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Cited by 517Sleep and Work-Related FatigueCircadian rhythm and melatoninSleep and related disorders

Shift Work: Disrupted Circadian Rhythms and Sleep—Implications for Health and Well-being

Open access
James, Stephen M., Honn, Kimberly A., Gaddameedhi, Shobhan, Van Dongen, Hans P.A.·2017·Current Sleep Medicine Reports
DOI 10.1007/s40675-017-0071-6PMC PMC5647832
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Abstract

Purpose of review Our 24/7 society is dependent on shift work, despite mounting evidence for negative health outcomes from sleep displacement due to shift work. This paper reviews short- and long-term health consequences of sleep displacement and circadian misalignment due to shift work.Recent findings We focus on four broad health domains: metabolic health; risk of cancer; cardiovascular health; and mental health. Circadian misalignment affects these domains by inducing sleep deficiency, sympathovagal and hormonal imbalance, inflammation, impaired glucose metabolism, and dysregulated cell cycles. This leads to a range of medical conditions, including obesity, metabolic syndrome, type II diabetes, gastrointestinal dysfunction, compromised immune function, cardiovascular disease, excessive sleepiness, mood and social disorders, and increased cancer risk.Summary Interactions of biological disturbances with behavioral and societal factors shape the effects of shift work on health and well-being. Research is needed to better understand the underlying mechanisms and drive the development of countermeasures.

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Crossref · 10.1007/s40675-017-0071-6

Cites

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Claims the paper makes

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  • Premisecitation

    Animal models with environmentally disturbed circadian systems (simulated shift work) indicate that circadian disruption increases cancer progression, possibly through cell cycle dysregulation, DNA damage accumulation, and reduced tumor suppression.

    “Findings in animal models with environmentally disturbed circadian systems (simulated shift work) indicate that circadian disruption increases the progression of cancer, possibly through dysregulation of the cell cycle, accumulation of DNA damage, and reduced tumor suppression [49,50,51,52].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [49] Lee S, Donehower LA, Herron AJ, Moore DD, Fu L. Disrupting circadian homeostasis of sympathetic signaling promotes tumor development in mice. PLoS One. 2010;5(6):e10995. doi: 10.1371/journal.pone.0010995 . source

      Not checked in the free run.

    • cites [50] • Kettner NM, Voicu H, Finegold MJ, Coarfa C, Sreekumar A, Putluri N, et al. Circadian homeostasis of liver metabolism suppresses hepatocarcinogenesis. Cancer Cell. 2016;30(6):909–24. doi: 10.1016/j.ccell.2016.10.007 . Study in mice linking circadian misalignment with altered gene expression, liver dysfunction, and carcinogenesis. source

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    • cites [51] • Papagiannakopoulos T, Bauer MR, Davidson SM, Heimann M, Subbaraj L, Bhutkar A, et al. Circadian rhythm disruption promotes lung tumorigenesis. Cell Metab. 2016;24(2):324–31. doi: 10.1016/j.cmet.2016.07.001 . Study in mice showing the effects of circadian disruption on cancer progression in lung tissue. source

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    • cites [52] • Van Dycke KC, Rodenburg W, van Oostrom CT, van Kerkhof LW, Pennings JL, Roenneberg T, et al. Chronically alternating light cycles increase breast cancer risk in mice. Curr Biol. 2015;25(14):1932–7. doi: 10.1016/j.cub.2015.06.012 . Study in mice linking altered light/dark cycles with breast cancer. source

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    • Rests on an assumption: Animal models with environmentally disturbed circadian systems are informative for human shift work cancer risk.
  • Premisecitation

    Sleep displacement and altered meal timing from shift work disturb hormonal balance, including leptin and ghrelin.

