Skip to main content
Top
Published in: Journal of Occupational Medicine and Toxicology 1/2018

Open Access 01-12-2018 | Research

Impact of shift work on the diurnal cortisol rhythm: a one-year longitudinal study in junior physicians

Authors: Jian Li, Martin Bidlingmaier, Raluca Petru, Francisco Pedrosa Gil, Adrian Loerbroks, Peter Angerer

Published in: Journal of Occupational Medicine and Toxicology | Issue 1/2018

Login to get access

Abstract

Background

Cumulative epidemiological evidence suggests that shift work exerts harmful effects on human health. However, the physiological mechanisms are not well understood. This study aimed to examine the impact of shift work on the dysregulation of the hypothalamic-pituitary-adrenal axis, i.e. diurnal cortisol rhythm.

Methods

Seventy physicians with a mean age 30 years participated in this one-year longitudinal study. Working schedules, either shift work or regular schedules with day shift, were assessed at baseline. Salivary cortisol samples were collected on two consecutive regular working days, four times a day (including waking, + 4 h, + 8 h, and + 16 h), at both baseline and the one-year follow-up. The diurnal cortisol decline (slope) and total cortisol concentration (area under the curve, AUC) were calculated.

Results

After adjusting for cortisol secretion at baseline and numerous covariates, shift work at baseline significantly predicted a steeper slope (p < 0.01) and a larger AUC (p < 0.05) of diurnal cortisol rhythm at follow-up in this sample of physicians. In particular, waking cortisol at follow-up was significantly higher among those engaged in shift work than day shift (p < 0.01).

