The Hidden Toll of On-Call Shifts: Reduced Heart Rate Variability and Increased Physiological Stress in Residents-Uncorrected Proof

Kılıç, Şahhan; Asal, Süha; Yılmaz Atinkaya, Ayça; Babaoğlu, Mert; Yavuz, Samet; Çiçek, Vedat; Korkmaz, Yetkin; Çınar, Tufan

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The Hidden Toll of On-Call Shifts: Reduced Heart Rate Variability and Increased Physiological Stress in Residents-Uncorrected Proof [Turk Kardiyol Dern Ars]

Turk Kardiyol Dern Ars. Ahead of Print: TKDA-93450 | DOI: 10.5543/tkda.2026.93450

The Hidden Toll of On-Call Shifts: Reduced Heart Rate Variability and Increased Physiological Stress in Residents-Uncorrected Proof

Şahhan Kılıç¹, Süha Asal¹, Ayça Yılmaz Atinkaya², Mert Babaoğlu³, Samet Yavuz³, Vedat Çiçek⁴, Yetkin Korkmaz³, Tufan Çınar⁵
¹Department of Cardiology, Ministry of Health Çorlu State Hospital, Tekirdağ, Türkiye
²Department of Emergency Medicine, Ministry of Health Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Türkiye
³Department of Cardiology, Health Sciences University Sultan 2. Abdülhamid Han Training and Research Hospital, İstanbul, Türkiye
⁴Department of Cardiology, Ministry of Health Tatvan State Hospital, Bitlis, Türkiye
⁵Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Maryland, USA

Objective: The aim of this study was to assess autonomic dysfunction via heart rate variability (HRV) in residents with on-call shifts.

Method: A cross-sectional study of 140 residents (104 on-call, 36 non-on-call) was conducted. HRV parameters, stress indices, and physical activity (International Physical Activity Questionnaire, IPAQ) were compared using parametric and non-parametric tests.

Results: On-call residents showed elevated heart rates (84 vs. 79 bpm, P = 0.006), higher stress indices (12.1 vs. 9.96, P = 0.003), and reduced parasympathetic markers (root mean square of successive differences [RMSSD], standard deviation of normal-to-normal intervals [SDNN], parasympathetic nervous system index [PNS index]; all P ≤ 0.006). Physical activity did not differ between groups.

Conclusion: An association between on-call shifts and altered autonomic balance was observed, suggesting a potential increase in cardiovascular risk independent of lifestyle factors. These findings may be considered by policymakers when planning resident physician workloads.

Keywords: Autonomic nervous system, exercise, heart rate, internship and residency, physiological, shift work schedule, stress, work schedule tolerance

Corresponding Author: Şahhan Kılıç, Türkiye
Manuscript Language: English

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