ORIGINAL PAPER
Prolonged job strain reduces time-domain heart rate variability on both working and resting days among cardiovascular-susceptible nurses
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1
University of Insubria, Varese, Italy
(Research Centre in Epidemiology and Preventive Medicine (EPIMED), Department of Clinical and Experimental Medicine)
2
Occupational and Preventive Medicine Units, Varese, Italy
(Ospedale di Circolo-Fondazione Macchi)
3
University of Milano-Bicocca, Monza, Italy (Research Centre in Public Health)
Corresponding author
Marco M. Ferrario
University of Insubria at Varese, Research Centre in Epidemiology and Preventive Medicine (EPIMED), Department of Clinical
and Experimental Medicine, Via O Rossi 9 – Pad Rossi – 1 piano, 21100 Varese, Italy
Int J Occup Med Environ Health. 2015;28(1):42-51
KEYWORDS
ABSTRACT
Introduction: Modifications of hearth rate variability (HRV) constitute a marker of the autonomic nervous system (ANS)
deregulation, a promising pathway linking job strain (JS) and cardiovascular diseases (CVD). The study objective is to assess
whether exposures to recent and prolonged JS reduce time-domain HRV parameters on working days (WD) among
CVD-susceptible nurses and whether the association also persists on resting days (RD). Material and methods: 313 healthy
nurses were investigated twice with one year interval to assess JS based on the demand-control and the effort-reward
models. 36, 9 and 16 CVD-susceptible nurses were classified as low JS in both surveys (stable low strain – SLS), recent
high JS (high JS at the second screening only-RHS) and prolonged high JS (high strain in both surveys-PHS), respectively.
In 9, 7 and 10 of them, free from comorbidities/treatments interfering with HRV, two 24-h ECG recordings were performed
on WD and RD. Differences in the time domain HRV metrics among JS categories were assessed using ANCOVA, adjusted
for age and smoking. Results: In the entire sample (mean age: 39 years, 83% females) the prevalence of high job
strain was 38.7% in the second survey. SDNN (standard deviation of all normal RR intervals) on WD significantly declined
among JS categories (p = 0.02), with geometric mean values of 169.1, 145.3 and 128.9 ms in SLS, RHS, PHS, respectively.
In the PHS group, SDNN remained lower on RD as compared to the low strain subjects (142.4 vs. 171.1 ms, p = 0.02).
Similar findings were found for the SDNN_Index, while SDANN (standard deviation of average RR intervals in all 5 min
segments of registration) mean values reduced in the PHS group during WD only. Conclusions: Our findings suggest that
persistent JS lowers HRV time-domain parameters, supporting the hypothesis that the ANS disorders may play an intermediate
role in the relationship between work stress and CVD.