    “Sleep displacement and altered meal timing due to shift work disturb hormonal balance—including key regulators of satiety and hunger, the hormones leptin and ghrelin, respectively [13].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Nguyen J, Wright Jr KP. Influence of weeks of circadian misalignment on leptin levels. Nat Sci Sleep. 2009;2:9–18. doi: 10.2147/NSS.S7624 . source

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  • Interpretationnone given

    Circadian misalignment between the biological clock and the sleep/wake cycle increases the risk of workplace accidents and injuries.

    “the implications of circadian misalignment between the biological clock and the sleep/wake cycle are perhaps best illustrated by how such misalignment increases the risk of workplace accidents and injuries.”
    Quote in the paperNot a substantial claim
  • Interpretationreasoning

    Persistent hypothalamic-pituitary-adrenal axis stimulation by external stressors during circadian misalignment may erode mental health in shift workers.

    “Persistent stimulation of the HPA axis by external stressors in the face of circadian misalignment may lead to erosion of mental health in shift workers.”
    Quote in the paperSubstantial claim
  • Interpretationcitation

    Altered sleep/wake schedules associated with shift work may desynchronize peripheral oscillators from the master clock.

    “These peripheral oscillators are normally in sync with the master clock in the SCN, but altered sleep/wake schedules associated with shift work may desynchronize them [46].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] •• Ackermann K, Plomp R, Lao O, Middleton B, Revell VL, Skene DJ, et al. Effect of sleep deprivation on rhythms of clock gene expression and melatonin in humans. Chronobiol Int. 2013;30(7):901–9. doi: 10.3109/07420528.2013.784773 . Demonstration of interaction between sleep loss and circadian misalignment at the level of gene expression. source

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  • May combine two claims. 15
  • Classified as probably not a substantial claim. 1

  • May combine two claims.

    Findingcitation

    Night or early morning shift work leads to shortened and disrupted sleep and excessive sleepiness while awake.

    “This leads to shortened and disrupted sleep, and excessive sleepiness while awake [8,9].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [8] Åkerstedt T. Shift work and disturbed sleep/wakefulness. Occup Med. 2003;53:89–94. doi: 10.1093/occmedkqg046 . source

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    • cites [9] Van Dongen HPA, Dinges DF. Sleep, circadian rhythms, and psychomotor vigilance. Clin Sports Med. 2005;24(2):237–49. doi: 10.1016/j.csm.2004.12.007 . source

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    Premisecitation

    The International Agency for Research on Cancer and the World Health Organization classified night shift work as a probable carcinogen while acknowledging limited human evidence.

    “Based on information from animal models and epidemiological evidence from the shift-working population, the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) has classified night shift work as a probable carcinogen, while acknowledging that there is currently limited evidence from human studies [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Straif K, Baan R, Grosse Y, Secretan B, El Ghissassi F, Bouvard V, et al. Carcinogenicity of shift-work, painting, and fire-fighting. Lancet Oncol. 2007;8(12):1065–6. source

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    Interpretationcitation

    Although causality is unclear, shift work is generally believed to lead to heightened stress reactivity and, in susceptible individuals, insomnia and shift work disorder.

    “Although it is unclear whether disruption of cortisol rhythms is causally involved, it is generally believed that shift work leads to heightened stress reactivity and—in those who are especially susceptible—the development of insomnia and shift work disorder [96].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [96] • Kalmbach DA, Pillai V, Cheng P, Arnedt JT, Drake CL. Shift work disorder, depression, and anxiety in the transition to rotating shifts: the role of sleep reactivity. Sleep Med. 2015;16(12):1532–8. doi: 10.1016/j.sleep.2015.09.007 . Discussion of the effect of sleep disruption from shift work on mental health. source

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    Interpretationcitation

    Variability in cancer findings may relate to individual susceptibility, occupational carcinogen exposure, and lifestyle.

