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Randomized Controlled Trial
. 2014 Oct;57(5):300-4.
doi: 10.1503/cjs.028813.

Decreased heart rate variability in surgeons during night shifts

Ilda Amirian  1 , Lærke Toftegård Andersen  1 , Jacob Rosenberg  1 , Ismail Gögenur  1
Affiliations
Randomized Controlled Trial

Decreased heart rate variability in surgeons during night shifts

Ilda Amirian et al. Can J Surg. 2014 Oct.

Abstract
in English, French

Background: Heart rate variability (HRV) has been used as a measure of stress and mental strain in surgeons. Low HRV has been associated with death and increased risk of cardiac events in the general population. The aim of this study was to clarify the effect of a 17-hour night shift on surgeons' HRV.

Methods: Surgeons were monitored prospectively with an ambulatory electrocardiography device for 48 consecutive hours, beginning on a precall day and continuing through an on-call (17-h shift) day. We measured HRV by frequency domain parameters.

Results: We included 29 surgeons in our analysis. The median pulse rate was decreased precall (median 64, interquartile range [IQR] 56-70 beats per minute [bpm]) compared with on call (median 81, IQR 70-91 bpm, p < 0.001). Increased high-frequency (HF) activity was found precall (median 199, IQR 75-365 ms2) compared with on call (median 99, IQR 48-177 ms2, p < 0.001). The low-frequency:high-frequency (LF:HF) ratio was lower precall (median 2.7, IQR 1.9-3.9) than on call (median 4.9, IQR 3.7-6.5, p < 0.001). We found no correlation between the LF:HF ratio and performance in laparoscopic simulation.

Conclusion: Surgeons working night shifts had a significant decrease in HRV and a significant increase in pulse rate, representing sympathetic dominance in the autonomic nervous system.

Trial registration: NCT01623674 (www.clinicaltrials.gov).

Contexte: La variabilité de la fréquence cardiaque (VFC) a été utilisée comme mesure du stress et de l’effort mental chez les chirurgiens. On a établi un lien entre une faible VFC et la mort et le risque accru d’événement cardiaque dans la population générale. Cette étude visait à clarifier l’effet d’un quart de nuit de 17 heures sur la VFC des chirurgiens.

Méthodes: On a surveillé prospectivement des chirurgiens au moyen d’un appareil d’électrocardiographie ambulatoire pendant 48 heures consécutives en commençant la veille de la période de garde et durant toute la journée de garde (quart de 17 heures). Nous avons mesuré la VFC au moyen de paramètres du domaine fréquentiel.

Résultats: Notre analyse a porté sur 29 chirurgiens. Le pouls médian a diminué avant la période de garde (médiane de 64, plage interquartile [PIQ] de 56 à 70 battements/minute [b/m]) comparativement à la période de garde (médiane de 81, PIQ de 70 à 91 b/m, p < 0,001). On a constaté une activité de haute fréquence (HF) accrue avant la période de garde (médiane de 199, PIQ de 75 à 365 ms2) comparativement à la période de garde (médiane de 99, PIQ de 48 à 177 ms2, p < 0,001). Le ratio basses fréquences:hautes fréquences (BF:HF) était moins élevé avant (médiane de 2,7, PIQ de 1,9 à 3,9) que pendant la période de garde (médiane de 4,9, PIQ de 3,7 à 6,5, p < 0,001). Nous n’avons constaté aucun lien entre le ratio BF:HF et le rendement au cours d’une simulation de laparoscopie.

Conclusion: Les chirurgiens qui faisaient des quarts de nuit présentaient une diminution importante de la VFC et une augmentation importante du pouls, ce qui représente une domination sympathique du système nerveux autonome.

Enregistrement de l'essai: NCT01623674 (www.clinicaltrials.gov).

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Figures

Fig. 1
Fig. 1
The development of high-frequency (HF) power from 4 pm to 8 am (16:00–08:00) for the precall and on-call days. Squares represent precall values with a p < 0.001. Circles represent on-call values with a p < 0.001. The p values were determined using the Friedman test. The decrease in HF power from 10 pm to 7 am (22:00–07:00) on call represents a decrease in vagal activity.
Fig. 2
Fig. 2
(A) Median pulse rate from 4 pm to 8 am precall and on call (p < 0.001, Wilcoxon test). (B) High-frequency (HF) power from 4 pm to 8 am precall and on call (p < 0.001, Wilcoxon test). The median precall HF value was higher and had a wider interquartile range (IQR) than the on-call value, demonstrating a greater parasympathetic influence. (C) The LF:HF ratio as a measure of the sympathovagal balance from 4 pm to 8 am precall and on call (p < 0.001, Wilcoxon test). The decrease in the LF:HF ratio precall represents a larger vagal influence, and the increase on call represents a larger sympathetic influence on heart rate variability. (D) Low- frequency (LF) power from 4 pm to 8 am precall and on-call (p = 0.39, Wilcoxon test). Boxes represent the IQRs. Lines within the boxes represent the medians. Whiskers represent minimum and maximum IQR values.
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