This study investigated whether sleep disorder risk and mental health outcomes in firefighters were associated with burnout, particularly emotional exhaustion, and examined the mediating role of ...sleep at work in these relationships. A secondary aim was to investigate associations between habitual sleep characteristics and burnout. North American firefighters (n = 6,307) completed the Maslach Burnout Inventory (emotional exhaustion, depersonalisation, personal accomplishment), and were screened for sleep disorders and self‐reported current mental health conditions and sleep characteristics. Multiple logistic regression analyses examined associations between sleep, mental health outcomes and burnout. Firefighters screening positive for a sleep disorder, particularly insomnia, had increased risk of emotional exhaustion (adjusted odds ratio 3.78, 95% confidence interval 2.97–4.79). Firefighters self‐reporting a current mental health condition were at greater risk of emotional exhaustion (adjusted odds ratio 3.45, 95% confidence interval 2.79–4.27). Sleep during overnight work mediated the impact of having a sleep disorder and mental health condition on high burnout. Sleepiness and sleep deficit (difference between required and actual sleep), even in firefighters without sleep disorder risk, were associated with depersonalisation (adjusted odds ratio 1.65, 95% confidence interval 1.34–2.03 and adjusted odds ratio 1.29, 95% confidence interval 1.06–1.57, respectively) and low personal accomplishment (adjusted odds ratio 1.25, 95% confidence interval 1.07–1.47 and adjusted odds ratio 1.17, 95% confidence interval 1.01–1.35, respectively). Sleep and mental health problems were associated with increased risk of burnout in firefighters, and sleep during overnight work mediated these relationships. The results suggest the need to examine the effectiveness of occupational interventions that improve the opportunity for sleep, together with screening for and treating sleep disorders, to reduce burnout risk.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Heart attacks and motor vehicle crashes are the leading causes of death in US firefighters. Given that sleep disorders are an independent risk factor for both of these, we examined the prevalence of ...common sleep disorders in a national sample of firefighters and their association with adverse health and safety outcomes.
Firefighters (n = 6,933) from 66 US fire departments were assessed for common sleep disorders using validated screening tools, as available. Firefighters were also surveyed about health and safety, and documentation was collected for reported motor vehicle crashes.
A total of 37.2% of firefighters screened positive for any sleep disorder including obstructive sleep apnea (OSA), 28.4%; insomnia, 6.0%; shift work disorder, 9.1%; and restless legs syndrome, 3.4%. Compared with those who did not screen positive, firefighters who screened positive for a sleep disorder were more likely to report a motor vehicle crash (adjusted odds ratio 2.00, 95% CI 1.29-3.12, p = 0.0021) and were more likely to self-report falling asleep while driving (2.41, 2.06-2.82, p < 0.0001). Firefighters who screened positive for a sleep disorder were more likely to report having cardiovascular disease (2.37, 1.54-3.66, p < 0.0001), diabetes (1.91, 1.31-2.81, p = 0.0009), depression (3.10, 2.49-3.85, p < 0.0001), and anxiety (3.81, 2.87-5.05, p < 0.0001), and to report poorer health status (p < 0.0001) than those who did not screen positive. Adverse health and safety associations persisted when OSA and non-OSA sleep disorders were examined separately.
Sleep disorders are prevalent in firefighters and are associated with increased risk of adverse health and safety outcomes. Future research is needed to assess the efficacy of occupational sleep disorders prevention, screening, and treatment programs in fire departments to reduce these safety and health risks.
