Rapid changes in overnight blood pressure after transitioning to early-morning shiftwork.
Rapid changes in overnight blood pressure after transitioning to early-morning shiftwork.
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DOI：
10.1093/sleep/zsab203
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发表时间：
2021-08
期刊：
影响因子：
5.6
通讯作者：
A. McHill;J. Velasco;Todd E Bodner;S. Shea;R. Olson
中科院分区：
文献类型：
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作者：
A. McHill;J. Velasco;Todd E Bodner;S. Shea;R. Olson
当血压在夜间不下降时（“非下降”，比白天血压下降<10%），不良心血管事件的风险增加。轮班改变了行为和内源性昼夜节律之间的关系（即，昼夜节律紊乱沿着可变的睡眠时间），慢性轮班工作增加了心血管疾病的风险。为了确定转变为轮班工作是否会改变夜间血压下降模式，我们利用了一项自然实验，该实验是在新雇用的公交车运营商从白天的培训时间表转变为清晨的轮班工作或日工时间表时进行的。20名参与者在新工作后接受了为期90天的研究，并接受了心脏代谢健康评估，包括动态血压监测和每周睡眠-觉醒日记。在过渡到一天或清晨轮班时间表后约30天和90天后重复测量。新雇用的轮班工人显示出夜间血压的巨大变化，62%的人从健康的下降血压转换为非下降模式，导致93%的轮班工人在90天内显示出非下降表型。相比之下，50%的日工在基线时具有非浸渍特征，并且在90天时下降至0%，与轮班工人存在显著差异（p=0.001）。在90天时，轮班工人的夜间血压下降比日工低约7%（-6.3% [95%CI -3.7至-8.8%] vs -13.1% [-10.3至-15.9%]：p<0.01），下降的变化与睡眠时间变异性的变化相关（r 2=0.28，p=0.03）。在新雇佣的清晨轮班工人中观察到的夜间血压下降的变化与睡眠时间变异性有关，这可能是轮班工人心血管风险增加的早期预警信号。
Risk for adverse cardiovascular events increases when blood pressure does not decrease at night ("non-dipping", <10% decrease from daytime blood pressure). Shiftwork alters relationships between behaviors and endogenous circadian rhythms (i.e., circadian disruption along with variable sleep timing), and chronic shiftwork increases cardiovascular disease risk. To determine whether transitioning into shiftwork changes the overnight blood pressure dipping pattern, we leveraged a natural experiment that occurs when newly-hired bus operators transition from a daytime training schedule into an early-morning shiftwork or daywork schedule. Twenty participants were studied in a 90-day protocol upon new employment and underwent cardio-metabolic health assessments, including ambulatory blood pressure monitoring, and weekly sleep-wake diaries. Measurements were repeated after ~30 and 90 days after transitioning to a day or an early-morning shiftwork schedule. Newly-hired shiftworkers displayed dramatic changes in overnight blood pressure, with 62% converting from a healthy dipping blood pressure to the non-dipping pattern, resulting in 93% of shiftworkers displaying a non-dipping phenotype at 90-days. In contrast, 50% of dayworkers had a non-dipping profile at baseline and this decreased to 0% at 90-days, a significant difference from shiftworkers (p=0.001). At 90-days, overnight blood pressure dipping was ~7% less in shiftworkers than dayworkers (-6.3% [95%CI -3.7 to -8.8%] vs -13.1% [-10.3 to -15.9%]: p<0.01), with changes in dipping associated with changes in sleep timing variability (r 2=0.28, p=0.03). The observed changes in overnight blood pressure dipping in newly-hired early-morning shiftworkers, which were associated with sleep timing variability, may be an early warning sign of increased cardiovascular risk among shiftworkers.