Conclusions

Our findings support the notion that shift work changes the diurnal cortisol pattern, and is predictive of increased cortisol secretion consequently in junior physicians.
Literature
1.
go back to reference Alterman T, Luckhaupt SE, Dahlhamer JM, Ward BW, Calvert GM. Prevalence rates of work organization characteristics among workers in the U.S.: data from the 2010 National Health Interview Survey. Am J Ind Med. 2013;56:647–59.CrossRefPubMed Alterman T, Luckhaupt SE, Dahlhamer JM, Ward BW, Calvert GM. Prevalence rates of work organization characteristics among workers in the U.S.: data from the 2010 National Health Interview Survey. Am J Ind Med. 2013;56:647–59.CrossRefPubMed
2.
go back to reference Slany C, Schütte S, Chastang JF, Parent-Thirion A, Vermeylen G, Niedhammer I. Psychosocial work factors and long sickness absence in Europe. Int J Occup Environ Health. 2014;20:16–25.CrossRefPubMedPubMedCentral Slany C, Schütte S, Chastang JF, Parent-Thirion A, Vermeylen G, Niedhammer I. Psychosocial work factors and long sickness absence in Europe. Int J Occup Environ Health. 2014;20:16–25.CrossRefPubMedPubMedCentral
3.
go back to reference Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210.CrossRefPubMed Kecklund G, Axelsson J. Health consequences of shift work and insufficient sleep. BMJ. 2016;355:i5210.CrossRefPubMed
4.
go back to reference Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, et al. Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol. 2007;8:1065–6.CrossRefPubMed Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, et al. Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol. 2007;8:1065–6.CrossRefPubMed
5.
go back to reference Lin X, Chen W, Wei F, Ying M, Wei W, Xie X. Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies. Sleep Med. 2015;16:1381–7.CrossRefPubMed Lin X, Chen W, Wei F, Ying M, Wei W, Xie X. Night-shift work increases morbidity of breast cancer and all-cause mortality: a meta-analysis of 16 prospective cohort studies. Sleep Med. 2015;16:1381–7.CrossRefPubMed
6.
go back to reference Rao D, Yu H, Bai Y, Zheng X, Xie L. Does night-shift work increase the risk of prostate cancer? A systematic review and meta-analysis. Onco Targets Ther. 2015;8:2817–26.PubMedPubMedCentral Rao D, Yu H, Bai Y, Zheng X, Xie L. Does night-shift work increase the risk of prostate cancer? A systematic review and meta-analysis. Onco Targets Ther. 2015;8:2817–26.PubMedPubMedCentral
7.
go back to reference Gan Y, Yang C, Tong X, Sun H, Cong Y, Yin X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015;72:72–8.CrossRefPubMed Gan Y, Yang C, Tong X, Sun H, Cong Y, Yin X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies. Occup Environ Med. 2015;72:72–8.CrossRefPubMed
8.
go back to reference Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012;345:e4800.CrossRefPubMedPubMedCentral Vyas MV, Garg AX, Iansavichus AV, Costella J, Donner A, Laugsand LE, et al. Shift work and vascular events: systematic review and meta-analysis. BMJ. 2012;345:e4800.CrossRefPubMedPubMedCentral
9.
go back to reference Reszka E, Peplonska B, Wieczorek E, Sobala W, Bukowska A, Gromadzinska J, et al. Circadian gene expression in peripheral blood leukocytes of rotating night shift nurses. Scand J Work Environ Health. 2013;39:187–94.CrossRefPubMed Reszka E, Peplonska B, Wieczorek E, Sobala W, Bukowska A, Gromadzinska J, et al. Circadian gene expression in peripheral blood leukocytes of rotating night shift nurses. Scand J Work Environ Health. 2013;39:187–94.CrossRefPubMed
10.
go back to reference Reszka E, Wieczorek E, Przybek M, Jabłońska E, Kałużny P, Bukowska-Damska A, et al. Circadian gene methylation in rotating-shift nurses: a cross-sectional study. Chronobiol Int. 2018;35:111–21.CrossRefPubMed Reszka E, Wieczorek E, Przybek M, Jabłońska E, Kałużny P, Bukowska-Damska A, et al. Circadian gene methylation in rotating-shift nurses: a cross-sectional study. Chronobiol Int. 2018;35:111–21.CrossRefPubMed
11.
