Differences in cortisol profiles and circadian adjustment time between nurses working night shifts and regular day shifts: A prospective longitudinal study
Abstract
Objective This study explored the differences in the circadian salivary cortisol profiles between nurses working night shifts and regular day shifts following a slow rotating shift schedule to assess the number of days required for adjusting the circadian rhythm of salivary cortisol levels in nurses working consecutive night shifts and the number of days off required to restore the diurnal circadian rhythm of salivary cortisol levels.Methods This was a prospective, longitudinal, parallel-group comparative study. The participants were randomly assigned to night and day-shift groups, and saliva samples were collected to measure their cortisol levels and circadian secretion patterns.Results Significant differences were observed in the overall salivary cortisol pattern parameters (cortisol awakening response, changes in cortisol profiles between 6 and 12h after awakening, and changes in cortisol profiles between 30 min and 12 h after awakening) from Days 2 to 4 of the workdays between both groups. However, on Day 2 of the days off, both groups exhibited similar cortisol profiles and the cortisol profiles in the night-shift group were restored.Conclusion Nurses working night shifts require at least 4 days to adjust their circadian rhythms of cortisol secretions. Moreover, on changing from night shift to other shifts, nurses must be allowed more than 2 days off work.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
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?
CAR may have been affected by confounding variables like the diurnal rhythm.
“Additionally, since 70% of our sample consisted of nurses with varying work shifts, CAR may have been affected by confounding variables like the diurnal rhythm [67, 68].”
Cites
GPOWER: A general power analysis program
Erdfelder, E., Faul, F., & Buchner, A. (1996) · Behavior Research Methods, Instruments, & Computers · doi:10.3758/bf03203630 · Cited by 4,864 · see citing works
Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress
Tsigos, C., & Chrousos, G. P. (2002) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00429-4 · Cited by 2,822 · see citing works
The cortisol awakening response (CAR): Facts and future directions
Fries, E., Dettenborn, L., & Kirschbaum, C. (2009) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2008.03.014 · Cited by 1,188 · see citing works
Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Sephton, S. E. (2000) · Journal of the National Cancer Institute · doi:10.1093/jnci/92.12.994 · Cited by 1,082 · see citing works
Assessing salivary cortisol in large-scale, epidemiological research
Adam, E. K., & Kumari, M. (2009) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2009.06.011 · Cited by 936 · see citing works
Day-to-day dynamics of experience–cortisol associations in a population-based sample of older adults
Adam, E. K., Hawkley, L. C., Kudielka, B. M., & Cacioppo, J. T. (2006) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0605053103 · Cited by 782 · see citing works
Bright light resets the human circadian pacemaker independent of the timing of the sleep-wake cycle
Czeisler, C. A., Allan, J. S., Strogatz, S. H., Ronda, J. M., Sánchez, R., Ríos, C. D., Freitag, W. O., Richardson, G. S., & Kronauer, R. E. (1986) · Science · doi:10.1126/science.3726555 · Cited by 770 · see citing works
Is the cortisol awakening rise a response to awakening?
