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.

Shift work and the assessment and management of shift work disorder (SWD).

Nearly 20% of the labor force worldwide, work shifts that include work hours outside 07:00 h to 18:00 h. Shift work is common in many occupations that directly affect the health and safety of others (e.g., protective services, transportation, healthcare), whereas quality of life, health, and safety during shift work and the commute home can affect workers in any field. Increasing evidence indicates that shift-work schedules negatively influence worker physiology, health, and safety. Shift work disrupts circadian sleep and alerting cycles, resulting in disturbed daytime sleep and excessive sleepiness during the work shift. Moreover, shift workers are at risk for shift work disorder (SWD). This review focuses on shift work and the assessment and management of sleepiness and sleep disruption associated with shift work schedules and SWD. Management strategies include approaches to promote sleep, wakefulness, and adaptation of the circadian clock to the imposed work schedule. Additional studies are needed to further our understanding of the mechanisms underlying the health risks of shift work, understanding which shift workers are at most risk of SWD, to investigate treatment options that address the health and safety burdens associated with shift work and SWD, and to further develop and assess the comparative effectiveness of countermeasures and treatment options.

Shift work and cancer: the evidence and the challenge.

BACKGROUND: In 2007, the International Agency for Research on Cancer (IARC) classified shift work with circadian disruption or chronodisruption as a probable human carcinogen. Short-term disturbances of biological 24-hour-rhythms following exposures to light and darkness at unusual times are well-known as "jet-lag" and "shift-lag" symptoms. However, that chronic disturbances or disruptions of timely sequenced circadian rhythms (chronodisruption) should contribute to long-term developments of cancer is a relatively new concept. This review provides background and practical information with regard to the open question "does shift-work cause cancer?" METHODS: Overview on the basis of a selective literature search via Medline and ISI Web of Knowledge until 2009 from the viewpoints of occupational medicine, epidemiology, chronobiology, and occupational science. RESULTS: The postulated causal links between shift-work and cancer in humans are biologically plausible in the light of experimental findings, but to date we lack epidemiological studies which could describe or exonerate risks in humans. Monetary compensation has already been paid for such cases in at least one country (Denmark). In Germany, however, according to the applicable law, a new occupational disease can only be recognized when certain conditions for the recognition of "general scientific merit" have been met. We present the current state of knowledge regarding prevention. CONCLUSION: While causal links between shift-work and cancer developments are not established, future shift-work planning should pay more attention to insights from occupational medicine, chronobiology, and occupational science.

Sleepy nurses: are we willing to accept the challenge today?

With a shortage of supply of nurses and the increasing demand for nursing care, hospitals require or allow nurses to work extended shifts (in excess of 12 hours) and many shifts per week (up to and in excess of 60 hours per week). The result of these excessive hours of work is that many nurses care for patients while suffering from sleep deprivation. Sleep deprivation has been shown to negatively impact judgment and performance resulting in errors and accidents. Sleep deprivation also negatively affects the health of individuals. Sleep deprivation in nurses is a significant issue that requires more attention.

Myths and realities of the 80-hour work week.

BACKGROUND: Myths are so ingrained into cultural traditions that emotion frequently overshadows a rational evaluation of the facts. The reduction in resident work hours has resulted in the formation of several myths. The purpose of this review is to examine the published data on resident work hours to separate out myth from reality. METHODS: An electronic database was searched for publications related to resident training, work-hours, continuity of care, sleep deprivation, quality of life, patient safety, clinical/operative experience, faculty work hours, and surgical education. RESULTS: Sleep deprivation has been shown to be harmful, and residents played a role in advocating for work-hour limits. Surgical residents have seen a less dramatic improvement in quality of life compared with other disciplines. Work-hour reductions have decreased participation in clinic but have not resulted in a significant decline in clinical or operative exposure. Limiting resident work hours will unlikely result in a decrease health-care cost. Reduction in resident work hours has not resulted in an improvement or deterioration in patient outcome. Reduction of work hours has not increased faculty work hours nor made surgery a more attractive career choice. CONCLUSIONS: Despite strongly held opinions, resident work-hour reduction has resulted in little significant change in lifestyle, clinical exposure, patient well-being, faculty work hours, or medical student recruitment.