    “The variability in these findings may be related to other contributing factors, such as individual differences in susceptibility to carcinogenesis, occupational exposure to carcinogenic agents, and lifestyle [68,69].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [68] Fritschi L, Glass DC, Heyworth JS, Aronson K, Girschik J, Boyle T, et al. Hypothesis for mechanisms linking shiftwork and cancer. Med Hypothesis. 2011;77:430–6. doi: 10.1016/j.mehy.2011.06.002 . source

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    • cites [69] Purdue MP, Hutchings SJ, Rushton L, Silverman DT. The proportion of cancer attributable to occupational exposures. Ann Epidemiol. 2015;25(3):188–92. doi: 10.1016/j.annepidem.2014.11.009 . source

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    Interpretationcitation

    Stimulation of the desynchronized hypothalamic-pituitary-adrenal axis activates the fear system and blunts the reward system, leading to abnormal stress responses.

    “Stimulation of the (desynchronized) HPA axis activates the fear system and blunts the reward system, leading to abnormal responses to stress [92].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Herman JP, Cullinan WE. Neurocircuitry of stress: central control of the hypothalamo-pituitary-adrenocortical axis. Trends Neurosci. 1997;20(2):78–84. doi: 10.1016/S0166-2236(96)10069-2 . source

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    Interpretationcitation

    Candidate mechanisms for elevated cardiovascular disease risk due to shift work include disrupted 24-hour rhythms of blood pressure and vascular function, atherosclerosis, proinflammatory states, and altered lipid and glucose metabolism.

    “Candidate mechanisms underlying elevated risk for CVD due to shift work include disrupted 24-hour rhythms of blood pressure [84] and vascular function [85], atherosclerosis [86], proinflammatory states [87], and altered lipid and glucose metabolism [88].”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [84] Smolensky MH, Hermida RC, Portaluppi F. Circadian mechanisms of 24-hour blood pressure regulation and patterning. Sleep Med Rev. 2016; doi: 10.1016/j.smrv.2016.02.003 . source

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    • cites [85] • Rodrigo GC, Denniff M. Time-of-day variation in vascular function. Exp Physiol. 2016;101(8):1030–4. doi: 10.1113/EP085780 . Review of the role of circadian rhythmicity in vascular function. source

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    • cites [86] Haupt CM, Alte D, Dorr M, Robinson DM, Felix SB, John U, et al. The relation of exposure to shift work with atherosclerosis and myocardial infarction in a general population. Atherosclerosis. 2008;201(1):205–11. doi: 10.1016/j.atherosclerosis.2007.12.059 . source

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    • cites [87] • Machado RM, Koike MK. Circadian rhythm, sleep pattern, and metabolic consequences: an overview on cardiovascular risk factors. Horm Mol Biol Clin Investig. 2014;18(1):47–52. doi: 10.1515/hmbci-2013-0057 . Overview of the role of circadian rhythms and sleep on risk of cardiovascular disease. source

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    • cites [88] Puttonen S, Härmä M, Hublin C. Shift work and cardiovascular disease-pathways from circadian stress to morbidity. Scand J Work Environ Health. 2010;36(2):96–108. doi: 10.5271/sjweh.2894 . source

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  • May combine two claims.

    Interpretationcitation

    Shortened and disrupted sleep and excessive sleepiness lead to increased workplace errors, greater accident and injury risk, and degraded health.

    “This in turn yields increased errors in the workplace, greater risk of accidents and injuries, and degraded health [10,11].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Folkard S, Lombardi DA, Tucker PT. Shiftwork: safety, sleepiness and sleep. Ind Health. 2005;43(1):20–3. source

      Not checked in the free run.

    • cites [11] Van Dongen HPA, Balkin TJ, Hursh SR. Performance deficits during sleep loss and their operational consequences. In: Kryger M, Roth T, Dement WC, editors. Principles and practice of sleep medicine. Philadelphia: Academic; 2016. p. 682–8.

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Circadian misalignment may alter cellular circadian clock rhythms and is believed to increase cancer risk.