Sleep deficiency is a hidden cost of our 24-7 society, with 70% of adults in the US admitting that they routinely obtain insufficient sleep. Further, it is estimated that 50-70 million adults in the ...US have a sleep disorder. Undiagnosed and untreated sleep disorders are associated with diminished health for the individual and increased costs for the employer. Research has shown that adverse impacts on employees and employers can be mitigated through sleep health education and sleep disorder screening and treatment programs. Smartphone applications (app) are increasingly commonplace and represent promising, scalable modalities for such programs. The dayzz app is a personalized sleep training program that incorporates assessment of sleep disorders and offers a personalized comprehensive sleep improvement solution. Using a sample of day workers affiliated with a large institution of higher education, we will conduct a single-site, parallel-group, randomized, waitlist control trial. Participants will be randomly assigned to either use the dayzz app throughout the study or receive the dayzz app at the end of the study. We will collect data on feasibility and acceptability of the dayzz app; employee sleep, including sleep behavioral changes, sleep duration, regularity, and quality; employee presenteeism, absenteeism, and performance; employee mood; adverse and safety outcomes; and healthcare utilization on a monthly basis throughout the study, as well as collect more granular daily data from the employee during pre-specified intervals. Our results will illuminate whether a personalized smartphone app is a viable approach for improving employee sleep, health, and productivity. Trial registration: ClinicalTrials.gov Identifier: NCT04224285.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
ObjectivesWe evaluated an online Sleep Health and Wellness (SHAW) programme paired with dayzz, a personalised sleep training programme deployed via smartphone application (dayzz app) that promotes ...healthy sleep and treatment for sleep disorders, among employees at a large healthcare organisation.DesignOpen-label, randomised, parallel-group controlled trial.SettingA healthcare employer in the USA.Participants1355 daytime workers.InterventionParticipants were randomised to intervention (n=794) or control (n=561) on consent. Intervention participants received the SHAW educational programme at baseline plus access to the personalised dayzz app for up to 9 months. The control condition received the intervention at month 10.Primary and secondary outcome measuresOur primary outcome measures were sleep-related behavioural changes (eg, consistent sleep schedule); sleep behaviour tracked on an electronic sleep diary and sleep quality. Our secondary outcome measures included employee absenteeism, performance and productivity; stress, mood, alertness and energy; and adverse health and safety outcomes (eg, accidents).ResultsAt follow-up, employees in the intervention condition were more likely to report increased sleep duration on work (7.20 vs 6.99, p=0.01) and on free (8.26 vs 8.04, p=0.03) nights. At follow-up, the prevalence of poor sleep quality was lower in the intervention (n=160 of 321, 50%) compared with control (n=184 of 327, 56%) (p=0.04). The mean total dollars lost per person per month due to reduced workplace performance (presenteeism) was less in the intervention condition (US$1090 vs US$1321, p=0.001). Employees in the intervention reported fewer mental health visits (RR 0.72, 95% CI 0.56 to 0.94, p=0.01) and lower healthcare utilisation over the study interval (RR 0.81, 95% CI 0.67 to 0.98, p=0.03). We did not observe differences in stress (4.7 (95% CI 4.6 to 4.8) vs 4.7 (95% CI 4.6 to 4.8)), mood (4.5 (95% CI 4.4 to 4.6) vs 4.6 (95% CI 4.5 to 4.7)), alertness (4.9 (95% CI 4.8 to 5.0) vs 5.0 (95% CI 4.9 to 5.1)) or adverse health and safety outcomes (motor vehicle crashes: OR 0.82 (95% CI 0.34 to 1.9); near-miss crashes: OR=0.89 (95% CI 0.5 to 1.5) and injuries: 0.9 (95% CI 0.6 to 1.3)); energy was higher at follow-up in the intervention group (4.3 vs 4.5; p=0.03).ConclusionsResults from this trial demonstrate that a SHAW programme followed by access to the digital dayzz app can be beneficial to both the employee and employer.Trial registration numberNCT04224285
Abstract
Introduction
Working at night leads to shortened and disturbed daytime sleep. Night workers usually adopt one of several sleep patterns between consecutive nights: sleeping right after night ...work (morning sleep), delaying sleep to the afternoon (afternoon sleep), or dividing sleep into two or more episodes (split sleep). However, few studies have examined sleep pattern and duration between consecutive nights in real-world workers. The objective of this study was to examine individual differences in sleep pattern and duration when working consecutive night shifts.
Methods
Night workers (n=241, 43.0±16.5y, 67.2% female) from various occupations who reported working consecutive nights completed an online survey. The survey included questions on socio-demographics and daytime sleep and nap schedules. Sleep pattern (morning vs. afternoon vs. split) and total sleep time (sleep+naps) were derived from survey responses. Cross-tabulations and ANOVA were conducted.
