the percentages of abnormal diastolic BP were 6.7 ± 11.0 %, 18.3 ± 11.1 %, and 27.1 ± 30.9 % for NDD, 1DD, and 2DD, respectively (p = 0.002). Total sleep time was negatively associated with sympathetic/parasympathetic balance and the percentage of abnormal diastolic BP. Admitting new patients was positively associated with the percentages of abnormal systolic BP.

Conclusions

This observational analysis suggests that the dose-dependent stress responses of the cardiovascular system in physicians were caused by the duty load.

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Acknowledgments

This study is based on data obtained using physicians of internal medicine and an observational method. The interpretation and perspectives contained herein do not represent those of the Bureau of National Health Insurance, Department of Health, or National Health Research Institutes. We thank all the participants, who provided blood samples at six occasions, participated in 24-h BP monitoring, administered a Holter machine to their bodies, and collected 24-h urine samples; furthermore, the participants were not allowed to miss any of the examinations (Source of Funding: Nil).

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Authors and Affiliations

  1. Institution of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan

    Hsiu-Hao Lee, Bing-Yu Chen, Tsun-Jen Cheng, Pau-Chung Chen & Yue-Liang Guo

  2. Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan

    Hsiu-Hao Lee, Shih-Hsiang Lo & Dachen Chu

  3. Department of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Yen-Hung Lin

  4. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan

    Pau-Chung Chen & Yue-Liang Guo

  5. Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan

    Yue-Liang Guo

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  1. Hsiu-Hao Lee
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Correspondence to Yue-Liang Guo.

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Lee, HH., Lo, SH., Chen, BY. et al. Increased night duty loading of physicians caused elevated blood pressure and sympathetic tones in a dose-dependent manner. Int Arch Occup Environ Health 89, 413–423 (2016). https://doi.org/10.1007/s00420-015-1080-8

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  • DOI: https://doi.org/10.1007/s00420-015-1080-8

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