Wilhelm, I., Born, J., Kudielka, B. M., Schlotz, W., & Wüst, S. (2007) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2007.01.008 · Cited by 454 · see citing works
Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety
Scott, L. D., Rogers, A. E., Hwang, W.-T., & Zhang, Y. (2006) · American Journal of Critical Care · doi:10.4037/ajcc2006.15.1.30 · Cited by 408 · see citing works
Schmidt-Reinwald, A., Pruessner, J. C., Hellhammer, D. H., Federenko, I., Rohleder, N., Schürmeyer, T. H., & Kirschbaum, C. (1999) · Life Sciences · doi:10.1016/s0024-3205(99)00103-4 · Cited by 367 · see citing works
Increased injuries on night shift
Smith, L., Folkard, S., & Poole, C. (1994) · The Lancet · doi:10.1016/s0140-6736(94)90636-x · Cited by 289 · see citing works
Diurnal cortisol decline is related to coronary calcification: CARDIA study
Matthews, K., Schwartz, J., Cohen, S., & Seeman, T. (2006) · Psychosomatic Medicine · doi:10.1097/01.psy.0000244071.42939.0e · Cited by 240 · see citing works
Shiftwork experience, age and cognitive performance
Rouch, I., Wild, P. P., Ansiau, D., & Marquié, J.-C. (2005) · Ergonomics · doi:10.1080/00140130500241670 · Cited by 221 · see citing works
Effects of rotating night shifts: literature review
Muecke, S. (2005) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2005.03409.x · Cited by 220 · see citing works
Ageing, working hours and work ability
Costa, G., & Sartori, S. (2007) · Ergonomics · doi:10.1080/00140130701676054 · Cited by 194 · see citing works
Putignano, P., Dubini, A., Toja, P. M., Invitti, C., Bonfanti, S., Redaelli, G., Zappulli, D., & Cavagnini, F. (2001) · European Journal of Endocrinology · doi:10.1530/eje.0.1450165 · Cited by 194 · see citing works
Reliability of Sleep Diaries for Assessment of Sleep/Wake Patterns
Rogers, A. E., Caruso, C. C., & Aldrich, M. S. (1993) · Nursing Research · doi:10.1097/00006199-199311000-00010 · Cited by 176 · see citing works
Psychological, lifestyle and coping contributors to chronic fatigue in shift‐worker nurses
Samaha, E., Lal, S., Samaha, N., & Wyndham, J. (2007) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2007.04338.x · Cited by 146 · see citing works
Changes in cortisol secretion during shiftwork: implications for tolerance to shiftwork?
Hennig, J., KIEFERDORF, P., MORITZ, C., Huwe, S., & Netter, P. (1998) · Ergonomics · doi:10.1080/001401398186784 · Cited by 128 · see citing works
Kudielka, B. M., Buchtal, J., Uhde, A., & Wüst, S. (2006) · Biological Psychology · doi:10.1016/j.biopsycho.2006.08.008 · Cited by 117 · see citing works
Circadian rhythms in cognitive performance: implications for neuropsychological assessment
Valdéz, P., Ramírez, C., & García, A. (2012) · ChronoPhysiology and Therapy · doi:10.2147/cpt.s32586 · Cited by 114 · see citing works
The impact of shift patterns on healthcare professionals
Wilson, J. L. (2002) · Journal of Nursing Management · doi:10.1046/j.1365-2834.2002.00308.x · Cited by 109 · see citing works
Härmä, M., TARJA, H., Kandolin, I., MIKAEL, S., Vahtera, J., Bonnefond, A., & PERTTI, M. (2005) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2005.08.005 · Cited by 95 · see citing works
Circadian rhythms in components of attention
Valdéz, P., Ramírez, C., García, A., Talamantes, J., Armijo, P., & Borrani, J. (2005) · Biological Rhythm Research · doi:10.1080/09291010400028633 · Cited by 92 · see citing works
Endocrine responses to nocturnal eating - possible implications for night work
Holmbäck, U. C., Forslund, A. H., Löwden, A., Forslund, J., Åkerstedt, T., Lennernäs, M. A. ‐., Hambræus, L., & Stridsberg, M. (2003) · European Journal of Nutrition · doi:10.1007/s00394-003-0386-6 · Cited by 79 · see citing works
What is the evidence for less shift work tolerance in older workers?