go back to reference Samulin Erdem J, Skare Ø, Petersen-Øverleir M, Notø HØ, Lie JS, Reszka E, et al. Mechanisms of breast Cancer in shift workers: DNA methylation in five Core circadian genes in nurses working night shifts. J Cancer. 2017;8:2876–84.CrossRefPubMedPubMedCentral Samulin Erdem J, Skare Ø, Petersen-Øverleir M, Notø HØ, Lie JS, Reszka E, et al. Mechanisms of breast Cancer in shift workers: DNA methylation in five Core circadian genes in nurses working night shifts. J Cancer. 2017;8:2876–84.CrossRefPubMedPubMedCentral
12.
13.
go back to reference Bracci M, Ciarapica V, Copertaro A, Barbaresi M, Manzella N, Tomasetti M, et al. Peripheral skin temperature and circadian biological clock in shift nurses after a day off. Int J Mol Sci. 2016;17:E623.CrossRefPubMed Bracci M, Ciarapica V, Copertaro A, Barbaresi M, Manzella N, Tomasetti M, et al. Peripheral skin temperature and circadian biological clock in shift nurses after a day off. Int J Mol Sci. 2016;17:E623.CrossRefPubMed
14.
15.
go back to reference Faraut B, Bayon V, Léger D. Neuroendocrine, immune and oxidative stress in shift workers. Sleep Med Rev. 2013;17:433–44.CrossRefPubMed Faraut B, Bayon V, Léger D. Neuroendocrine, immune and oxidative stress in shift workers. Sleep Med Rev. 2013;17:433–44.CrossRefPubMed
19.
go back to reference Rosmond R, Bjorntorp P. The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Int Med. 2000;247:188–97.CrossRef Rosmond R, Bjorntorp P. The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Int Med. 2000;247:188–97.CrossRef
20.
go back to reference Vogelzangs N, Beekman AT, Milaneschi Y, Bandinelli S, Ferrucci L, Penninx BW. Urinary cortisol and six-year risk of all-cause and cardiovascular mortality. J Clin Endocrinol Metab. 2010;95:4959–64.CrossRefPubMedPubMedCentral Vogelzangs N, Beekman AT, Milaneschi Y, Bandinelli S, Ferrucci L, Penninx BW. Urinary cortisol and six-year risk of all-cause and cardiovascular mortality. J Clin Endocrinol Metab. 2010;95:4959–64.CrossRefPubMedPubMedCentral
21.
go back to reference Kumari M, Shipley M, Stafford M, Kivimaki M. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab. 2011;96:1478–85.CrossRefPubMedPubMedCentral Kumari M, Shipley M, Stafford M, Kivimaki M. Association of diurnal patterns in salivary cortisol with all-cause and cardiovascular mortality: findings from the Whitehall II study. J Clin Endocrinol Metab. 2011;96:1478–85.CrossRefPubMedPubMedCentral
22.
go back to reference Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull. 2007;133:25–45.CrossRefPubMed Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychol Bull. 2007;133:25–45.CrossRefPubMed
23.
go back to reference Van Cauter E. Diurnal and ultradian rhythms in human endocrine function: a minireview. Horm Res. 1990;34:45–53.CrossRefPubMed Van Cauter E. Diurnal and ultradian rhythms in human endocrine function: a minireview. Horm Res. 1990;34:45–53.CrossRefPubMed
24.
go back to reference Czeisler CA, Klerman EB. Circadian and sleep-dependent regulation of hormone release in humans. Recent Prog Horm Res. 1999;54:97–130.PubMed Czeisler CA, Klerman EB. Circadian and sleep-dependent regulation of hormone release in humans. Recent Prog Horm Res. 1999;54:97–130.PubMed
25.
go back to reference Kudielka BM, Gierens A, Hellhammer DH, Wust S, Schlotz W. Salivary cortisol in ambulatory assessment – some dos, some don’ts, and some open questions. Psychosom Med. 2012;74:418–31.CrossRefPubMed Kudielka BM, Gierens A, Hellhammer DH, Wust S, Schlotz W. Salivary cortisol in ambulatory assessment – some dos, some don’ts, and some open questions. Psychosom Med. 2012;74:418–31.CrossRefPubMed
26.
go back to reference Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. 2009;34:1423–36.CrossRefPubMed Adam EK, Kumari M. Assessing salivary cortisol in large-scale, epidemiological research. Psychoneuroendocrinology. 2009;34:1423–36.CrossRefPubMed
27.
