Cortisol and shiftwork: A scoping review

Abstract

The aim of this review was to explore the extent and nature of evidence exploring shiftwork and disruptions to cortisol. A systematic search was conducted across five databases: Medline, EMBASE, Psych INFO, Joanna Briggs Institute and PubMed between July-August 2020. Cortisol data were characterised into three main outcomes, 1) cortisol levels, 2) cortisol rhythm, and 3) cortisol awakening response (CAR) during shiftwork. Main findings demonstrate that shiftwork, especially night shift, significantly disrupts production of cortisol, the cortisol rhythm and CAR and, irregular shift schedules produce greater disruptions to cortisol than regular shift schedules. It was difficult to draw conclusions about the impact of shiftwork on movement of the cortisol rhythm and adaptation or recovery of the cortisol rhythm to and from night shift as the literature lacks consistency in definition of methods and variables. The present state of literature demonstrates cortisol levels, cortisol rhythm and the CAR are all disrupted by shiftwork, but there is a lack of consistency between studies on use of variables and most of the literature focuses on acute disruption rather than chronic effects. It will be important for future studies to investigate possible mechanisms that link shiftwork, disruptions to cortisol and chronic health conditions prevalent in shiftworkers.

Keywords: Cortisol; Cortisol awakening response (CAR); Shiftwork.