Results
On average, night workers reported a total daytime sleep of 5.37±2.69 hours (range 0-14.25 hours). 65.1% reported morning sleep, 10% afternoon sleep, and 24.9% split sleep. Split sleepers (6.78±2.13 hours) reported longer total sleep than morning (4.86±2.75 hours) or afternoon (5.11±2.37 hours) sleepers. Younger age (< 50y), single marital status, shorter night shift tenure (≤10 years), working ≤3 consecutive shifts, and having ill or disabled dependents were associated with greater prevalence of morning sleep; older age (≥50y), married or separated/widowed, >10 years night shift tenure, working ≥4 consecutive shifts, and having no dependents were associated with greater prevalence of afternoon or split sleep. Having childcare responsibility was associated with more split sleep than no children. Similarly, younger age (< 50y), singles, shorter night shift tenure, working three or fewer consecutive shifts, having ill or disabled dependents, and having a second job were associated with shorter total sleep. However, having childcare responsibility was associated with greater total sleep.
Conclusion
Sleep timing and duration between consecutive nights were influenced by age, marital status, dependents, night work tenure, and number of consecutive night shifts. Future studies are needed to explore what sleep pattern is most beneficial for sleep, performance, safety, and health outcomes of these workers.
Support (if any)
The study was supported by grant R01 AG044416 from the US National Institutes of Health.
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these ...work-hour regulations on physician safety.
All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders.
Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk RR 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio IRR 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort.
The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
Summary
The objective of the study was to determine if sleep disorder, depression or anxiety screening status was associated with safety outcomes in a diverse population of hospital workers. A sample ...of shift workers at four hospitals participated in a prospective cohort study. Participants were screened for five sleep disorders, depression and anxiety at baseline, then completed prospective monthly surveys for the next 6 months to capture motor vehicle crashes, near‐miss crashes, occupational exposures and medical errors. We tested the associations between sleep disorders, depression and anxiety and adverse safety outcomes using incidence rate ratios adjusted for potentially confounding factors in a multivariable negative binomial regression model. Of the 416 hospital workers who participated, two in five (40.9%) screened positive for a sleep disorder and 21.6% screened positive for depression or anxiety. After multivariable adjustment, screening positive for a sleep disorder was associated with 83% increased incidence of adverse safety outcomes. Screening positive for depression or anxiety increased the risk by 63%. Sleep disorders and mood disorders were independently associated with adverse outcomes and contributed additively to risk. Our findings suggest that screening for sleep disorders and mental health screening can help identify individuals who are vulnerable to adverse safety outcomes. Future research should evaluate sleep and mental health screening, evaluation and treatment programmes that may improve safety.
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BackgroundThe Accreditation Council for Graduate Medical Education (ACGME) enacted a policy in 2011 that restricted first-year resident physicians in the USA to work no more than 16 consecutive ...hours. This was rescinded in 2017.MethodsWe conducted a nationwide prospective cohort study of resident physicians for 5 academic years (2002–2007) before and for 3 academic years (2014–2017) after implementation of the 16 hours 2011 ACGME work-hour limit. Our analyses compare trends in resident physician-reported medical errors between the two cohorts to evaluate the impact of this policy change.Results14 796 residents provided data describing 78 101 months of direct patient care. After adjustment for potential confounders, the work-hour policy was associated with a 32% reduced risk of resident physician-reported significant medical errors (rate ratio (RR) 0.68; 95% CI 0.64 to 0.72), a 34% reduced risk of reported preventable adverse events (RR 0.66; 95% CI 0.59 to 0.74) and a 63% reduced risk of reported medical errors resulting in patient death (RR 0.37; 95% CI 0.28 to 0.49).ConclusionsThese findings have broad relevance for those who work in and receive care from academic hospitals in the USA. The decision to lift this work hour policy in 2017 may expose patients to preventable harm.
Sleep Disorders, Health, and Safety in Police Officers Rajaratnam, Shantha M. W; Barger, Laura K; Lockley, Steven W ...