    “Circadian misalignment may alter the rhythms of cellular circadian clocks, and it is believed that this may increase the risk of cancer [48].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [48] • Sancar A, Lindsey-Boltz LA, Gaddameedhi S, Selby CP, Ye R, Chiou YY, et al. Circadian clock, cancer, and chemotherapy. Biochemistry. 2015;54(2):110–23. doi: 10.1021/bi5007354 . Discussion of the role of circadian rhythms in cancer and anti-cancer therapies. source

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  • May combine two claims.

    Premisecitation

    Night shift workers tend to have significantly higher BMI and greater waist-to-hip ratio than day shift workers.

    “Indeed, night shift workers tend to have significantly higher body mass index (BMI) and greater waist-to-hip ratio than day shift workers [22,23,24].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] Morikawa Y, Nakagawa H, Miura K, Soyama Y, Ishizaki M, Kido T, et al. Effect of shift work on body mass index and metabolic parameters. Scand J Work Environ Health. 2007;33(1):45–50. doi: 10.5271/sjweh.1063 . source

      Not checked in the free run.

    • cites [23] Zhao I, Bogossian F, Turner C. Does maintaining or changing shift types affect BMI? A longitudinal study. J Occup Environ Med. 2012;54(5):525–31. doi: 10.1097/JOM.0b013e31824e1073 . source

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    • cites [24] Siqueria K, Griep R, Rotenberg L, Silva-Costa A, Fonseca M. Weight gain and body mass index following change from daytime to night shift—a panel study with nursing professionals. Chronobiol Int. 2016;33(6):776–9. doi: 10.3109/07420528.2016.1167719 . source

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  • May combine two claims.

    Premisecitation

    Working night and rotating shifts is associated with elevated risk of heart disease and ischemic stroke.

    “Working night shifts and rotating shifts has been associated with elevated risk of heart disease [76] and ischemic stroke [77,78].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [76] Pimenta AM, Kac G, De Souza RRC, Ferreira LMBA, Silqueira SMF. Night-shift work and cardiovascular risk among employees of a public university. Rev Assoc Med Bras. 2011;58(2):168–77. doi: 10.1016/S2255-4823(12)70177-7 . source

      Not checked in the free run.

    • cites [77] Hermansson J, Gådin KG, Karlsson B, Lindahl B, Stegmayr B, Knutsson A. Ischemic stroke and shift work. Scand J Work Environ Health. 2007;33(6):435–9. doi: 10.5271/sjweh.1165 . source

      Not checked in the free run.

    • cites [78] Brown DL, Feskanich D, Sanchez BN, Rexrode KM, Schernhammer ES, Lisabeth LD. Rotating night shift work and the risk of ischemic stroke. Am J Epidemiol. 2009;169(11):1370–7. doi: 10.1093/aje/kwp056 . source

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  • May combine two claims.

    Interpretationcitation

    Sympathovagal balance is disrupted by circadian misalignment, as indicated by heart rate variability changes believed to reflect increased cardiovascular disease risk.

    “Sympathovagal balance is then disrupted [72], as indicated by changes in heart rate variability that are believed to reflect increased risk of cardiovascular disease (CVD) [73].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [72] •• Grimaldi D, Carter JR, Van Cauter E, Leproult R. Adverse impact of sleep restriction and circadian misalignment on autonomic function in healthy young adults. Hypertension. 2016;68(1):243–50. doi: 10.1161/HYPERTENSIONAHA.115.06847 . Demonstration of the effects of sleep restriction and circadian misalignment on the autonomic nervous system. source

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    • cites [73] Boudreau P, Dumont GA, Boivin DB. Circadian adaptation to night shift work influences sleep, performance, mood and the autonomic modulation of the heart. PLoS One. 2013;8(7):e70813. doi: 10.1371/journal.pone.0070813 . source

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  • May combine two claims.

    Premisecitation

    Law enforcement professionals have a significantly higher risk of suicide and stress-related and mood disorders than the general public.