go back to reference Touitou Y, Motohashi Y, Reinberg A, Touitou C, Bourdeleau P, Bogdan A, et al. Effect of shift work on the night-time secretory patterns of melatonin, prolactin, cortisol and testosterone. Eur J Appl Physiol Occup Physiol. 1990;60:288–92.CrossRefPubMed Touitou Y, Motohashi Y, Reinberg A, Touitou C, Bourdeleau P, Bogdan A, et al. Effect of shift work on the night-time secretory patterns of melatonin, prolactin, cortisol and testosterone. Eur J Appl Physiol Occup Physiol. 1990;60:288–92.CrossRefPubMed
28.
go back to reference Weibel L, Spiegel K, Follenius M, Ehrhart J, Brandenberger G. Internal dissociation of the circadian markers of the cortisol rhythm in night workers. Am J Phys. 1996;270:E608–13.CrossRef Weibel L, Spiegel K, Follenius M, Ehrhart J, Brandenberger G. Internal dissociation of the circadian markers of the cortisol rhythm in night workers. Am J Phys. 1996;270:E608–13.CrossRef
29.
go back to reference Mirick DK, Bhatti P, Chen C, Nordt F, Stanczyk FZ, Davis S. Night shift work and levels of 6-sulfatoxymelatonin and cortisol in men. Cancer Epidemiol Biomark Prev. 2013;22:1079–87.CrossRef Mirick DK, Bhatti P, Chen C, Nordt F, Stanczyk FZ, Davis S. Night shift work and levels of 6-sulfatoxymelatonin and cortisol in men. Cancer Epidemiol Biomark Prev. 2013;22:1079–87.CrossRef
30.
go back to reference Manenschijn L, van Kruysbergen RG, de Jong FH, Koper JW, van Rossum EF. Shift work at young age is associated with elevated long-term cortisol levels and body mass index. J Clin Endocrinol Metab. 2011;96:E1862–5.CrossRefPubMed Manenschijn L, van Kruysbergen RG, de Jong FH, Koper JW, van Rossum EF. Shift work at young age is associated with elevated long-term cortisol levels and body mass index. J Clin Endocrinol Metab. 2011;96:E1862–5.CrossRefPubMed
31.
go back to reference Bostock S, Steptoe A. Influences of early shift work on the diurnal cortisol rhythm, mood and sleep: within-subject variation in male airline pilots. Psychoneuroendocrinology. 2013;38:533–41.CrossRefPubMedPubMedCentral Bostock S, Steptoe A. Influences of early shift work on the diurnal cortisol rhythm, mood and sleep: within-subject variation in male airline pilots. Psychoneuroendocrinology. 2013;38:533–41.CrossRefPubMedPubMedCentral
32.
go back to reference Hung EW, Aronson KJ, Leung M, Day A, Tranmer J. Shift work parameters and disruption of diurnal cortisol production in female hospital employees. Chronobiol Int. 2016;33:1045–55.CrossRefPubMed Hung EW, Aronson KJ, Leung M, Day A, Tranmer J. Shift work parameters and disruption of diurnal cortisol production in female hospital employees. Chronobiol Int. 2016;33:1045–55.CrossRefPubMed
33.
go back to reference Hennig J, Kieferdorf P, Moritz C, Huwe S, Netter P. Changes in cortisol secretion during shiftwork: implications for tolerance to shiftwork? Ergonomics. 1998;41:610–21.CrossRefPubMed Hennig J, Kieferdorf P, Moritz C, Huwe S, Netter P. Changes in cortisol secretion during shiftwork: implications for tolerance to shiftwork? Ergonomics. 1998;41:610–21.CrossRefPubMed
34.
go back to reference Lac G, Chamoux A. Biological and psychological responses to two rapid shiftwork schedules. Ergonomics. 2004;47:1339–49.CrossRefPubMed Lac G, Chamoux A. Biological and psychological responses to two rapid shiftwork schedules. Ergonomics. 2004;47:1339–49.CrossRefPubMed
35.
go back to reference Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, et al. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med. 2012;19:85–91.CrossRefPubMed Machi MS, Staum M, Callaway CW, Moore C, Jeong K, Suyama J, et al. The relationship between shift work, sleep, and cognition in career emergency physicians. Acad Emerg Med. 2012;19:85–91.CrossRefPubMed
36.
go back to reference Fekedulegn D, Burchfiel CM, Violanti JM, Hartley TA, Charles LE, Andrew ME, et al. Associations of long-term shift work with waking salivary cortisol concentration and patterns among police officers. Ind Health. 2012;50:476–86.CrossRefPubMedPubMedCentral Fekedulegn D, Burchfiel CM, Violanti JM, Hartley TA, Charles LE, Andrew ME, et al. Associations of long-term shift work with waking salivary cortisol concentration and patterns among police officers. Ind Health. 2012;50:476–86.CrossRefPubMedPubMedCentral
