Night shift work and blood pressure: focusing on exposure doses

Silva-Costa, Aline; Braz, Bruna Pereira; Griep, Rosane Härter; Rotenberg, Lúcia

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Revista Brasileira de Saúde Ocupacional

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Research article • Rev. bras. saúde ocup. 46 • 2021 • https://doi.org/10.1590/2317-6369000023319 copy

Night shift work and blood pressure: focusing on exposure doses

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to determine whether levels of night work exposure (current dose; accumulated dose) are associated with hypertension (HBP), systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Methods:

cross-sectional study of 893 nursing personnel. We collected data on sociodemographic, work-related and health behaviour factors and measured blood pressure using a digital monitor.

Results:

after adjusting for sociodemographic variables, working >4 nights per fortnight was associated with increased SBP (4.0 mmHg; 95% CI: 1.01; 6.97) and DBP (2.3 mmHg; 95% CI: 0.24; 4.35). Working more than four nights per fortnight was associated to hypertension (OR 1.57; 95% CI 1.01; 2.43). Individuals who worked at night for >9 years displayed, on average, higher blood pressure levels (SBP of 3.7 mmHg [95% CI: 1.49; 5.92] and DBP of 2.0mmHg [95% CI: 0.46; 3.52]), compared to those who worked at night for ≤9 years.

Conclusion:

these findings suggest that effects of night work begin after a certain exposure dose, i.e, after 9 years of night work or when exposed to night work for more than 4 nights per fortnight.

Keywords:
shift work; hypertension; blood pressure; nursing; occupational health

	*Current doses of night work (nights/fortnight)*
	*2 - 4 nights (n=410)*		*>4 nights (n=142)*		p
	n	%	n	%	p
Sex
Female	343	83,7	106	74,6	0,018
Male	67	16,3	36	25,4	0,018
Age
≤40 years	204	49,8	78	54,9	0,288
>40 years	206	50,2	64	45,1	0,288
Race/Ethnicity*
White	160	39,5	51	35,9	0,449
Black/Brown/Yellow (Asian)	245	60,5	91	64,1	0,449
Schooling
Upper secondary	128	31,2	49	34,5	0,469
University	282	68,8	93	65,5	0,469
Marital status
Married	247	60,2	79	55,6	0,192
Separated	56	13,7	14	9,9
Widowed	10	2,4	3	2,1
Single	97	23,7	46	32,4
Professional category
Nurse	140	34,1	38	26,8	0,105
Nursing technician/assistant	270	65,9	104	73,2	0,105
Physical activity
None	252	61,5	90	63,4	0,600
<150 min/week	60	14,6	16	11,3
≥150 min/week	98	23,9	36	25,3
Smoking
Non-smoker	314	76,6	106	74,6	0,895
Former smoker	54	13,2	20	14,1	0,895
Current smoker	42	10,2	16	11,3
Alcohol consumption*
Never	208	50,9	68	47,9	0,542
Moderate	183	44,9	63	44,4
High	17	4,2	11	7,7
Insomnia complaints
No	298	72,7	96	67,6	0,249
Yes	112	27,3	46	32,4	0,249
Hypertension
No	277	67,6	86	60,6	0,130
Yes	133	32,4	56	39,4
Prescribed antihypertensive drugs
No	301	73,4	107	74,4	0,650
Yes	109	26,6	35	24,6
	Median; IQR
Per capita income (minimum wages)^#	3,0; 1,9 - 4,0		3,0; 1,8 - 4,0		0,760
Accumulated dose of night work (yrs)^#	10,0; 5,0 - 18,0		8,0; 6,0 - 15,0		0,456
Body Mass Index (kg/m²)^#	26,6; 23,9 - 31,3		27,6; 24,6 - 31,3		0,130
Systolic blood pressure (mmHg)^#	117,3; 107,3 - 128,2		120,2; 112,7 - 131,0		0,016
Diastolic blood pressure (mmHg)^#	75,5; 75,0 - 82,7		76,5; 76,5 - 83,8		0,050

	*Accumulated dose of night work*
	*1 - 9 years (n=504)*		*>9 years (n=389)*		p
	n	%	n	%	p
Sex
Female	445	88,3	305	78,4	< 0,001
Male	59	11,7	84	21,6
Age
≤40 years	306	60,7	92	23,7	< 0,001
>40 years	198	39,3	297	76,3
Race/Ethnicity*
White	197	39,3	145	37,7	0,615
Black/Brown/Yellow (Asian)	304	60,7	240	62,3
Schooling
Upper secondary	148	29,4	155	39,8
University	356	70,6	234	60,2	0,001
Marital status
Married	304	60,3	216	55,5	0,020
Separated	59	11,7	70	18,1
Widowed	9	1,8	13	3,3
Single	132	26,2	90	23,1
Professional category
Nurse	190	37,7	127	32,6	0,118
Nursing technician/assistant	314	62,3	262	67,4
Physical activity
None	293	58,1	252	64,8	0,059
<150 min/week	72	14,3	56	14,4
≥150 min/week	139	27,6	81	20,8
Smoking
Non-smoker	411	81,6	258	66,3	< 0,001
Former smoker	56	11,1	81	20,8
Current smoker	37	7,3	50	12,9
Alcohol consumption*
Never	255	50,6	193	49,9	0,616
Moderate	223	44,2	168	43,4
High	26	5,2	26	6,7
Insomnia complaints*
No	357	70,8	268	69,1	0,569
Yes	147	29,2	120	30,9
Hypertension
No	357	70,8	195	50,1	< 0,001
Yes	147	29,2	194	49,9
Prescribed of antihypertensive drugs
No	383	76,0	232	59,6	< 0,001
Yes	112	24,0	157	40,4
	Median; IQR
Per capita income (minimum wages)^#	3,0; 2,0 - 4,0		3,0; 1,9 - 4,0		0,172
Body Mass Index (kg/m2)^#	26,1; 23,6 - 29,8		28,6; 25,2 - 32,4		< 0,001
Systolic blood pressure (mmHg)^#	114,7; 106,3 - 123,7		124,0; 112,7 - 135,0		< 0,001
Diastolic blood pressure (mmHg) ^#	73,7; 67,3 - 80,7		77,7; 71,3 - 85,3		< 0,001

