Altered coordination between sleep timing and cortisol profiles in night working female hospital employees

Katarzyna Burek; Sylvia Rabstein; Thomas Kantermann; Céline Vetter; Rui Wang-Sattler; Martin Lehnert; Dirk Pallapies; Karl-Heinz Jöckel; Thomas Brüning; Thomas Behrens

doi:10.1016/j.psyneuen.2024.107066

Altered coordination between sleep timing and cortisol profiles in night working female hospital employees

Psychoneuroendocrinology. 2024 Apr 30:166:107066. doi: 10.1016/j.psyneuen.2024.107066. Online ahead of print.

Affiliations

¹ Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany. Electronic address: katarzyna.burek@dguv.de.
² Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany.
³ Institute for Labor and Personnel (IAP), University of Applied Sciences for Economics and Management (FOM), Essen, Germany; SynOpus, Bochum, Germany.
⁴ Department of Integrative Physiology, University of Colorado, Boulder, CO, United States.
⁵ Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany.
⁶ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany.

PMID: 38723404
DOI: 10.1016/j.psyneuen.2024.107066

Abstract

Background: Cortisol typically peaks in the morning after waking up and declines throughout the day, reaching its lowest levels during nighttime sleep. Shift work can cause misalignment between cortisol levels and sleep-wake timing. We analyzed this misalignment in female shift workers focusing on the timing and extent of these changes.

Methods: We conducted a cross-sectional study involving 68 shift workers (aged 37 ± 10 years) and 21 non-shift workers (aged 45 ± 10 years) from a hospital. Shift workers were monitored through two day shifts and three night shifts, whereas non-shift workers were monitored during two day shifts. Each participant collected six to eight saliva samples (depending on their shift type) and provided sleep timing information, which was recorded via polysomnography and sleep diaries. Generalized additive mixed models were used to estimate shift-specific differences in cortisol smooth curves. Summary measures calculated for the cortisol smooth curves included cortisol awakening response, peak-to-bed slope, and total output.

Results: Between shift workers and non-shift workers, we observed similar diurnal cortisol profiles with a steep negative diurnal slope during day shifts. In shift workers on night shifts, a flattened U-shaped cortisol profile after the post-awakening maximum was observed, with a peak-to-bed slope close to zero. When comparing night to day shifts in the group of shift workers, mean cortisol levels were lower between 42 and 56 minutes and 1.8-11.9 hours after waking up, and higher between 14.9 and 22 hours after waking up.

Conclusion: Our findings indicate altered cortisol profiles in female hospital employees on night shifts. Specifically, cortisol levels were lower at night when higher levels would typically be necessary for work activities, and higher at bedtime after a night shift, when levels should normally be low.

Keywords: Circadian rhythm; Glucocorticoid; Healthcare; Saliva; Shift work; Women.