37.
go back to reference Charles LE, Fekedulegn D, Burchfiel CM, Hartley TA, Andrew ME, Violanti JM, et al. Shiftwork and diurnal salivary cortisol patterns among police officers. J Occup Environ Med. 2016;58:542–9.CrossRefPubMedPubMedCentral Charles LE, Fekedulegn D, Burchfiel CM, Hartley TA, Andrew ME, Violanti JM, et al. Shiftwork and diurnal salivary cortisol patterns among police officers. J Occup Environ Med. 2016;58:542–9.CrossRefPubMedPubMedCentral
38.
go back to reference Wong IS, Ostry AS, Demers PA, Davies HW. Job strain and shift work influences on biomarkers and subclinical heart disease indicators: a pilot study. J Occup Environ Hyg. 2012;9:467–77.CrossRefPubMed Wong IS, Ostry AS, Demers PA, Davies HW. Job strain and shift work influences on biomarkers and subclinical heart disease indicators: a pilot study. J Occup Environ Hyg. 2012;9:467–77.CrossRefPubMed
39.
go back to reference Harris A, Waage S, Ursin H, Hansen AM, Bjorvatn B, Eriksen HR. Cortisol, reaction time test and health among offshore shift workers. Psychoneuroendocrinology. 2010;35:1339–47.CrossRefPubMed Harris A, Waage S, Ursin H, Hansen AM, Bjorvatn B, Eriksen HR. Cortisol, reaction time test and health among offshore shift workers. Psychoneuroendocrinology. 2010;35:1339–47.CrossRefPubMed
40.
go back to reference Merkus SL, Holte KA, Huysmans MA, Hansen ÅM, van de Ven PM, van Mechelen W, et al. Neuroendocrine recovery after 2-week 12-h day and night shifts: an 11-day follow-up. Int Arch Occup Environ Health. 2015;88:247–57.CrossRefPubMed Merkus SL, Holte KA, Huysmans MA, Hansen ÅM, van de Ven PM, van Mechelen W, et al. Neuroendocrine recovery after 2-week 12-h day and night shifts: an 11-day follow-up. Int Arch Occup Environ Health. 2015;88:247–57.CrossRefPubMed
41.
go back to reference Niu SF, Chung MH, Chu H, Tsai JC, Lin CC, Liao YM, et al. Differences in cortisol profiles and circadian adjustment time between nurses working night shifts and regular day shifts: a prospective longitudinal study. Int J Nurs Stud. 2015;52:1193–201.CrossRefPubMed Niu SF, Chung MH, Chu H, Tsai JC, Lin CC, Liao YM, et al. Differences in cortisol profiles and circadian adjustment time between nurses working night shifts and regular day shifts: a prospective longitudinal study. Int J Nurs Stud. 2015;52:1193–201.CrossRefPubMed
42.
go back to reference Jensen MA, Hansen ÅM, Kristiansen J, Nabe-Nielsen K, Garde AH. Changes in the diurnal rhythms of cortisol, melatonin, and testosterone after 2, 4, and 7 consecutive night shifts in male police officers. Chronobiol Int. 2016;33:1280–92.CrossRef Jensen MA, Hansen ÅM, Kristiansen J, Nabe-Nielsen K, Garde AH. Changes in the diurnal rhythms of cortisol, melatonin, and testosterone after 2, 4, and 7 consecutive night shifts in male police officers. Chronobiol Int. 2016;33:1280–92.CrossRef
43.
go back to reference Kudielka BM, Buchtal J, Uhde A, Wüst S. Circadian cortisol profiles and psychological self-reports in shift workers with and without recent change in the shift rotation system. Biol Psychol. 2007;74:92–103.CrossRefPubMed Kudielka BM, Buchtal J, Uhde A, Wüst S. Circadian cortisol profiles and psychological self-reports in shift workers with and without recent change in the shift rotation system. Biol Psychol. 2007;74:92–103.CrossRefPubMed
44.
go back to reference Lammers-van der Holst HM, Kerkhof GA. Individual differences in the cortisol-awakening response during the first two years of shift work: a longitudinal study in novice police officers. Chronobiol Int. 2015;32:1162–7.CrossRefPubMed Lammers-van der Holst HM, Kerkhof GA. Individual differences in the cortisol-awakening response during the first two years of shift work: a longitudinal study in novice police officers. Chronobiol Int. 2015;32:1162–7.CrossRefPubMed
45.
go back to reference Copertaro A, Bracci M, Gesuita R, Carle F, Amati M, Baldassari M, et al. Influence of shift-work on selected immune variables in nurses. Ind Health. 2011;49:597–604.CrossRefPubMed Copertaro A, Bracci M, Gesuita R, Carle F, Amati M, Baldassari M, et al. Influence of shift-work on selected immune variables in nurses. Ind Health. 2011;49:597–604.CrossRefPubMed
