Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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Job Stress, Heart Rate Variability and Metabolic Syndrome

직무스트레스, 심박동수 변이 및 대사증후군

Chang, Sei-Jin;Koh, Sang-Baek;Choi, Hong-Ryul;Woo, Jong-Min;Cha, Bong-Suk;Park, Jong-Ku;Chen, Yong-Hee;Chung, Ho-Keun
장세진;고상백;최홍열;우종민;차봉선;박종구;천용희;정호근

  • Published : 20040300
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Abstract

Objective: A growing body of literature has documented that job stress is associated with the development of cardiovascular disease. Nevertheless, the pathophysiological mechanism of thisassociation remains unclear. Therefore, we tried to elucidate the relationship between job stress, heart rate variability and metabolic syndrome. Method: The study design was cross-sectional, and 169 industrial workers were recruited. A structured-questionnaire was used to assess the general characteristics and job characteristics (work demand, decision latitude). Heart rate variability (HRV) was recorded using SA-2000 (medi-core). HRV was assessed by time-domain and by frequency-domain analyses. Time domain analysis was performed for SDNN (Standard Deviation of NN interval), and spectral analysis for low-frequency (LF), high-frequency (HF) and total frequency power. Metabolic syndrome was defined on the basis of clustering of risk factors, when three or more of the following cardiovascular risk factors were included in the fifth quintile: glucose, systolic blood pressure, HDL-cholesterol (bottom quintile), triglyceride and waist-hip ratio. Results: The results showed that job characteristics were not associated with cardiovascular risk factors. The high strain group had a less favorable cardiovascular risk profile with higher levels of blood pressure, glucose, homocysteine, and clotting factor than the lower strain group (low strain+passive+active group), but the difference was not statistically significant. The SDNN of HRV was significantly lower in the high strain group than in the low strain group. The prevalence of metabolic syndrome in the low strain, passive, active and high strain groups was 9.7%, 13.9%, 14.9% and 23.8%, respectively. In the high strain group, the metabolic syndrome was significantly related to a decreased SDNN. However, we could not find a significant association in LF/HF ratio. Conclusion: This result suggests that decreased HRV does not play a role in the development of disease; however, it can induce cardiovascular abnormalities or dysfunctions related to the onset of heart disease among high risk groups.

목적: 이 연구는 Karasek의 직업성 긴장 모델에 따라 직무스트레스에 따른 심박동수 변이의 차이를 알아보았으며, 직업성 긴장 수준을 대사증후군에 따라 층화하여 심박동수 변이의 관련성을 알아보고자 하였다. 방법: 이 연구는 영남지역에 위치한 일개 제조업체를 대상으로 2003년 8월 1일부터 10월 30일 까지 종합건강진단에 참여한 40세 이후의 남자 근로자들을 연구대상으로 하였다. 연구대상자는 169명이었고, 구조화된 설문지를 이용하여 사회인구학적 변수, 직업적 특성 등을 조사하였다. 심박동수 변이 측정은 SA-2000E (medi-core를 ) 이용하였고, 크게 시간 영역과 주파수 영역으로 나누어 분석하였다. 시간영역 분석 지표로 S D N N을 사용하였고, 주파수 범위지표들은 LF, HF 및 total power 등을 사용하였다. 대사증후군은 수축기 혈압, 혈당, 중성지방, 고밀도(HDL)콜레스테롤, 허리-엉덩이 둘레비 중세가지 이상이 위험도가 높은 상위 5분위 수에 포함될 경우로 정의하였다. 결과: 직업적 특성에 따른 심혈관계 위험요인의 차이를 알아본 결과, 통계적으로 유의한 차이를 보이는 변수는 없었다. 직업성 긴장수준에 따른 위험인자의 분포는 다른 집단에 비해 고긴장집단이 혈당, 호모시스테인, 혈액응고인자, 혈압 등이 높았으나 통계적으로 유의하지 않았고, 이완기 혈압은 고긴장집단이 가장 높았으며 경계적으로 유의한 차이를 보였다. 심박동수 변이는 고긴장 집단에서 SDNN이 유의한 감소를 보였고, 주파수 영역의 분석지표는 감소하였으나 유의하지 않았다. 직업성긴장수준의 경우 대사증후군은 저긴장, 수동적, 활동적 및 고긴장 집단이 각각 9.7%, 13.9%, 14.9%, 23.8%로 고긴장집단의 경우 저긴장집단에 비해 교차비 2.92로 높았으나 95% 신뢰구간 0.73~11.67로 유의하지 않았다. 직업성 긴장 수준을 대사증후군 여부로 층화하여 심박동수 변이의 차이를 알아보았다. 그 결과 저긴장집단 정상군에 비해 고긴장집단 대사증후군이 있는 위험군에서 심박동수 변이 SDNN이 통계적으로 유의하게 감소하였다. 주파수 분석영역 지표에서는 LF/HF 비가 높아 자율신경계가 과반응을 보이는 것을 시사하였으나 통계적으로 유의하지는 않았다. 결론: 고긴장집단에서의 심박동수의 변이 감소는 질병의 직접적인 지표라고 말할 수는 없으나, 심박동수 변이는 심혈관계의 기능장애를 유발하거나 위험신호로 받아들일수 있다고 판단된다.

Keywords

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