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Int Arch Occup Environ Health. 2016 Apr;89(3):413-23. doi: 10.1007/s00420-015-1080-8. Epub 2015 Aug 1.

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

Author information

1
Institution of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
2
Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan.
3
Department of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
4
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
5
Institution of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan. leonguo@ntu.edu.tw.
6
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan. leonguo@ntu.edu.tw.
7
Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, 1, Sec. 1, Jen-Ai Road, Taipei, 100, Taiwan. leonguo@ntu.edu.tw.

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.

KEYWORDS:

Cardiovascular disease; Duty loading; Physician; Stress response

PMID:
26231250
DOI:
10.1007/s00420-015-1080-8
[Indexed for MEDLINE]

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