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Burek K, Rabstein S, Kantermann T, Vetter C, Wang-Sattler R, Lehnert M, Pallapies D, Jöckel KH, Brüning T, Behrens T. Altered coordination between sleep timing and cortisol profiles in night working female hospital employees. Psychoneuroendocrinology 2024; 166:107066. [PMID: 38723404 DOI: 10.1016/j.psyneuen.2024.107066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 06/16/2024]
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.
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Affiliation(s)
- Katarzyna Burek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany.
| | - Sylvia Rabstein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Kantermann
- Institute for Labor and Personnel (IAP), University of Applied Sciences for Economics and Management (FOM), Essen, Germany; SynOpus, Bochum, Germany
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO, United States
| | - Rui Wang-Sattler
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany
| | - Martin Lehnert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany
| | - Dirk Pallapies
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance (IPA), Institute of the Ruhr-Universität Bochum, Bochum, Germany
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Martelli M, Salvio G, Lazzarini R, Milinkovic M, Ciarloni A, Balercia G, Santarelli L, Bracci M. Night shift work and serum markers of bone turnover in male shift workers. Chronobiol Int 2023; 40:1270-1278. [PMID: 37781875 DOI: 10.1080/07420528.2023.2262570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023]
Abstract
Night shift work is related to sleep disorders, disruption of circadian rhythm and low serum levels of vitamin D. It is known that all these conditions can adversely affect bone mass. The rate of bone turnover can be assessed through the measurement of molecules called bone turnover markers, including C-terminal telopeptide fragment of type I collagen (CTX) and procollagen type I N-terminal propeptide (P1NP). In this study, we evaluated the serum levels of CTX, P1NP and 25-Hydroxy Vitamin D in 82 male subjects (42 daytime workers and 40 night shift workers) to assess the possible risk of osteoporosis in male shift workers. Serum levels of CTX and P1NP were found to be higher in night shift workers than in daytime workers. No significant difference was found in vitamin D levels between night shift and daytime workers. The increased CTX and P1NP levels reveal a higher rate of bone turnover in night shift workers and thus a possible increased risk of osteoporosis in this category of workers compared with daytime workers. In view of this, our results highlight the importance of further studies investigating the bone health in male night shift workers.
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Affiliation(s)
- Margherita Martelli
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Gianmaria Salvio
- Endocrinology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Raffaella Lazzarini
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Marijana Milinkovic
- Occupational Medicine Unit, Department of Medical and Surgical Specialties, Marche University Hospital, Ancona, Italy
| | - Alessandro Ciarloni
- Endocrinology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Giancarlo Balercia
- Endocrinology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Lory Santarelli
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Massimo Bracci
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
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3
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Bracci M, Zingaretti L, Martelli M, Lazzarini R, Salvio G, Amati M, Milinkovic M, Ulissi A, Medori AR, Vitale E, Ledda C, Santarelli L. Alterations in Pregnenolone and Testosterone Levels in Male Shift Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3195. [PMID: 36833889 PMCID: PMC9964973 DOI: 10.3390/ijerph20043195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 06/01/2023]
Abstract
Steroid hormone levels are closely related to the endogenous circadian rhythm induced by sleep-wake and dark-light cycles. Shift work that disrupts the circadian rhythm may influence the levels of steroid hormones. The association between shift work and alterations in female sex steroid hormone levels has been studied, but little is known about testosterone and its precursor pregnenolone levels in male shift workers. The present study investigated serum pregnenolone and testosterone levels in a group of shift and daytime male workers. All participants were sampled at the beginning of the morning shift. Lower levels of serum pregnenolone and total testosterone were found in the shift workers compared to the daytime workers. Variations in pregnenolone levels may have consequences for well-being, and they might produce consequences for the levels of hormones downstream of the steroid hormone cascade, such as testosterone. The low levels of testosterone found in shift workers demonstrate the perturbative effect of shift work on testosterone serum levels, which may be independent and/or related to pregnenolone synthesis.
