Effects of stress on brachial artery flow mediated vasodilatation in doctors after a 24-hour-duty oncall.


Muhammad Ali ROSLEDZANA 1, Nurolaini MUHAMMAD KIFLI 1, Lin NAING 1, Chee Fui CHONG 2

1 Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah (PAPRSB) Institute of Health Science, University Brunei Darussalam, and 2 Thoracic Unit, Department of Surgery, RIPAS Hospital, Brunei Darussalam



Introduction: Psychosocial stress including work-related stress has been shown to cause endothelial dysfunction and plays a role in the aetiology and pathogenesis of a wide range of cardiovascular diseases. Junior doctors are exposed to high levels of daily work-related stress and more so when they are on-call. This study aimed to investigate the adverse effects of stress of being on-call for 24-hours on endothelial function in junior doctors in a busy tertiary referral hospital. Materials and Methods: A prospective single arm study of junior doctors working in a busy tertiary referral hospital was conducted. Junior doctors aged between 25 years and 50 years were recruited to have their brachial artery flow mediated vasodilatation (BAFMD) assessed on the morning, before and after being on-call for 24-hours. Blood supply to the forearm was occluded for 5 minutes and the brachial artery diameter was measured at 1, 2, 3 and 5 minutes post cuff deflation, using a duplex Doppler ultrasound. A within-participant (paired) analysis was performed to compare diameter changes at all time intervals. Results: BAFMD in junior doctors after a 24-hour on-call was significantly attenuated when compared to pre-call BAFMD. This trend was significant at 2 minutes (p=0.03) and 3 minutes (p=0.003) hyperaemic response after cuff release. Analysis on variables such as duration of sleep (<5hrs), gender, racial origin of junior doctors were all significant factors for attenuation of BAFMD after a period of 24 hours on-call. Conclusion: The effect of stress of a 24-hour on-call has significant adverse effects on BAFMD in junior doctors working in a busy tertiary referral hospital. This adverse effect is significantly more prominent in junior doctors who had less than 5 hours of sleep of male gender, of Malay racial origin and of single marital status.


Keywords: Endothelial function, brachial artery flow mediated vasodilatation, junior doctors, stress, on-call


Correspondence: Chee Fui CHONG. Department of Surgery, RIPAS Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. Tel: +673 2242424 Ext 6280. E mail: wcfchong@gmail.com


Brunei Int Med J. 2013; 9 (4): 227-235