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0248 Predicting physician’s duty stress by parasympathetic nervous function (also to be considered for mini-symposium: Early detection and management of workers under stress)
  1. Hsiu-Hao Lee1,2,
  2. Bing-Yu Chen1,
  3. Shih-Hsiang Lo2,
  4. Pau-Chung Chen1,
  5. Yue-Liang Guo1,3
  1. 1Institution of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
  2. 2Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan
  3. 3Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and NTU Hospital, Taipei, Taiwan


Objectives Early stress markers are useful in detecting workers with occupational stress. The aim of this study was to determine whether heart rate variability was associated with physicians’ duty loading, and also a good predictor for stress markers.

Method An observational study on physicians with variable duty loading was conducted in a secondary referral medical centre in northern Taiwan in 2012. For every participant, 24-hr electrocardiography (EKG) and hourly blood pressure were obtained during three test days, i.e., regular-duty (only day shift), moderate-duty (day and night-shift with moderate number of patients cared), and high-duty days (day and night-shift with higher number of patients cared). Blood samples for stress markers were obtained at 8 am on the test day, and 8 am on the second morning.

Results A total of 12 staff physicians satisfactorily completed the study. The number of patients covered at night shift was 0, 92 ± 8, and 187 ± 9, for regular-, moderate-, and high-duty nights, respectively. Total phone calls, urgent procedures, new patients admitted, critical patients cared and times of awakenings were significantly higher as the duty loads increased. The parasympathetic indicator derived from continuous EKG, high frequency normalised unit (HFnu), was negatively related to loading of total patient cared (P < 0.0001). Reduced HFnu predicted elevated night systolic blood pressure (P = 0.016) and serum uric acid (P = 0.024), and 24 h urine vanillylmandelic acid (P = 0.0045), dopamine (P = 0.011), and norepinephrine (P = 0.027).

Conclusions HFnu derived from heart rate variability measurement may predict several important stress markers during nightshift duties.

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