Assessment and management of sleep disorders in shift workers: Challenges and considerations for general practice.

BACKGROUND: Shift work is characterised by displaced sleep opportunities and associated sleep disturbance. Shift workers often report sleepiness and other wake time symptoms associated with poor sleep. However, clinical sleep disorders are also prevalent in shift workers. Although prevalence rates are similar or higher in shift workers compared with the general population, help seeking in shift workers with sleep disorders is low. OBJECTIVE: This article aims to provide general practitioners with a contemporary overview of the prevalence rates for sleep disorders in shift workers, to clarify the existing evidence relating to mental and physical health consequences of sleep disorders in shift workers and to highlight the need to consider undiagnosed sleep disorders before attributing sleep-related symptoms solely to work schedules. DISCUSSION: Symptoms of sleep loss associated with shift work overlap with symptoms experienced by individuals living with sleep disorders. Although >40% of middle-aged Australians live with a sleep disorder that requires investigation and management, symptoms in shift workers are often attributed to the work schedule and, as a result, might not be investigated for appropriate diagnosis and treatment. We argue that screening for sleep disorders in shift workers with sleep complaints should be a priority.

A pre-drive ocular assessment predicts alertness and driving impairment: A naturalistic driving study in shift workers.

Sleepiness is a major contributor to motor vehicle crashes and shift workers are particularly vulnerable. There is currently no validated objective field-based measure of sleep-related impairment prior to driving. Ocular parameters are promising markers of continuous driver alertness in laboratory and track studies, however their ability to determine fitness-to-drive in naturalistic driving is unknown. This study assessed the efficacy of a pre-drive ocular assessment for predicting sleep-related impairment in naturalistic driving, in rotating shift workers. Fifteen healthcare workers drove an instrumented vehicle for 2 weeks, while working a combination of day, evening and night shifts. The vehicle monitored lane departures and behavioural microsleeps (blinks >500 ms) during the drive. Immediately prior to driving, ocular parameters were assessed with a 4-min test. Lane departures and behavioural microsleeps occurred on 17.5 % and 10 % of drives that had pre-drive assessments, respectively. Pre-drive blink duration significantly predicted behavioural microsleeps and showed promise for predicting lane departures (AUC = 0.79 and 0.74). Pre-drive percentage of time with eyes closed had high accuracy for predicting lane departures and behavioural microsleeps (AUC = 0.73 and 0.96), although was not statistically significant. Pre-drive psychomotor vigilance task variables were not statistically significant predictors of lane departures. Self-reported sleep-related and hazardous driving events were significantly predicted by mean blink duration (AUC = 0.65 and 0.69). Measurement of ocular parameters pre-drive predict drowsy driving during naturalistic driving, demonstrating potential for fitness-to-drive assessment in operational environments.