Job stress, burnout, and job satisfaction in sleep apnea patients

Burnout Syndrome and Sleep Quality in Basic Education Teachers in Mexico

Burnout syndrome (BS) is the result of chronic stress in the workplace. Moreover, chronic stress can affect sleep. A unidirectional relationship has been established between burnout and sleep, and it is known that white-collar workers with burnout syndrome have sleep fragmentation and marked daytime sleepiness.

OBJECTIVE

The aim of this study was to assess the relationships between burnout and sleep quality in elementary school teachers in Mexico.

METHODS

We collected data from more than 400 teachers who completed tests. Correlation analyses controlled for anxiety and depression, and Poisson logistic regression analyses were performed to examine the relationships of burnout with sleep quality, depression, and anxiety.

RESULTS

There was a significant correlation between burnout syndrome (mainly in the dimension of emotional exhaustion) and sleep disturbances; significant correlations were also observed with other burnout, depression, and anxiety dimensions. The strength of the correlations decreased after controlling for depression and anxiety.

CONCLUSIONS

The symptoms of burnout syndrome in teachers can overlap with sleep disorders, so it is necessary to make a differential diagnosis to differentiate burnout syndrome from depression and anxiety, among others.

Clarifying sleep characteristics and analyzing risk factors of sleep disorders to promote a predictive, preventive, and personalized medicine in patients with burn scars

Purpose

This study assessed sleep quality in patients with burn scars and investigated risk factors of sleep disorders to guide clinical therapy. From the strategy of predictive, preventive, and personalized medicine (PPPM/3PM), we proposed that risk assessment based on clinical indicators could prompt primary prediction, targeted prevention, and personalized interventions to improve the management of sleep disorders present in patients with burn scars.

Methods

This retrospective study recruited patients with burn scars and healthy volunteers from the Shanghai Burn Treatment Center between 2017 and 2022. Relevant information and data, including demographic characteristics, scar evaluation, and sleep quality, were obtained through the hospital information system, classical scar scale, and self-report questionnaires. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and monitored using a cardiopulmonary-coupled electrocardiograph. Pain and pruritus were assessed using the visual analog scale (VAS). Scar appearance was assessed using the modified Vancouver scar scale (mVSS).

Results

The sample was comprised of 128 hypertrophic scar (HS) patients, with 61.7% males, a mean age of 41.1 ± 11.6 years, and burn area of 46.2 ± 27.9% total body surface area (TBSA). Patients with PSQI ≥ 7 accounted for 76.6%, and the global PSQI score was 9.4 ± 4.1. Objective sleep data showed that initial enter deep sleep time, light sleep time, awakening time, light sleep efficiency, and sleep apnea index were higher but deep sleep time, sleep efficiency, and deep sleep efficiency were lower in HS patients than that in healthy controls. Preliminary univariate analysis showed that age, hyperplasia time of scar, narrow airway, microstomia, VAS for pain and pruritus, and mVSS total (comprised of pigmentation, vascularity, height and pliability) were associated with the PSQI score (p < 0.1). Multivariable linear regression showed narrow airway, VAS for pain and pruritus, and mVSS specifically height, were the risk factors for PSQI score (p < 0.1).

Conclusions

This study model identified that narrow airway, pain, pruritus and scar appearance specifically height may provide excellent predictors for sleep disorders in HS patients. Our results provided a basis for the predictive diagnostics, targeted prevention, and individualized therapy of somnipathy predisposition and progression of HS patients in the setting of PPPM/3PM health care system, which contributed to a paradigm shift from reactive cure to advanced therapy.

Sleep and Safety among Healthcare Workers: The Effect of Obstructive Sleep Apnea and Sleep Deprivation on Safety

Almost one billion people worldwide are affected by Obstructive Sleep Apnea (OSA). Affected individuals experience disordered breathing patterns during sleep, which results in fatigue, daytime drowsiness, and/or sleep deprivation. Working under the influence of these symptoms significantly impairs work productivity and leads to occupational accidents and errors. This impact is seen in healthcare workers (HCWs) who are not immune to these conditions. However, poorly controlled OSA in this subset of individuals takes a heavy toll on patient care due to the increased risk of medical errors and can also alter the mental and physical well-being of the affected HCW in various ways. OSA and safety issues have been recognized and mitigated among the airline and transport industries; however, the healthcare industry lags in addressing these concerns. This article reviews hypersomnolence and sleep disorder as key clinical features of OSA and their effect on HCW safety.

