I came across an interesting editorial the other day while researching different staffing models. The editorial was entitled Light at night and health: the perils of rotating shift work. The group I work for covers night shifts, so I was interested in the article and the potential health effects of working these shifts. While I thought that most of the medical problems working night shifts focused around sleep disorders, the editorial opened my eyes to a whole host of problems I hadn't even thought of.
I cover at least five night shifts a month, so what I found was disturbing. The editorial summarized the current thinking on the health effects of shift work. One author, Dr. Schernhammer, has written several other articles on the topic, including a retrospective study in the Journal of the National Cancer Institute in 2001 that found an association of higher rates of breast cancer in women working rotating night shifts.1 In the current editorial, the authors bring to light the growing body of evidence that shift work may be linked with several health disorders.
I must admit that prior to reading this editorial, I thought that shift worker disorder was simply a sophisticated name for the sleep disturbance that I think everyone who does shift work experiences. After all, who hasn't lain awake at 9:30 am after a long night shift while the neighbors are having their house power-washed?
But according to this editorial, shift workers may be at risk for much more than just sleep disturbances. As mentioned earlier, a retrospective study suggested a higher rate of breast cancer, and in 2007, the World Health Organization classified work that disrupts normal circadian rhythm as “probably” carcinogenic, based on a few epidemiologic surveys and animal research. The editorial points to several other medical conditions that may be associated with shift work, including cardiovascular disease, obesity, depression, and lower pregnancy rates.
Now, before everyone refuses to work nights, a little perspective is needed. The data behind these associations are all small epidemiologic studies or animal research. In the editorial, Schernhammer points out that research is lacking and better studies are needed to clarify the scope of the problems and the effects that specific occupations and/or shifts have on workers. With an estimated 15% to 20% of the workforce engaged in some degree of shift work, the potential number of people affected by this problem is enormous. I think this problem may be of particular interest to PAs, as we are asked to do more “off hours” work in light of residency hour duty restrictions.
For me, this field bears watching for personal and professional reasons. I don't plan to change my work pattern based on the limited data at hand, but I certainly will be more conscious of my health and sleep, especially on a stretch of night shifts. Second, what I've learned will remind me to take a more detailed occupational history from patients and at least keep in mind these possible health effects in patients engaged in shift work.
Zachary Hartsell works in hospital medicine in Phoenix, Arizona. This blog post expresses his personal views and does not express or represent the views or policies of AAPA.