	*Hypertension*
	*No (n= 552)*		*Yes (n=341)*		p
	n	%	n	%	p
Sex
Female	474	85,9	276	80,9	0,032
Male	78	14,1	65	19,1
Age
≤40 years	315	57,1	83	24,3	< 0,001
>40 years	237	42,9	258	75,7
Race/Ethnicity*
White	231	42,1	111	32,9	0,007
Black/Brown/Yellow (Asian)	318	57,9	226	67,1
Schooling
Upper secondary	153	27,7	150	44,0	< 0,001
University	399	72,3	191	56,0
Marital status
Married	330	59,8	190	55,7	0,001
Separated	67	12,1	62	18,2
Widowed	6	1,1	16	4,7
Single	149	27,0	73	21,4
Professional category
Nurse	215	38,9	102	29,9	0,006
Nursing technician/assistant	337	61,1	239	70,1
Smoking
Non-smoker	431	78,1	238	69,8	0,018
Former smoker	72	13,0	65	19,1
Current smoker	49	8,9	38	11,1
Alcohol consumption*
Never	281	51,1	167	49,0	0,815
Moderate	238	43,3	153	44,9
High	31	5,6	21	6,1
Insomnia complaints*
No	386	70,1	239	70,1	0,992
Yes	165	29,9	102	29,9
Physical activity
None	149	27,0	71	20,8	0,060
<150 min/week	71	12,9	57	16,7
≥150 min/week	332	60,1	213	62,5
Prescribed antihypertensive drugs
No	552	100	63	18,5	-
Yes	0,0	0,0	278	81,5
	Median; IQR
Per capita income (minimum wages) ^#	3,0; 2,0 - 4,4		2,4; 1,8 - 3,7		0,020
Body Mass Index (kg/m²)^#	25,7; 23,3 - 28,9		29,9; 26,5 - 33,0		< 0,001
Systolic blood pressure (mmHg)^#	112,6; 105,4 - 120,7		129,9; 119,2 - 144,7		< 0,001
Diastolic blood pressure (mmHg)^#	72,3; 66,3 - 78,0		82,0; 74,3 - 91,2		< 0,001

	*Systolic blood pressure*		*Diastolic blood pressure*		*Hypertension*
	*Crude model*	*Adjusted model*	*Crude model*	*Adjusted model*	*Crude model*	*Adjusted model*
	β	β	β	β	OR	OR
	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)	(95% CI)
Current dose of night work (N=552)
2 - 4 nights/fortnight	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
>4 nights/fortnight	4,1	4,0	2,3	2,3	1,37	1,57
>4 nights/fortnight	(0,69; 7,43)*	(1,01; 6,97)*	(0,14; 4,41)*	(0,24; 4,35)*	(0,93; 2,01)	(1,01; 2,43)*
Accumulated dose of night work (N=893)
1 - 9 years	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
>9 years	9,5	3,7	4,0	2,0	2,39	1,33
>9 years	(7,22; 11,70)*	(1,49; 5,92)*	(2,52; 5,41)*	(0,46; 3,52)*	(1,81; 3,16)*	(0,97;1,82)

	*Systolic blood pressure*		*Diastolic blood pressure*		*Hypertension*
	*Crude model*	*Adjusted model*	*Crude model*	*Adjusted model*	*Crude model*	*Adjusted model*
	β	β	β	β	OR	OR
	*(95% CI)*	*(95% CI)*	*(95% CI)*	*(95% CI)*	*(95% CI)*	*(95% CI)*
Current dose of night work (n=408)
2 - 4 nights/fortnight	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
>4 nights/fortnight	4,8	4,7	2,8	2,9	2,80	3,06
>4 nights/fortnight	(1,47; 8,09)*	(1,73; 7,68)*	(0,52; 5,16)*	(0,61; 5,13)*	(1,48; 5,27)*	(1,54; 6,05)*
Accumulated dose of night work (n=615)
1 - 9 years	Ref.	Ref.	Ref.	Ref.	Ref.	Ref.
>9 years	7,8	4,0	3,8	2,1	2,60	1,88
>9 years	(5,48; 10,18)*	(1,62; 6,38)*	(2,14; 5,52)*	(0,32; 3,94)*	(1,53; 4,43)*	(1,04; 3,42)*

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E-mail: rbso@fundacentro.gov.br

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[1] Contact: Aline Silva-Costa E-mail: aline.costa@uftm.edu.br