46.
go back to reference Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003;28:916–31.CrossRefPubMed Pruessner JC, Kirschbaum C, Meinlschmid G, Hellhammer DH. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology. 2003;28:916–31.CrossRefPubMed
47.
48.
go back to reference Stevens RG, Hansen J, Costa G, Haus E, Kauppinen T, Aronson KJ, et al. Considerations of circadian impact for defining “shift work” in cancer studies: IARC working group report. Occup Environ Med. 2011;68:154–62.CrossRefPubMed Stevens RG, Hansen J, Costa G, Haus E, Kauppinen T, Aronson KJ, et al. Considerations of circadian impact for defining “shift work” in cancer studies: IARC working group report. Occup Environ Med. 2011;68:154–62.CrossRefPubMed
49.
go back to reference Veldhuis JD, Sharma A, Roelfsema F. Age-dependent and gender-dependent regulation of hypothalamic-adrenocorticotropic-adrenal axis. Endocrinol Metab Clin N Am. 2013;42:201–25.CrossRef Veldhuis JD, Sharma A, Roelfsema F. Age-dependent and gender-dependent regulation of hypothalamic-adrenocorticotropic-adrenal axis. Endocrinol Metab Clin N Am. 2013;42:201–25.CrossRef
50.
go back to reference Roelfsema F, van Heemst D, Iranmanesh A, Takahashi P, Yang R, Veldhuis JD. Impact of age, sex and body mass index on cortisol secretion in 143 healthy adults. Endocr Connect. 2017;6:500–9.CrossRefPubMedPubMedCentral Roelfsema F, van Heemst D, Iranmanesh A, Takahashi P, Yang R, Veldhuis JD. Impact of age, sex and body mass index on cortisol secretion in 143 healthy adults. Endocr Connect. 2017;6:500–9.CrossRefPubMedPubMedCentral
51.
go back to reference Stalder T, Kirschbaum C, Kudielka BM, Adam EK, Pruessner JC, Wüst S, et al. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016;63:414–32.CrossRefPubMed Stalder T, Kirschbaum C, Kudielka BM, Adam EK, Pruessner JC, Wüst S, et al. Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology. 2016;63:414–32.CrossRefPubMed
52.
go back to reference Lunn RM, Blask DE, Coogan AN, Figueiro MG, Gorman MR, Hall JE, et al. Health consequences of electric lighting practices in the modern world: a report on the National Toxicology Program's workshop on shift work at night, artificial light at night, and circadian disruption. Sci Total Environ. 2017;607-608:1073–84.CrossRefPubMed Lunn RM, Blask DE, Coogan AN, Figueiro MG, Gorman MR, Hall JE, et al. Health consequences of electric lighting practices in the modern world: a report on the National Toxicology Program's workshop on shift work at night, artificial light at night, and circadian disruption. Sci Total Environ. 2017;607-608:1073–84.CrossRefPubMed
53.
go back to reference Neil-Sztramko SE, Pahwa M, Demers PA, Gotay CC. Health-related interventions among night shift workers: a critical review of the literature. Scand J Work Environ Health. 2014;40:543–56.CrossRefPubMed Neil-Sztramko SE, Pahwa M, Demers PA, Gotay CC. Health-related interventions among night shift workers: a critical review of the literature. Scand J Work Environ Health. 2014;40:543–56.CrossRefPubMed
54.
go back to reference Vangelova K. The effect of shift rotation on variations of cortisol, fatigue and sleep in sound engineers. Ind Health. 2008;46:490–3.CrossRefPubMed Vangelova K. The effect of shift rotation on variations of cortisol, fatigue and sleep in sound engineers. Ind Health. 2008;46:490–3.CrossRefPubMed
Metadata
Title
Impact of shift work on the diurnal cortisol rhythm: a one-year longitudinal study in junior physicians
Authors
Jian Li
Martin Bidlingmaier
Raluca Petru
Francisco Pedrosa Gil
Adrian Loerbroks
Peter Angerer
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Occupational Medicine and Toxicology / Issue 1/2018
Electronic ISSN: 1745-6673
DOI
https://doi.org/10.1186/s12995-018-0204-y

Other articles of this Issue 1/2018

Journal of Occupational Medicine and Toxicology 1/2018 Go to the issue