Fetal heart rate patterns and sudden infant death syndrome.

OBJECTIVE: To determine differences in electronic fetal monitoring patterns between infants who died of sudden infant death syndrome and controls. DESIGN: Case-control study (N = 127). SETTING: A tertiary-level women's hospital in Providence, Rhode Island. PARTICIPANTS: Infants born between 1990 and 1998 who subsequently died of sudden infant death syndrome and controls. Demographic and clinical data included medical maternal charts and fetal monitoring records. RESULTS: Compared with controls (n = 98), the mothers whose infants subsequently died of sudden infant death syndrome (n = 29) had lower birthweight babies (sudden infant death syndrome 2,840 vs. controls 3,385 g; p < .01), were younger (22 vs. 28 years; p < .01), were more likely to receive Medicaid health insurance (odds ratio 4.6; confidence interval 1.9-11.2), were more likely to be unmarried (odds ratio 5.2; confidence interval 2.1-12.8), had less intention to breastfeed (26% vs. 57%), and were more likely to smoke (odds ratio 4.6; confidence interval 9-11.2). MAIN OUTCOME MEASURES: There were no statistical differences in fetal heart rate variability or sleep/wake cycles detected between groups. CONCLUSION: Statistical differences were found in demographic characteristics between sudden infant death syndrome mother-infant couples and their controls. However, no differences were detected in the intrapartum electronic fetal monitoring records, specifically in variability and sleep/wake cycles.

[Assessment of excessive day-time sleepiness in professional drivers with suspected obstructive sleep apnea syndrome]. / Evaluación de la somnolencia diurna excesiva en conductores profesionales con sospecha de síndrome de apnea obstructiva durante el sueño.

Excessive daytime sleepiness is a common symptom of obstructive sleep apnea syndrome (OSAS) and can be a cause of traffic accidents, creating a problem of particular importance for professional drivers given the associated death, disability and professional repercussions. We assessed whether the Epworth sleepiness scale (ESS), which is a subjective measure of daytime sleepiness, correlates well with multiple sleep latency (MSL) testing, which gives an objective measure of daytime sleepiness. We also compared each method with the results of polysomnography (apnea-hypopnea index, arousal index and minimum oxygen saturation). We studied 55 professional drivers suspected of OSAS. All answered the ESS questionnaire and underwent polysomnographic and MSL testing. We found a significant, though not relevant, correlation between the degree of excessive daytime sleepiness estimated by the ESS and by MSL testing (r = -0.41; p = 0.002). A significant, though weak, correlation was found between the ESS score and the arousal index (r = 0.26; p < 0.05). Our results do not clarify which method is best for measuring excessive daytime sleepiness in professional drivers suspected of OSAS.

[Shift work, social class and ischemic heart disease in middle-aged and elderly men. A 22-year follow-up in the "Copenhagen Male Study"]. / Skiftearbejde, socialklasse og iskaemisk hjertesygdom hos midaldrende og aeldre maend. 22-års opfølgning i "Copenhagen Male Study".

Shift work has been reported as a risk factor for ischaemic heart disease. Most studies have only partly controlled for social class differences, a recognized risk factor for ischaemic heart disease (IHD), and the relative risk of 1.4 could be a result of confounding. The Copenhagen Male Study was established in 1971 as a prospective cohort study of 5,249 men, and included questions on working time, social class and other potential confounders. The cohort was followed through registers for 22 years. Risk of IHD and all cause mortality did not differ between shift and day workers, the adjusted relative risk for IHD being 0.9 (0.7-1.1). Restriction to social class III led to lower risk estimates, with an adjusted relative risk of 0.7 (0.5-1.0). The study gave no support to the hypothesis that shift work is an independent risk factor for IHD. The role of shift work as an independent risk factor for IHD is still controversial.