From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Anesth Analg. 2018 Mar;126(3):1013-1018. doi: 10.1213/ANE.0000000000002439.
In residency programs, it is well known that autonomic regulation is influenced by night duty due to workload stress and sleep deprivation. A less investigated question is the impact on the autonomic nervous system of residents before or when anticipating a night duty shift. In this study, heart rate variability (HRV) was evaluated as a measure of autonomic nervous system regulation.
Eight residents in the Department of Anesthesiology were recruited, and 5 minutes of electrocardiography were recorded under 3 different conditions: (1) the morning of a regular work day (baseline); (2) the morning before a night duty shift (anticipating the night duty); and (3) the morning after a night duty shift. HRV parameters in the time and frequency domains were calculated. Repeated measures analysis of variance was performed to compare the HRV parameters among the 3 conditions.
There was a significant decrease of parasympathetic-related HRV measurements (high-frequency power and root mean square of the standard deviation of R-R intervals) in the morning before night duty compared with the regular work day. The mean difference of high-frequency power between the 2 groups was 80.2 ms (95% confidence interval, 14.5-146) and that of root mean square of the standard deviation of R-R intervals was 26 milliseconds (95% confidence interval, 7.2-44.8), with P = .016 and .007, respectively. These results suggest that the decrease of parasympathetic activity is associated with stress related to the condition of anticipating the night duty work. On the other hand, the HRV parameters in the morning after duty were not different from the regular workday.
The stress of anticipating the night duty work may affect regulation of the autonomic nervous system, mainly manifested as a decrease in parasympathetic activity. The effect of this change on the health of medical personnel deserves our concern.
在住院医师培训项目中，众所周知，由于工作量压力和睡眠剥夺，自主调节会受到夜班的影响。一个较少被研究的问题是，居民在值夜班之前或当值夜班时，自主神经系统会受到怎样的影响。在这项研究中，心率变异性（HRV）被评估为自主神经系统调节的一种测量方法。
招募了麻醉科的 8 名住院医师，并在 3 种不同条件下记录了 5 分钟的心电图：（1）正常工作日的早晨（基线）；（2）值夜班前的早晨（ anticipating the night duty）；（3）值夜班后的早晨。计算了时域和频域的 HRV 参数。采用重复测量方差分析比较 3 种条件下的 HRV 参数。
与正常工作日相比，值夜班前的早晨，副交感神经相关的 HRV 测量（高频功率和 RR 间期标准差的均方根）显著降低。两组间高频功率的平均差异为 80.2ms（95%置信区间，14.5-146），RR 间期标准差的均方根差异为 26ms（95%置信区间，7.2-44.8），P 分别为.016 和.007。这些结果表明，副交感神经活动的降低与值夜班的压力有关。另一方面，值夜班后的早晨 HRV 参数与正常工作日没有差异。
值夜班前的压力可能会影响自主神经系统的调节，主要表现为副交感神经活动的降低。这种变化对医务人员健康的影响值得我们关注。