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Affiliation(s)
- Massimo Bracci
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Laura Zingaretti
- Occupational Medicine Unit, Management Staff Department, Marche University Hospital, 60126 Ancona, Italy
| | - Margherita Martelli
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Raffaella Lazzarini
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Gianmaria Salvio
- Endocrinology Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Monica Amati
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Marijana Milinkovic
- Occupational Medicine Unit, Department of Medical and Surgical Specialties, Marche University Hospital, 60126 Ancona, Italy
| | - Alfio Ulissi
- Occupational Medicine Unit, Management Staff Department, Marche University Hospital, 60126 Ancona, Italy
| | - Anna Rita Medori
- Occupational Medicine Unit, Management Staff Department, Marche University Hospital, 60126 Ancona, Italy
| | - Ermanno Vitale
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Caterina Ledda
- Section of Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy
| | - Lory Santarelli
- Occupational Health, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, 60126 Ancona, Italy
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4
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Zou H, Zhou H, Yan R, Yao Z, Lu Q. Chronotype, circadian rhythm, and psychiatric disorders: Recent evidence and potential mechanisms. Front Neurosci 2022; 16:811771. [PMID: 36033630 PMCID: PMC9399511 DOI: 10.3389/fnins.2022.811771] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/21/2022] [Indexed: 12/27/2022] Open
Abstract
The circadian rhythm is crucial for physiological and behavioral functions. Chronotype, which represents individual preferences for activity and performance, is associated with human health issues, particularly psychiatric disorders. This narrative review, which focuses on the relationship between chronotype and mental disorders, provides an insight into the potential mechanism. Recent evidence indicates that (1) the evening chronotype is a risk factor for depressive disorders and substance use disorders, whereas the morning chronotype is a protective factor. (2) Evening chronotype individuals with bipolar disorder tend to have more severe symptoms and comorbidities. (3) The evening chronotype is only related to anxiety symptoms. (4) The relationship between chronotype and schizophrenia remains unclear, despite increasing evidence on their link. (5) The evening chronotype is significantly associated with eating disorders, with the majority of studies have focused on binge eating disorders. Furthermore, the underlying mechanisms or influence factors are described in detail, including clock genes, brain characteristics, neuroendocrinology, the light/dark cycle, social factors, psychological factors, and sleep disorders. These findings provide the latest evidence on chronotypes and psychiatric disorders and serve as a valuable reference for researchers.
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Affiliation(s)
- Haowen Zou
- Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hongliang Zhou
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Yan
- Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Zhijian Yao
- Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- *Correspondence: Zhijian Yao,
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
- Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
- Qing Lu,
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Silva L, Dias M, Folgado D, Nunes M, Namburi P, Anthony B, Carvalho D, Carvalho M, Edelman E, Gamboa H. Respiratory Inductance Plethysmography to Assess Fatigability during Repetitive Work. SENSORS 2022; 22:s22114247. [PMID: 35684868 PMCID: PMC9185634 DOI: 10.3390/s22114247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
Cumulative fatigue during repetitive work is associated with occupational risk and productivity reduction. Usually, subjective measures or muscle activity are used for a cumulative evaluation; however, Industry 4.0 wearables allow overcoming the challenges observed in those methods. Thus, the aim of this study is to analyze alterations in respiratory inductance plethysmography (RIP) to measure the asynchrony between thorax and abdomen walls during repetitive work and its relationship with local fatigue. A total of 22 healthy participants (age: 27.0 ± 8.3 yrs; height: 1.72 ± 0.09 m; mass: 63.4 ± 12.9 kg) were recruited to perform a task that includes grabbing, moving, and placing a box in an upper and lower shelf. This task was repeated for 10 min in three trials with a fatigue protocol between them. Significant main effects were found from Baseline trial to the Fatigue trials (p < 0.001) for both RIP correlation and phase synchrony. Similar results were found for the activation amplitude of agonist muscle (p < 0.001), and to the muscle acting mainly as a joint stabilizer (p < 0.001). The latter showed a significant effect in predicting both RIP correlation and phase synchronization. Both RIP correlation and phase synchronization can be used for an overall fatigue assessment during repetitive work.
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Affiliation(s)
- Luís Silva
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Correspondence:
| | - Mariana Dias
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
| | - Duarte Folgado
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
| | - Maria Nunes
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
| | - Praneeth Namburi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- MIT.nano Immersion Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Brian Anthony
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- Device Realization Laboratory, Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Diogo Carvalho
- Faculty of Medicine, Rīga Stradiņš University, 16 Dzirciema iela, LV-1007 Rīga, Latvia;
| | - Miguel Carvalho
- Campus de Azurém, Minho University, 4800-058 Guimarães, Portugal;
| | - Elazer Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; (P.N.); (B.A.); (E.E.)
- Brigham and Women’s Hospital, Cardiovascular Division, 75 Francis Street, Boston, MA 02115, USA
| | - Hugo Gamboa
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys-UNL), Departamento de Física, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, 2829-516 Caparica, Portugal; (M.D.); (D.F.); (H.G.)
