Shift Work Linked with Risk of Severe Stroke

New research with rats suggests that for the 15 million Americans who don’t have the typical nine-to-five workday, working the graveyard shift or rotating shifts may have serious implications for the brain.

“The body is synchronized to night and day by circadian rhythms — 24-hour cycles controlled by internal biological clocks that tell our bodies when to sleep, when to eat and when to perform numerous physiological processes.”

said David Earnest, Ph.D., a professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M Health Science Center College of Medicine.

“A person on a shift work schedule, especially on rotating shifts, challenges, or confuses, their internal body clocks by having irregular sleep-wake patterns or meal times.”

According to Earnest, it’s not the longer hours — or the weird hours — that is the problem. Instead, it is the change in the timing of waking, sleeping, and eating every few days that “unwinds” our body clocks and makes it difficult for them to maintain their natural, 24-hour cycle.

When body clocks are disrupted, as they are when people go to bed and get up at radically different times every few days, there can be a major impact on health. Earnest and his colleagues have found that shift work can lead to more severe ischemic strokes, the leading cause of disability in the United States, which occur when blood flow is cut off to part of the brain.

Earnest and his team, including colleague Farida Sohrabji, Ph.D., also a professor in the Department of Neuroscience and Experimental Therapeutics and director of the Women’s Health in Neuroscience Program, found that subjects on shift work schedules had more severe stroke outcomes. Those outcomes included both more severe brain damage and loss of sensation and limb movement than those in a control group on regular 24-hour cycles of day and night.

Supported by the American Heart Association, the study also found that males and females show major differences in the degree to which the stroke was exacerbated by circadian rhythm disruption. In males, the gravity of stroke outcomes in response to shift work schedules was much worse than in females, according to the study’s findings.

“These sex differences might be related to reproductive hormones. Young women are less likely to suffer strokes, as compared with men of a similar age, and when they do, the stroke outcomes are likely to be less severe.”

In females, estrogen is thought to be responsible for this greater degree of neuroprotection, she noted:

“Essentially, estrogen helps shield the brain in response to stroke.”

However, older women approaching menopause show increasing incidence of ischemic stroke and poor prognosis for recovery, compared with men at the same age.

Earnest’s earlier work showed that a high-fat diet can also alter the timing of internal body clocks, as well as dramatically increase inflammatory responses that can be a problem in cardio- and cerebrovascular disease. These conditions are caused by problems that affect the blood supply to the brain, which includes stroke as Earnest explains:

“Next we would like to explore whether inflammation is a key link between circadian rhythm disruption and increased stroke severity. With this information, we may be able to identify therapeutic interventions that limit damage after a stroke in patients with a history of shift work. This research has clear implications for shift workers with odd schedules, but probably extends to many of us who keep schedules that differ greatly from day-to-day, especially from weekdays to weekends. These irregular schedules can produce what is known as ‘social jet lag,’ which similarly unwinds our body clocks so they no longer keep accurate time, and thus can lead to the same effects on human health as shift work.”

He adds that people who are in professions where they are on different shifts should be monitored more closely and more frequently for cardio- and cerebrovascular disease and risk factors such as hypertension and obesity.

In the meantime, Earnest suggests that those with irregular sleeping patterns should at least try to maintain regular mealtimes, in addition to avoiding the usual cardiovascular risk factors, such as a high-fat diet, inactivity and smoking.

The study is accepted for publication in the journal Endocrinology.

This guest article originally appeared on Rat Study Shows Shift Work May Be Bad for Brain


Earnest, D. J., Neuendorff, N., Coffman, J., Selvamani, A., & Sohrabji, F. (2016). Sex differences in the impact of shift work schedules on pathological outcomes in an animal model of Ischemic stroke. Endocrinology. doi:10.1210/en.2016-1130


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