Night Shift Work and Incident Atrial Fibrillation: A Systematic Review of Longitudinal Studies

Abstract

Introduction: Circadian disruption from night shift work has been linked to metabolic and cardiovascular disorders. However, its association with atrial fibrillation (AF), the most common arrhythmia, is less established.
Methods: A literature search in Medline, PsycINFO, and CINAHL (2000–2024) identified longitudinal studies examining night shift work exposure and new-onset AF. Exclusion: shift work <1 year, prevalent AF. Risk of bias assessed using ROBINS-E tool.
Results: 9 cohort studies (total 670,000 workers, median follow-up 12 years) met criteria. Five studies reported significant positive associations. Pooled adjusted HR for AF comparing ever vs. never night shift was 1.16 (95%CI 1.05–1.28). Duration-response: >10 years of night shifts increased risk by 35% (HR 1.35, 95%CI 1.15–1.58). Current night shift workers had higher risk than former ones.
Discussion: Possible mechanisms include autonomic imbalance, inflammation (elevated CRP and IL-6), and sleep deprivation leading to atrial remodeling. Heterogeneity across studies in shift intensity and AF ascertainment (ECG vs. administrative codes) limits precision. Healthy worker bias may underestimate risk.
Conclusions: Long-term night shift work is associated with modestly increased AF risk, especially beyond 10 years. Clinicians should consider shift work history in AF risk assessment. Workplace interventions (scheduled rotation, napping) warrant testing.