- Associação Fraunhofer Portugal Research, Rua Alfredo Allen 455/461, 4200-135 Porto, Portugal;
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Burek K, Rabstein S, Kantermann T, Vetter C, Rotter M, Wang-Sattler R, Lehnert M, Pallapies D, Jöckel KH, Brüning T, Behrens T. Night work, chronotype and cortisol at awakening in female hospital employees. Sci Rep 2022; 12:6525. [PMID: 35443768 PMCID: PMC9021274 DOI: 10.1038/s41598-022-10054-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/25/2022] [Indexed: 11/09/2022] Open
Abstract
To examine the effect of night shift on salivary cortisol at awakening (C1), 30 min later (C2), and on the cortisol awakening response (CAR, the difference between C2 and C1). We compared shift and non-shift workers with a focus on the impact of worker chronotype. Our study included 66 shift-working females (mean age = 37.3 years, SD = 10.2) and 21 non-shift working females (mean age = 47.0 years, SD = 8.9). The shift workers collected their saliva samples at C1 and C2 on each two consecutive day shifts and night shifts. Non-shift workers collected their samples on two consecutive day shifts. We applied linear mixed-effects models (LMM) to determine the effect of night shift on CAR and log-transformed C1 and C2 levels. LMMs were stratified by chronotype group. Compared to non-shift workers, shift workers before day shifts (i.e. after night sleep) showed lower cortisol at C1 (exp [Formula: see text]=0.58, 95% CI 0.42, 0.81) but not at C2. In shift workers, the CARs after night shifts (i.e. after day sleep) were lower compared to CARs before day shifts ([Formula: see text]= - 11.07, 95% CI - 15.64, - 6.50). This effect was most pronounced in early chronotypes (early: [Formula: see text]= - 16.61, 95% CI - 27.87, - 5.35; intermediate: [Formula: see text]= - 11.82, 95% CI - 18.35, - 5.29; late: [Formula: see text]= - 6.27, 95% CI - 14.28, 1.74). Chronotype did not modify the association between night shift and CAR. In our population of shift workers, there was a mismatch between time of waking up and their natural cortisol peak at waking up (CAR) both during day and night shift duties.
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Affiliation(s)
- Katarzyna Burek
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Sylvia Rabstein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Kantermann
- Institute for Labor and Personnel (IAP), University of Applied Sciences for Economics and Management (FOM), Essen, Germany.,SynOpus, Bochum, Germany
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA.,XIMES GmbH, Vienna, Austria
| | - Markus Rotter
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Rui Wang-Sattler
- Research Unit of Molecular Epidemiology, Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Lehnert
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Dirk Pallapies
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Cocco P, Piro S, Meloni F, Montagna A, Pani M, Pilia I, Padoan M, Miligi L, Magnani C, Gambelunghe A, Muzi G, Ferri GM, Vimercati L, Zanotti R, Scarpa A, Zucca M, Latte GC, Angelucci E, De Matteis S, Puligheddu M. Night shift work and lymphoma: results from an Italian multicentre case-control study. Occup Environ Med 2022; 79:452-459. [PMID: 35027441 DOI: 10.1136/oemed-2021-107845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Night shift work can disrupt circadian rhythm and cause chronic sleep deprivation, which might increase the risk of lymphoma through immunosuppression and oxidative stress. MATERIAL AND METHODS We investigated the association between night shift work and risk of lymphoma subtypes in 867 incident cases and 774 controls, who participated in a multicentre Italian study between 2011 and 2017. Based on questionnaire information, occupational experts assessed the lifetime probability of night shift work, the total number of night shifts and years of night shift work among study participants. OR and 95% CI for lymphoma and its major subtypes associated with night shift work was calculated with logistic regression, adjusting by age, gender, education, study area, marital status and family history of haemolymphatic cancer. RESULTS Ever working night shifts was associated with an increase in the risk of chronic lymphocytic leukaemia (CLL) (OR 1.9, 95% CI 1.14 to 3.32), which was highest after a 15-34 years latency. However, there was not a linear increase in risk by probability of exposure, years of night shift work, nor lifetime number of night shifts whether under rotating or permanent work schedules. Risk of lymphoma overall, B cell lymphoma (BCL), its major subtypes other than CLL, and other less prevalent BCL subtypes combined did not show an association. CONCLUSIONS We found conflicting evidence of an association between night shift work and the risk of CLL. We did not observe an association with other lymphoma subtypes.
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Affiliation(s)
- Pierluigi Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy .,Centre for Occupational and Environmental Health, Division of Population Health, The University of Manchester, Manchester, UK
| | - Sara Piro
- Environmental and Occupational Epidemiology Branch - Cancer Risk Factors and Lifestyle Epidemiology Unit, ISPRO - Institute for Prevention, Research, and Cancer Network, Florence, Italy
| | - Federico Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Andrea Montagna
- Department of Medicine and Surgery, Occupational Medicine, Respiratory Diseases and Toxicology Section, University of Perugia, Perugia, Italy
| | - Michele Pani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Ilaria Pilia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Marina Padoan
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Lucia Miligi
- Environmental and Occupational Epidemiology Branch - Cancer Risk Factors and Lifestyle Epidemiology Unit, ISPRO - Institute for Prevention, Research, and Cancer Network, Florence, Italy
| | - Corrado Magnani
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Angela Gambelunghe
- Department of Medicine and Surgery, Occupational Medicine, Respiratory Diseases and Toxicology Section, University of Perugia, Perugia, Italy
| | - Giacomo Muzi
- Department of Medicine and Surgery, Occupational Medicine, Respiratory Diseases and Toxicology Section, University of Perugia, Perugia, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, Bari, Italy
| | - Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, University of Bari, Bari, Italy
| | - Roberta Zanotti
- Department of Haematology, University of Verona, Verona, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Mariagrazia Zucca
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Emanuele Angelucci
- Deaprtment of Haematology, IST - National Institute for Cancer Research, Genova, Italy
| | - Sara De Matteis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Monica Puligheddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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