title: No stress after 24-hour on-call shifts?
abstract: OBJECTIVE
  Irregular sleep patterns can adversely affect physiological functions and have been associated with increased physiological and psychological stress. Nocturnal work of physicians during 24-hour on-call shifts (OCS) disrupts the sleep/wake cycle. Chronic exposure to distress has been shown to affect cardiovascular homeostasis and to impair performance in neurocognitive and simulated clinical tasks.
  
  
  METHODS
  In a prospective cohort study, biochemical and physiological stress parameters were assessed in 11 female and 9 male physicians (median age: 32 years, range 26-42 years) before a normal working day and after a 24-hour OCS in internal medicine. In addition, various tests of attentional performance (TAP) were conducted.
  
  
  RESULTS
  The levels of thyroid stimulating hormone (TSH) were significantly higher after a 24- hour OCS, while there were no significant changes in cortisol, epinephrine, and norepinephrine levels. Heart rate variability and skin resistance increased following an OCS, although the differences were not statistically significant. Intrinsic alertness was comparable, while phasic alertness was significantly improved following a 24-hour OCS. Focused attention tended to be better following a night shift. There was no correlation with age or medical working experience; however, men experienced more stress than women.
  
  
  CONCLUSIONS
  Following a 24-hour OCS, (i) TSH may be an early and sensitive biochemical predictor of stress; (ii) other classical biochemical stress parameters do not depict the psychological stress perceived by physicians; (iii) there may be a mismatch between experienced and objective stress levels; (iv) neurocognitive functions are not impaired, while performance may even be improved; and (v) men might be more sensitive to distress.
authors.affiliation: Department of Medicine I, University of Luebeck.
authors.forename: Birgit
authors.initials: B
authors.lastname: Harbeck
authors.forename: Sven
authors.initials: S
authors.lastname: Suefke
authors.forename: Christian S
authors.initials: CS
authors.lastname: Haas
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lehnert
authors.forename: Peter
authors.initials: P
authors.lastname: Kropp
authors.forename: Heiner
authors.initials: H
authors.lastname: Moenig
mesh_terms: D000328:Adult; D001288:Attention / Q000502:physiology; D015415:Biomarkers / Q000097:blood; D002940:Circadian Rhythm; D018592:Cross-Over Studies; D004837:Epinephrine / Q000097:blood; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D009638:Norepinephrine / Q000097:blood; D009784:Occupational Diseases / Q000097:blood / Q000523:psychology*; D011446:Prospective Studies; D012737:Sex Factors; D020178:Sleep Disorders, Circadian Rhythm / Q000097:blood / Q000523:psychology*; D013315:Stress, Psychological / Q000097:blood / Q000523:psychology*; D013972:Thyrotropin / Q000097:blood; D014851:Wakefulness / Q000502:physiology; D014940:Work Schedule Tolerance / Q000502:physiology / Q000523:psychology*
chemical_list: D015415:Biomarkers; D013972:Thyrotropin; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine