Desincronización de los ciclos circadianos en el personal de urgencias que realizan turno de noche

María Mérida-Raigón; María Plaza-Carmona; Carmen Juan-García

María Mérida-Raigón Hospital Universitario Reina Sofía (Córdoba, España)
María Plaza-Carmona Complejo Asistencial Universitario de León (León, España)
Carmen Juan-García Complejo Asistencial Universitario de León (León, España)

Palabras clave: Turno de noche, Horario de trabajo por turnos, Trastornos del sueño del ritmo circadiano, Urgencias

Key-words: Night shift, Shift work schedule, Circadian rhythm sleep disorders, Emergency room

Resumen

Introducción: La actividad en los Servicios de Urgencias Hospitalarios (SUH), puede ser compleja, combinando situaciones críticas, alta carga de trabajo y turnicidad. Trabajar en turno de noche altera los ciclos de luz/oscuridad, actividad y con ello, los ritmos biológicos. El objetivo del trabajo es analizar la producción científica relacionada con la alteración de los ritmos circadianos en personal de sanitario (enfermeras, médicos y auxiliares de enfermería) que trabaja en turnos de noche. Metodología: Revisión sistemática de la literatura en las bases de datos PubMed, Web of Science y Scopus. La búsqueda tuvo lugar entre el 15/12/2015 y 15/12/2021. Los términos MeSH empleados fueron: “Shift work”, “Circadian rhythm” y “Emergency medical services”. Se incluyeron artículos cuya temática fuera la alteración de los ritmos circadianos en el personal de SUH, trabajando en turno de noche. Resultados: Se seleccionaron 18 artículos (9 estudios de cohortes, 5 transversales y 4 ensayos aleatorizados). Los/as profesionales sanitarios que trabajan durante la noche, presentan alteraciones cardiocirculatorias, inmunológicas, funcionales, del sueño, cognitivas, estrés y síndrome de Burnout. Conclusiones: El turno de noche es un factor desencadenante de multitud de alteraciones asociadas principalmente a la disrupción de los ciclos circadianos

Abstract

Introduction: The activity in the Hospital Emergency Services (ED) can be complex, combining critical situations, high workload and shifts. Working the night shift alters light/dark cycles, activity, and with it, biological rhythms. The objective of the work is to analyze the scientific production related to the alteration of circadian rhythms in health personnel (nurses, doctors and nursing assistants) who work night shifts. Methodology: Systematic review of the literature in PubMed, Web of Science and Scopus databases. The search took place between 12/15/2015 and 12/15/2021. The MeSH terms used were: “Shift work”, “Circadian rhythm” and “Emergency medical services”. Articles whose theme was the alteration of circadian rhythms in HED personnel, working on night shift, were included. Results: 18 articles were selected (9 cohort studies, 5 cross-sectional and 4 randomized trials). Health professionals who work at night present cardiocirculatory, immunological, functional, sleep, cognitive, stress and Burn-out syndrome disorders. Conclusions: The night shift is a triggering factor for a multitude of alterations associated mainly with the disruption of circadian cycles

Bibliografía

1. Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer T. An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occup Environ Med [Internet]. 2015 Nov [citado el 30 de diciembre de 2021];72(15):798–804. Disponible en: https://doi:10.1136/oemed- 2015-102966.
2. Ministerio de Sanidad, Consumo y Bienestar Social. Unidad de Urgencias Hospitalarias. Estándares y recomendaciones [Internet]. 2010. Disponible en: http://www.msc.es/organizacion/sns/planCalidadSNS/ docs/UUH.pdf.
3. Tomás Vecina S, Chanovas M, Roqueta F, Alcaraz J, Toranzo T. EVADUR: estudio sobre los eventos adversos ligados a la asistencia en los servicios de urgencias de hospitales españoles. Emergencias. 2010; 22:415–28.
4. Fabbian F, Zucchi B, De Giorgi A, Tiseo R, Boari B, Salmi R, et al. Chronotype, gender and general health. Chronobiol Int [Internet]. 2016 May [ citado el 2 de enero de 2022]; 33(7):863–82. Disponible en: https://doi.org/10.1080/07420528.2016.1176927.
5. Urrutia G, Bonfill X. PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses. Med Clin (Barc) [Internet]. 2010 Mar [citado el 31 de diciembre de 2021]; 135(11):507–11. Disponible en: https://doi.org/10.1016/j.medcli. 2010.01.015.
6. Elm E, Altman D, Egger M, Pocock SJ, Gotzsche, P.C. Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ Br Med Journal [Internet]. 2007 [citado el 20 de enero de 2022]; 335:806–8. Disponible en: https://doi.org/10.1016/j. medcli.2010.01.015.
7. Tacconelli E. Systematic reviews: CRD’s guidance for undertaking reviews in health care. Lancet Infect Dis [Internet]. 2010; 10(226–231). Disponible en: https://doi.org/10.1016/S1473-3099(10)70065-7.
8. Belayachi J, Benjelloun O, Madani N, Abidi K, Dendane T, Zeggwagh AA. Self-perceived sleepiness in emergency training physicians: prevalence and relationship with quality of life. J Occup Med Toxicol [Internet]. 2013 Sep [citado el 8 de diciembre de 2021]; 8(1):1–8. Disponible en https://doi.org/10.1186/1745-6673-8-24.
9. Neufeld EV, Carney JJ, Dolezal BA, Boland DM, Cooper CB. Exploratory study of heart rate variability and sleep among emergency medical services shift worker. Prehospital Emerg Care [Internet]. 2017 [citado el 12 de febrero de 2022]; 21(1):18–23. Disponible en https:// doi.org/10.1080/10903127.2016.1194928.
10. Smith-Coggins R, Howard SK, Mac DT, Wang C, Kwan S, Rosekind MR, et al. Improving alertness and performance in emergency department physicians and nurses: the use of planned naps. Ann Emerg Med [Internet]. 2006 Nov [citado el 10 de diciembre de 2021]; 48(5):596-604. Disponible en https://doi.org/10.1016/j.annemergmed. 2006.02.005.
11. Ruggiero JS, Avi-Itzhak T. Sleep patterns of emergency department nurses on workdays and days off. J Nurs Res [Internet]. 2016 Jun [citado el 28 de febrero de 2022]; 24(2):173–80. Disponible en: https://doi.org/10.1097/jnr.0000000000000121.
12. 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(1):85–91.
13. Patterson PD, Buysse DJ, Weaver MD, Callaway CW, Yealy DM. Recovery between work shifts among emergency medical services clinicians. Prehosp Emerg Care [Internet]. 2015 Jul-Sep [citado el 3 de enero de 2022];19(3):365-75. Disponible en: https://doi.org/10.31 09/10903127.2014.995847.
14. Patterson PD, Weaver MD, Frank RC, Warner CW, Martin-Gill C, Guyette FX, et al. Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emerg Care. 2012;16(1):86–97.
15. Costa C, Mondello S, Micali E, Indelicato G, Licciardello AA, Vitale E, et al. Night shift work in resident physicians: does it affect mood states and cognitive levels? J Affect Disord [Internet]. 2020 Jul [citado el 3 de enero de 2022]; 272:289–94. Disponible en: https://doi. org/10.1016/j.jad.2020.03.139.
16. Smith-Coggins R, Broderick KB, Marco CA. Night shifts in emergency medicine: the american board of emergency medicine longitudinal study of emergency physicians. J Emerg Med [Internet]. 2014 Sep [citado el 20 de diciembre de 2021]; 47(3):372–378. Disponible en: https://doi.org/10.1016/j.jemermed.2014.04.020.
17. Edgerley S, McKaigney C, Boyne D, Ginsberg D, Dagnone JD, Hall AK. Impact of night shifts on emergency medicine resident resuscitation performance. Resuscitation [Internet]. 2018 Mar [citado el 23 de diciembre de 2021]; 127:26–30. Disponible en: https://doi.org/ 10.1016/j.resuscitation.2018.03.019.
18. Frey R, Decker K, Reinfried L, Klösch G, Saletu B, Anderer P, et al. Effect of rest on physicians’ performance in an emergency department, objectified by electroencephalographic analyses and psychometric tests. Crit Care Med [Internet]. 2002 Oct [citado el 20 de enero de 2022]; 30(10):2322–29. Disponible en: https://doi. org/10.1097/00003246-200210000-00022.
19. Dula DJ, Dula, NL, Hamrick C, Wood GC. The effect of working serial night shifts on the cognitive functioning of emergency physicians. Ann Emerg Med [Internet]. 2001 Aug [citado el 18 de enero de 2022]; 38(2):152–5. Disponible en: https://doi.org/doi: 10.1067/ mem.2001.116024.
20. Rollinson DC, Rathlev NK, Moss M, Killiany R, Sassower KC, Auerbach S, et al. The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study. Ann Emerg Med [Internet]. 2003 Mar [citado el 22 de enero de 2022]; 41(3):400–6. Disponible en: https://doi.org/10.1067/ mem.2003.77.
21. Maggio D, Anderson E, Herring A, Page-Wills C, Figueiro MG. Circadian Rhythm Disruption in Emergency Medicine Residents. Ann Emerg Med [Internet]. 2012 Feb [citado el 22 de enero de 2022]; 60(4): S128. Disponible en: https://doi.org/10.4300/JGME-D-14-00056.1.
22. Dutheil F, Trousselard M, Perrier C, Lac G, Chamoux A, et al. Urinary Interleukin-8 Is a Biomarker of Stress in Emergency Physicians, Especially with Advancing Age — The JOBSTRESS* Randomized Trial. PLoS ONE[Internet]. 2013 Aug [citado el 12 de enero de 2022]; 8(8): e71658. Disponible en: https://doi.org/10.1371/journal. pone.0071658.
23. Nakajima Y, Takahashi T, Shetty V, Yamaguchi M. Patterns of salivary cortisol levels can manifest work stress in emergency care providers. J Physiol Sci [Internet]. 2012 May [citado el 10 de febrero de 2022]; 62(3):191–7. Disponible en: https://doi.org/10.1007/s12576- 012-0197-8.
24. Okamoto H, Tsunoda T, Teruya K, Takeda N, Uemura T, Matsui T, et al. An occupational health study of emergency physicians in Japan: health assessment by immune variables (CD4, CD8, CD56, and NK cell activity) at the beginning of work. J Occup Health. 2008;50(2):136–46.
25. Fialho G, Cavichio L, Povoa R, Pimenta J. Effects of 24-h shift work in the emergency room on ambulatory blood pressure monitoring values of medical residents. Am J Hypertens. 2006;19(10):1005–9.
26. Dutheil F, Marhar F, Boudet G, Perrier C, Naughton G, Chamoux A, et al. Maximal tachycardia and high cardiac strain during night shifts of emergency physicians. Int Arch Occup Environ Health [Internet]. 2017 Jul [citado el 13 de enero de 2022]; 90(6):467–80. Disponible en: https://doi.org/10.1007/s00420-017-1211-5.
27. Tacconelli E. Systematic reviews: CRD’s guidance for undertaking reviews in health care. Lancet Infect Dis. 2010; 10:226-34.
28. Sharma A, Sethi G, Tambuwala MM, Aljabali AA, Chellappan DK, Dua K, et al. Circadian rhythm disruption and Alzheimer’s disease: The dynamics of a vicious cycle. Curr Neuropharmacol [Internet]. 2021 Feb [citado el 21 de febrero de 2022]; 19(2):248–64. Disponible en: https://doi.org/10.2174/1570159X18666200429013041.