JAMA : the journal of the American Medical Association,
12/2011, Volume:
306, Issue:
23
Journal Article
Peer reviewed
Open access
CONTEXT Sleep disorders often remain undiagnosed. Untreated sleep disorders among police officers may adversely affect their health and safety and pose a risk to the public. OBJECTIVE To quantify ...associations between sleep disorder risk and self-reported health, safety, and performance outcomes in police officers. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional and prospective cohort study of North American police officers participating in either an online or an on-site screening (n=4957) and monthly follow-up surveys (n=3545 officers representing 15 735 person-months) between July 2005 and December 2007. A total of 3693 officers in the United States and Canada participated in the online screening survey, and 1264 officers from a municipal police department and a state police department participated in the on-site survey. MAIN OUTCOME MEASURES Comorbid health conditions (cross-sectional); performance and safety outcomes (prospective). RESULTS Of the 4957 participants, 40.4% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously. Of the total cohort, 1666 (33.6%) screened positive for obstructive sleep apnea, 281 (6.5%) for moderate to severe insomnia, 269 (5.4%) for shift work disorder (14.5% of those who worked the night shift). Of the 4608 participants who completed the sleepiness scale, 1312 (28.5%) reported excessive sleepiness. Of the total cohort, 1294 (26.1%) reported falling asleep while driving at least 1 time a month. Respondents who screened positive for obstructive sleep apnea or any sleep disorder had an increased prevalence of reported physical and mental health conditions, including diabetes, depression, and cardiovascular disease. An analysis of up to 2 years of monthly follow-up surveys showed that those respondents who screened positive for a sleep disorder vs those who did not had a higher rate of reporting that they had made a serious administrative error (17.9% vs 12.7%; adjusted odds ratio OR, 1.43 95% CI, 1.23-1.67); of falling asleep while driving (14.4% vs 9.2%; adjusted OR, 1.51 95% CI, 1.20-1.90); of making an error or safety violation attributed to fatigue (23.7% vs 15.5%; adjusted OR, 1.63 95% CI, 1.43-1.85); and of exhibiting other adverse work-related outcomes including uncontrolled anger toward suspects (34.1% vs 28.5%; adjusted OR, 1.25 95% CI, 1.09-1.43), absenteeism (26.0% vs 20.9%; adjusted OR, 1.23 95% CI, 1.08-1.40), and falling asleep during meetings (14.1% vs 7.0%; adjusted OR, 1.95 95% CI, 1.52-2.52). CONCLUSION Among a group of North American police officers, sleep disorders were common and were significantly associated with increased risk of self-reported adverse health, performance, and safety outcomes.
Abstract
Introduction
Sleep deficiency is a severe problem faced by night shift workers. Approximately one-third of night workers report insomnia during daytime sleep and excessive sleepiness during ...nighttime work; when severe, these symptoms characterize shift work disorder (SWD). Difficulty sustaining 7 to 9 hours of sleep during the daytime is partly due to a circadian drive for wakefulness. Not much is known, however, about how non-work activities contribute to the inability to obtain recovery sleep. We sought to explore how much time night workers are able to allocate for daytime sleep, and how this relates to insomnia-like symptoms and the likelihood of developing SWD.
Methods
Night shift workers (n=452, 19–69 years old, 54% men) from various occupations who worked at least four night shifts per month completed an online survey. This included questions related to shift duration, hours per workday of non-optional non-work activities, self-rated sleep need, the Insomnia Severity Index (ISI) and a validated 4-item SWD screening questionnaire. For each participant, we calculated the duration of work plus non-optional activities and compared the remaining available time for sleep to their self-described sleep need. Non-parametric Chi-square analyses and Pearson correlations were conducted.
Results
On average, shift duration was 8.9±1.6 hours, non-optional activities were 3.6±2.9 hours, and sleep need was 7.6±1.6 hours, leaving 15% of shift workers with insufficient free time to obtain the amount of sleep they needed. The percentage of workers at high risk for SWD was significantly greater among those who did not have enough free time for sleep compared to those whose schedules allowed sufficient sleep time (72% vs. 42%; χ2=20.2, p<0.0001). We also found that shift workers with insufficient free time for sleep reported higher insomnia severity (r2=-0.20, p<0.0001).
Conclusion
About 15% of night workers have non-optional activities outside work that limit their time to obtain sufficient sleep, and this contributes to greater insomnia-like symptoms and increased risk for SWD. Future research should focus on understanding what these non-optional activities are and whether they differ between night and day workers. These insights will enable personalized countermeasures to maximize the sleep and health of shift workers.
Support (if any)
Supported by US NIH grant R01-AG044416.
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