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Night Shift Work and Vascular Function Parameters: A Systematic Review of Occupational and Healthcare Evidence with
Suneet Paulson1, Suresh Sukumar1, Poovitha Shruthi Paramshiva2
1Department of Medical Imaging Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Background:
Shift workers face elevated cardiovascular disease risk. Radiographers represent a unique occupational group exposed to both low-level ionizing radiation and chronic night shift work - each independently associated with subclinical vascular disease - yet no synthesis exists on vascular function in this population.
Objective:
To systematically identify and narratively synthesize evidence on associations between night shift work and objective vascular parameters - including CIMT, PWV, augmentation index, reactive hyperaemia index, and cerebrovascular white matter integrity - and assess applicability to radiographers.
Methods:
A systematic search of Medline, Embase, Web of Science, Scopus, and CINAHL was conducted per PRISMA 2020. Eligible studies were primary observational studies reporting objective vascular outcomes in night shift workers. Risk of bias was assessed using JBI critical appraisal tools. Narrative synthesis with vote-counting was used; meta-analysis was not feasible due to heterogeneity.
Results:
Ten studies from 2,257 records met the inclusion criteria across five vascular outcome domains. Cumulative night shift exposure was associated with increased arterial stiffness (PWV +1.29 m/s over 3 years) and reduced endothelial function (RHI -0.054). Associations were frequently attenuated to non-significance after covariate adjustment, and CIMT findings were directionally inconsistent. Poor sleep quality independently predicted higher CIMT in healthcare workers. Former shift workers showed persistent cerebrovascular white matter changes.
Conclusion:
Current evidence suggests possible associations between night shift work and arterial stiffness, though findings for other vascular outcomes remain inconsistent. No primary data exist for radiographers. The hypothesis of synergistic vascular injury from combined radiation and circadian disruption is biologically plausible but requires direct investigation through longitudinal, occupation-specific studies with standardized vascular outcome measures.
Study Registration:
The review was developed and recorded following the PRISMA guidelines and has been registered with PROSPERO (CRD420261378070) on 24 April 2026.
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