Blok, M. M., & de Looze, M. P. (2011) · Ergonomics · doi:10.1080/00140139.2010.548876 · Cited by 78 · see citing works
Takeyama, H., Itani, T., Tachi, N., Sakamura, O., Murata, K., Inoue, T., Takanishi, T., Suzumura, H., & Niwa, S. (2004) · Ergonomics · doi:10.1080/00140130412331303920 · Cited by 71 · see citing works
A Comparison of the Effects of Fixed- and Rotating-Shift Schedules on Nursing Staff Attention Levels
Niu, S., Chu, H., Chen, C.-H., Chung, M., Chang, Y., Liao, Y., & Chou, K. (2012) · Biological Research For Nursing · doi:10.1177/1099800412445907 · Cited by 71 · see citing works
Self-citationEffects of working conditions and sleep of the previous day on cognitive performance
Ansiau, D., Wild, P. P., Niezborala, M., Rouch, I., & Marquié, J.-C. (2007) · Applied Ergonomics · doi:10.1016/j.apergo.2007.01.004 · Cited by 60 · see citing works
Experimental shift work studies of permanent night, and rapidly rotating, shift systems
Knauth, P., & Rutenfranz, J. (1976) · International Archives of Occupational and Environmental Health · doi:10.1007/bf00378059 · Cited by 60 · see citing works
Biological and psychological responses to two rapid shiftwork schedules
Lac, G., & Chamoux, A. (2004) · Ergonomics · doi:10.1080/00140130410001724237 · Cited by 53 · see citing works
Hossain, J. L., Reinish, L. W., Heslegrave, R. J., Hall, G. W., Kayumov, L., Chung, S. A., Bhuiya, P., Jovanovic, D., Huterer, N., Volkov, J., et al. (2004) · Journal of Occupational and Environmental Medicine · doi:10.1097/01.jom.0000117421.95392.31 · Cited by 51 · see citing works
Mitani, S., Fujita, M., & Shirakawa, T. (2005) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-005-0026-y · Cited by 27 · see citing works
Thomson, P. C. (2003) · Genetics Selection Evolution · doi:10.1186/1297-9686-35-3-257 · Cited by 19 · see citing works
Is the night shift worth the risk
Perkins, L. A. (2001) · Cited by 16 · see citing works
The effect of age and time of a 24-hour period on accidents at work in operators
Zużewicz, K., & Konarska, M. (2005) · International Congress Series · doi:10.1016/j.ics.2005.02.083 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Orellana-Rios, C. L., Radbruch, L., Kern, M., Regel, Y. U., Anton, A., Sinclair, S., & Schmidt, S. (2018) · BMC Palliative Care · doi:10.1186/s12904-017-0219-7 · Cited by 162 · see citing works
Tabarin, A., Assié, G., Barat, P., Bonnet, F., Bonneville, J. F., Borson-Chazot, F., Bouligand, J., Boulin, A., Brue, T., Caron, P., et al. (2022) · Annales d Endocrinologie · doi:10.1016/j.ando.2022.02.001 · Cited by 59 · see citing works
Molecular Derangements and the Diagnosis of ACTH-Dependent Cushing’s Syndrome
Nieman, L. K. (2022) · Endocrine Reviews · doi:10.1210/endrev/bnab046 · Cited by 33 · see citing works
- Authors
- Niu, S.-F., Chung, M.-H., Chu, H., Tsai, J.-C., Lin, C.-C., Liao, Y.-M., Ou, K.-L., O’Brien, A. P., & Chou, K.-R.
- Affiliations
- Fu Jen Catholic University (TW)
- Taipei Medical University (TW)
- Tri-Service General Hospital (TW)
- Taipei Medical University-Shuang Ho Hospital (TW)
- University of Newcastle Australia (AU)
- Taipei Medical University Hospital (TW)
- Corresponding author
- Chou, Kuei-Ru
- ORCID
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 52
- Issue
- 7
- Pages
- 1193-1201
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W2006140008
- Cited by
- 80
- References
- 36
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 10 · 2023: 5 · 2022: 12 · 2021: 16 · 2020: 4 · 2019: 3 · 2018: 10 · 2017: 5 · 2016: 3
- FWCI
- 9.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Keywords
- salivary cortisol, circadian rhythm, night shift work, rotating shifts, nurses, cortisol awakening response, shift work, rest days
- MeSH terms
- Circadian Rhythm, Humans, Hydrocortisone, Longitudinal Studies, Nursing Staff, Hospital, Prospective Studies, Random Allocation, Saliva, Work Schedule Tolerance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