29. Brown JP, Martin D, Nagaria Z, Verceles AC, Jobe SL, Wickwire EM. Mental health consequences of shift work: an updated review. Curr Psychiatry Rep [Internet]. 2020 Jan [citado el 20 de febrero de 2022]; 22(2):1–7. Disponible en: https://doi.org/10.1007/s11920- 020-1131-z.
30. Eso V, Caturano A, Vetrani I, Iavicoli I. Shift or night shift work and dementia risk: A systematic review. Eur Rev Med Pharmacol Sci [Internet]. 2021 Feb [citado el 18 de febrero de 2022]; 24(1):222–32. Disponible en: https://doi.org/10.26355/eurrev_202101_24388.
31. Coomans CP, van den Berg SA, Houben T, van Klinken JB, van den Berg R, Pronk AC, et al. Detrimental effects of constant light exposure and high‐fat diet on circadian energy metabolism and insulin sensitivity. FASEB J [Internet]. 2013 Apr [citado el 13 de enero de 2022]; 27(4):1721–32. Disponible en: https://doi.org/10.1096/fj.12-210898.
32. Manenschijn L, van Kruysbergen RG, de Jong FH, Koper JW, van Rossum EF. Shift work at young age is associated with elevated longterm cortisol levels and body mass index. J Clin Endocrinol Metab [Internet]. 2011 Nov [citado el 13 de enero de 2022]; 96(11):E1862–5. Disponible en: https://doi.org/10.1210/jc.2011-1551.
33. Jensen MA, Garde AH, Kristiansen J, Nabe-Nielsen K, Hansen ÅM. The effect of the number of consecutive night shifts on diurnal rhythms in cortisol, melatonin and heart rate variability (HRV): a systematic review of field studies. Int Arch Occup Environ Health [Internet]. 2016 May [citado el 10 de enero de 2022]; 89(4):531–45. Disponible en: https://doi.org/10.1007/s00420-015-1093-3.
34. Garbarino S, Beelke M, Costa G, Violani C, Lucidi F, Ferrillo F, et al. Brain function and effects of shift work: implications for clinical neuropharmacology. 2002;45(1):50–6.
35. Chau YM, West S, Mapedzahama V. Night work and the reproductive health of women: an integrated literature review. J Midwifery Womens Health [Internet]. 2014 Mar [citado el 12 de febrero de 2022]; 59(2):113–26. Disponible en: https://doi.org/10.1111/ jmwh.12052.
36. Shy BD, Portelli I, Nelson LS. Emergency medicine residents’ use of psychostimulants and sedatives to aid in shift work. Am J Emerg Med [Internet]. 2011 Nov [citado el 12 de febrero de 2022]; 29(9):1034–6. Disponible en: https://doi.org/10.1016/j.ajem.2010.06.004.
37. Armanios M, Blackburn EH. The telomere syndromes. Nat Rev Genet [Internet]. 2012 Oct [citado el 10 de enero de 2022]; 13(10):693– 704. Disponible en: https://doi.org/10.1038/nrg3246.
38. Travis RC, Balkwill A, Fensom GK, Appleby PN, Reeves GK, Wang XS, Roddam A, Gathani T, Peto R, Green J, Key T, Beral V. Night shift work and breast cancer incidence: three prospective studies and meta-analysis of published studies. JNCI J Natl Cancer Inst [Internet]. 2016 Oct [citado el 21 de febrero de 2022]; 108(12):169. Disponible en: https://doi.org/10.1093/jnci/djw169.
39. Samulin Erdem J, Notø HØ, Skare Ø, Lie JAS, Petersen‐Øverleir M, Reszka E, Pepłońska B, Zienolddiny S. Mechanisms of breast cancer risk in shift workers: association of telomere shortening with the duration and intensity of night work. Cancer Med [Internet]. 2017 Jul [citado el 20 de febrero de 2022]; 6(8):1988–97. Disponible en: https://doi.org/10.1002/cam4.1135.
40. Molzof HE, Wirth MD, Burch JB, Shivappa N, Hebert JR, Johnson RL, Gamble K. The impact of meal timing on cardiometabolic syndrome indicators in shift workers. Chronobiol Int [Internet]. 2017 Feb [citado el 18 de enero de 2022]; 34(3):337–48. Disponible en: https://doi.org/ 10.1080/07420528.2016.1259242

Desincronización de los ciclos circadianos en el personal de urgencias que realizan turno de noche

Desynchronisation of circadian cycles in emergency room staff on night shift

Resumen

Abstract

Bibliografía