William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- What are biologic rhythms?
- How does the "body clock" affect symptoms of illness?
- Heart attack
- High blood pressure (hypertension)
- Hay fever (allergic rhinitis)
- Can the "body clock" affect diagnostic testing?
- Can drug therapy be matched to the "body clock?"
Can the "body clock" affect diagnostic testing?
The body clock's powerful influence can also be seen in the way it affects diagnostic test results. These results can vary significantly, possibly producing inaccurate readings, depending on the time of day when a test is done.
Consider how the body clock affects blood pressure. Blood pressure isn't constant throughout the day and night; it normally rises in the morning, remains elevated during the day and early evening, and decreases to its lowest level during sleep. So a single reading taken during the day may not give a true picture of whether blood pressure is within the normal range or requires treatment. Some doctors now ask patients to wear special monitoring devices that provide a complete 24-hour blood pressure pattern by recording blood pressures a number of times during the day.
The body clock also affects skin testing for allergies. Results are lower in the morning, considerably higher in the evening, and greatest just before bedtime.
The body clock may complicate testing for asthma severity. Airway patency, or degree of openness, is poorest during the night and best during midday and evening. The same is generally true for forced expiratory volume and peak expiratory flow readings, which can be up to 50% higher at midday and in the afternoon than overnight or when the patient wakes up. Unless these circadian rhythms are taken into account, daytime evaluation of asthma patients could result in underestimating the severity of the disease.
What's being done to help doctors obtain the most accurate results from diagnostic tests likely to be affected by the body clock?
Just heightening their awareness of the problem helps. In addition, medical chronobiologists are working to develop test interpretation guidelines for doctors that take circadian rhythms into account.
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