    “For example, law enforcement professionals have a significantly higher risk of suicide and stress-related and mood disorders [104] than the general public.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [104] Violanti JM, Charles LE, Hartley TA, Mnatsakanova A, Andrew ME, Fekedulegn D, et al. Shift-work and suicide ideation among police officers. Am J of Industrial Med. 2008;51:758–68. doi: 10.1002/ajim.20629 . source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Increased sleepiness and worsened mood associated with night work make maintaining a healthy lifestyle even more difficult and impede change.

    “Increased sleepiness and worsened mood associated with night work make it even more difficult to maintain a healthy lifestyle, and are a further impediment to change.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Making healthier meal choices is time-consuming and more expensive due to night shift cravings and limited healthy food availability at night.

    “However, actually making healthier meal choices—at odds with the night shift-induced cravings and the limited availability of healthy food options at night—is not only time-consuming but tends to be more expensive as well.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Shift workers with degraded health may transfer to day work, leaving the shift work cohort healthier and the day work cohort less healthy.

    “Shift workers experiencing degraded health or well-being may transfer to the day-working population, leaving the shift work cohort relatively healthier and the day work cohort relatively less so.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Behavioral, societal, and environmental forces may ameliorate or exacerbate the biological consequences of circadian misalignment.

    “When considering the impact of shift work on health and well-being, it is essential to also consider the effects of behavioral, societal and environmental forces that may ameliorate or exacerbate the biological consequences of circadian misalignment.”
    Quote in the paperNot a substantial claim
16 of 16

  • The paper relies on this without support.

    Animal models with environmentally disturbed circadian systems are informative for human shift work cancer risk.

    “Findings in animal models with environmentally disturbed circadian systems (simulated shift work) indicate that circadian disruption increases the progression of cancer, possibly through dysregulation of the cell cycle, accumulation of DNA damage, and reduced tumor suppression [49,50,51,52].”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Shift-work has been associated with increased risk of cancer, obesity, heart disease, gastrointestinal dysfunction, sleep disorders, diabetes and depression.

    “Shift-work has been associated with increased risk of cancer, obesity, heart disease, gastrointestinal dysfunction, sleep disorders, diabetes and depression227.”

    From Rhythms of life: circadian disruption and brain disorders across the lifespan (2019) · cites this paper as [227]

  • Various factors such as shift work, jet lag, social jetlag, exposure to artificial light, and irregular eating time disrupt circadian rhythms.

    “Various factors such as shift work [ 125 ], jet lag [ 126 ], social jetlag [ 127 , 128 ], exposure to artificial light [ 129 ], and irregular eating time [ 130 ] disrupt the circadian rhythms.”

    From Physiological Rhythms and Biological Variation of Biomolecules: The Road to Personalized Laboratory Medicine (2023) · cites this paper as [125]

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Authors
James, S. M., Honn, K. A., Gaddameedhi, S., & Van Dongen, H. P. A.
Affiliations
Washington State University Spokane (US)
ORCID
Venue
Current Sleep Medicine Reports
Publisher
Springer Science and Business Media LLC
Published
2017-04-27
Volume
3
Issue
2
Pages
104-112
ISSN
2198-6401 (ISSN-L)
DOI
10.1007/s40675-017-0071-6
PMC
PMC5647832
OpenAlex
W2607662745
Cited by
517
References
114
Citations by year
2026: 53 · 2025: 94 · 2024: 80 · 2023: 50 · 2022: 73 · 2021: 79 · 2020: 45 · 2019: 23 · 2018: 17 · 2017: 3
FWCI
31.11
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • Current Sleep Medicine Reports (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL124211)
  • National Institute of Environmental Health Sciences (R00ES022640)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
shift work, circadian misalignment, insufficient sleep, metabolic health, cancer risk, cardiovascular disease, mental health, obesity, metabolic syndrome, type 2 diabetes, inflammation, glucose metabolism, immune function, excessive sleepiness, well-being

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