Mental Health Conditions According to Stress and Sleep Disorders

The purpose of this study was to compare associations between stress and sleep disorders (insomnia, hypersomnia, and sleep apnea), identify potential modifying effects, and compare associations between stress and types of sleep disorders with selected mental health conditions. Analyses were based on 21,027 employees aged 18–64 years in 2020 who were insured by the Deseret Mutual Benefit Administrators (DMBA). The risk of stress (2.3%) was significantly greater in women, singles, and those with dependent children. The risk of a sleep disorder was 12.1% (2.1% for insomnia, 1.0% for hypersomnia, and 10.1% for sleep apnea). The risk of stress was significantly greater for those with a sleep disorder (136% overall, 179% for insomnia, and 102% for sleep apnea after adjusting for age, sex, marital status, dependent children, and sleep disorders). The risk of stress among those with sleep apnea was significantly greater for singles than for married individuals. Approximately 9.5% had anxiety, 8.5% had depression, 2.0% had ADHD, 0.6% had bipolar disorder, 0.4% had OCD, and 0.1% had schizophrenia. Each of these mental health conditions was significantly positively associated with stress and sleep disorders. Bipolar disorder and schizophrenia were more strongly associated with stress and sleep disorders than were the other mental health conditions. Insomnia was more strongly associated with anxiety, bipolar disorder, OCD, and schizophrenia than was sleep apnea.

Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea: a systematic review protocol

BACKGROUND

Obstructive sleep apnoea (OSA) is a significant public health problem affecting a large proportion of the population and is associated with adverse health consequences and a substantial economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet the test is expensive, labour intensive and time-consuming. Home-based, limited channel sleep study testing (levels 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA.

METHODS

Eligible studies will be identified using a comprehensive strategy across the following databases from inception onwards: MEDLINE, PsychINFO, SCOPUS, CINAHL, Cochrane Library, Emcare and Web of Science Core Collection and ProQuest databases. The search will include a full economic evaluation (i.e. cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) that assesses limited channel tests and PSG. Two reviewers will screen, extract data for included studies and critically appraise the articles for bias and quality. Meta-analyses will be conducted if aggregation of outcomes can be performed. Qualitative synthesis using a dominance ranking matrix will be performed for heterogeneous data.

DISCUSSION

This systematic review protocol uses a rigorous, reproducible and transparent methodology and eligibility criteria to provide the current evidence relating to the clinical and economic impact of limited channel and full PSG OSA diagnostic tests. Evidence will be examined using standardised tools specific for economic evaluation studies.

TRIAL REGISTRATION

PROSPERO (CRD42020150130).

Is working in the emergency department a risk factor for sleep disorders for healthcare workers?

OBJECTIVE

This study aims to investigate the relationship between work-related stress and sleep disorders in healthcare personnel working in emergency department and in other departments.

MATERIAL AND METHODS

This cross-sectional study included 34 emergency department healthcare personnel (emergency group [EG]) and 35 healthcare personnel working in other departments (non-emergency group [NEG]) and was conducted between November 10, 2019 and March 1, 2020. All participants were administered the following questionnaires: work-related strain inventory (WRSI), Epworth sleepiness scale (ESS), Berlin questionnaire, insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI).

RESULTS

While the mean WRSI score of EG was 39.53±7.77, the mean WRSI score of NEG was 30.06±7.26 (t=5.236, p<0.001). According to PSQI, 79.4% of EG and 57.1% of NEG were found to have poor sleep quality (X²=3.938, df=1, p=0.047). Median PSQI overall score was 12 (IQR 25th-75th percentiles: 10-14) in EG, and 7 (IQR 25th-75th percentiles: 4-9) in NEG (U=285.5, p<0.001). While the mean anxiety score of EG was 13.35±5.70, the mean anxiety score of NEG was 9.06±6.00 (t=3.046, p=0.003). Median depression score was 12 (IQR 25th-75th percentiles: 10-16) in EG, and was 8 (IQR 25th-75th percentiles: 4-12) in NEG (U=354, p=0.004). A significant positive correlation was found between work-related strain scores and sleep quality, sleepiness, and insomnia severity scores (r=0.541, p<0.001; r=0.310, p=0.010; r=0.357, p=0.004; respectively).

