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Background  Cumulative epidemiological evidence suggests that shift work exerts harmful effects on human health. However, the physiological mechanisms are not well understood. This study aimed to examine the impact of shift work on the dysregulation of the hypothalamic-pituitary-adrenal axis, i.e. diurnal cortisol rhythm.    Methods  Seventy physicians with a mean age 30 years participated in this one-year longitudinal study. Working schedules, either shift work or regular schedules with day shift, were assessed at baseline. Salivary cortisol samples were collected on two consecutive regular working days, four times a day (including waking, + 4 h, + 8 h, and + 16 h), at both baseline and the one-year follow-up. The diurnal cortisol decline (slope) and total cortisol concentration (area under the curve, AUC) were calculated.    Results  After adjusting for cortisol secretion at baseline and numerous covariates, shift work at baseline significantly predicted a steeper slope ( p  < 0.01) and a larger AUC ( p  < 0.05) of diurnal cortisol rhythm at follow-up in this sample of physicians. In particular, waking cortisol at follow-up was significantly higher among those engaged in shift work than day shift ( p  < 0.01).    Conclusions  Our findings support the notion that shift work changes the diurnal cortisol pattern, and is predictive of increased cortisol secretion consequently in junior physicians.

Impact of shift work on the diurnal cortisol rhythm: a one-year longitudinal study in junior physicians