Article Text

other Versions

Download PDFPDF
Original research
Ambulatory blood pressure monitoring among emergency medical services night shift workers
  1. P Daniel Patterson1,
  2. Kristina A Mountz1,
  3. Michael G Agostinelli1,2,
  4. Matthew D Weaver3,4,
  5. Yi-Chuan Yu1,2,
  6. Brandon M Herbert1,2,
  7. Mark A Markosyan1,
  8. David R Hopkins1,
  9. Alana C Alameida1,2,
  10. John A Maloney III1,2,
  11. Sarah E Martin1,
  12. Bridget N Brassil1,2,
  13. Christian Martin-Gill1,
  14. Francis X Guyette1,
  15. Clifton W Callaway1,
  16. Daniel J Buysse5
  1. 1Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  3. 3Departments of Medicine and Neurology, Brigham and Women's Hospital Division of Sleep and Circadian Disorders, Boston, Massachusetts, USA
  4. 4Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
  5. 5Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr P Daniel Patterson, Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; pdp3{at}


Objectives Higher 24-hour blood pressure (BP) and blunted BP dipping during sleep and night-time hours are associated with adverse health outcomes. Night shift work may affect 24-hour BP and dipping patterns, but empirical data in emergency medical services (EMS) clinician shift workers are sparse. We implemented ambulatory blood pressure monitoring (ABPM) in EMS workers to characterise BP during night shift work versus a non-workday, and sleep versus wake.

Methods Participants worked night shifts. Hourly ABPM and wrist actigraphy (to measure sleep) were collected during two 24-hour periods, one scheduled night shift and one non-workday. Blunted BP dipping was defined as a BP decrease of <10%.

Results Of 56 participants, 53 (53.6% female, mean age 26.5 (SD 7.5) years) completed the study. During daytime sleep on a workday, 49.1% of participants had blunted systolic BP (SBP) or diastolic BP (DBP) dipping. During night-time sleep on a non-workday, 25% had blunted SBP dipping and 3.9% blunted DBP dipping. Blunted SBP or DBP dipping occurred among all participants who did not nap during the night shift or who napped <60 min. Blunted SBP dipping occurred in only 14.3% of participants who napped 60–120 min.

Conclusions During night shift work, the BP dipping of EMS shift workers is blunted; however, most who nap for 60 min or longer experience a healthy dip in BP. The potential health consequences of these observations in EMS clinicians warrant further study.

  • shift work
  • cardiovascular
  • sleep

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors PDP, KAM, MDW, CM-G, FXG, CWC and DJB contributed to study conception and study design. PDP, KAM, BMH, MAM, DRH, SEM, CM-G and FXG contributed to execution of the study protocol and/or data collection. PDP, KAM, MGA, MDW, Y-CY, BMH, MAM, DRH, ACA, JAM, SEM, BNB, CM-G, FXG, CWC and DJB contributed to the analysis of study data and interpretation of study findings. All authors contributed to reporting of study results and writing the manuscript.

  • Funding The Pittsburgh Emergency Medicine Foundation (; Pittsburgh, Pennsylvania, USA) and the Linaburg Foundation (Pittsburgh, Pennsylvania, USA) provided funding for this study.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Institutional Review Board of the University of Pittsburgh approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be made available upon reasonable request and based on the data use agreement policies of the University of Pittsburgh.