J Neurol. 2026 Apr 19;273(5):280. doi: 10.1007/s00415-026-13827-9.
ABSTRACT
BACKGROUND: Shift work is highly prevalent globally, yet evidence linking it to ischemic cerebrovascular disease remains inconsistent. Existing studies are limited by unsystematic quantification of night shift exposure and outcome definitions failing to capture the clinical continuum of ischemic events. We performed a large prospective cohort study using refined shift pattern classification and acute ischemic cerebrovascular syndrome (AICS) as the primary end point to enable a robust evaluation of the association between shift patterns and ischemic cerebrovascular disease.
METHODS: 204,261 participants with employment information from the UK Biobank were included. Cox proportional hazards regression was used to assess associations between current shift work and AICS risk, with cross-classification by shift status and job duration. We further quantified average lifetime night shift frequency and cumulative duration among participants with complete occupational histories. Transient ischemic attack (TIA) and ischemic stroke (IS) were analyzed separately to identify the main driver of AICS and potential heterogeneity.
RESULTS: During a median follow-up exceeding 14 years, irregular shift work was significantly associated with elevated AICS risk (HR 1.118, 95% CI 1.019-1.227, P = 0.019), while always night shift work was not (HR 0.904, 95% CI 0.707-1.157, P = 0.423). AICS risk was driven by irregular shift patterns rather than duration. Lifetime night shift frequency and duration showed significant dose-response relationships with AICS.
CONCLUSIONS: Irregular shift work increases AICS risk relative to non-shift work, and lifetime night shift exposure exhibits a clear dose-response effect. IS constitutes the primary driver of the composite AICS end point.
PMID:42001336 | DOI:10.1007/s00415-026-13827-9