CONCLUSION

It was determined that healthcare personnel working in the emergency department were at higher risk of developing sleep disorders compared to healthcare personnel working in other departments and that there was a significant relationship between sleep disorders and work-related stress.

Burnout in university faculty: An interaction between subjective sleep quality and the OXTR rs2268498 polymorphism

BACKGROUND

Job burnout is a stress-related syndrome influenced by both genetic and environmental factors. Poor sleep quality acting as a stressor may lead to job burnout. The oxytocin receptor gene (OXTR) related to stress reactivity may also exert an effect on job burnout. We aimed to explore the effect of sleep quality, a functional OXTR rs2268498 polymorphism, and their interaction on job burnout in the Chinese population, which has not been explored yet.

METHODS

A preliminary study was performed using a cross-sectional design. The Pittsburgh Sleep Quality Index (PSQI) and the Malash Burnout Inventory (MBI) were measured from 575 healthy subjects. The OXTR rs2468498 polymorphism was genotyped in 376 subjects.

RESULTS

There were significant main effects of sleep quality (p<0.05), but not of the OXTR rs2468498 genotype on burnout. Interestingly, the interaction between sleep quality and the rs2468498 genotype was significant (p<0.05). In the poor sleep group, the C allele (C/C and T/C) carriers showed higher Emotional Exhaustion level than T homozygotes, while in the good sleep group, the C allele carrier showed a lower Emotional Exhaustion level.

LIMITATIONS

This study covered subjects from only one university and the sample size for genotyping was relatively small. As we analyzed only the OXTR rs2268498 polymorphism, this study could not reveal the effects of the cerebrospinal oxytocin concentration and the haplotypes.

CONCLUSIONS

Our findings suggest that the OXTR polymorphism modulates the influence of subjective sleep quality on burnout. We conclude that the C allele of the OXTR rs2468498 polymorphism plays a susceptible role in job burnout.

Effect of a Graduated Walking Program on the Severity of Obstructive Sleep Apnea Syndrome. A Randomized Clinical Trial

Background: Obstructive sleep apnea syndrome (OSAS) is a common disease. The objective of this research was to determine the effectiveness of a graduated walking program in reducing the apnea–hypopnea index number in patients with obstructive sleep apnea syndrome (OSAS). Methods: A randomized controlled clinical trial with a two-arm parallel in three tertiary hospitals was carried out with seventy sedentary patients with moderate to severe OSAS. Twenty-nine subjects in each arm were analyzed by protocol. The control group received usual care, while usual care and an exercise program based on progressive walks without direct supervision for 6 months were offered to the intervention group. Results: The apnea–hypopnea index decreased by six points in the intervention group, and improvements in oxygen desaturation index, total cholesterol, and Low-Density Lipoprotein of Cholesterol (LDL-c) were observed. A higher decrease in sleep apnea–hypopnea index (45 ± 20.6 vs. 34 ± 26.3/h; p = 0.002) was found in patients with severe vs. moderate OSAS, as well as in oxygen desaturation index from baseline values (43.3 vs. 34.3/h; p = 0.046). Besides, High-Density Lipoprotein of Cholesterol (HDL-c) values showed a higher increase in the intervention group (45.3 vs. 49.5 mg/dL; p = 0.009) and also, a higher decrease in LDL-c was found in this group (141.2 vs. 127.5 mg/dL; p = 0.038). Conclusion: A home physical exercise program is a useful and viable therapeutic measure for the management of OSAS.

Association of sleep quality with job burnout among Chinese coal mine staff: a propensity score weighting analysis

This study examines the association of sleep quality with job burnout among Chinese coal mine staff. 3832 subjects were selected from a coal mine group located in Shanxi Province in China. Job burnout was evaluated by the Maslach Burnout Inventory-General Survey and sleep quality was acquired with a self-reported questionnaire. We used the inverse probability of treatment weighting with propensity score to mimic the randomization and to minimize bias in estimations. Sensitivity analysis was conducted to test the robustness of our findings. We identified that good sleep quality was significantly associated with lower risk of job burnout (OR: 0.70; 95%CI, 0.60 to 0.82, p = 6.02e-06), with 0.21 decrease in the score of exhaustion (95%CI,−0.29 to −0.12, p = 5.00e-06), and with 0.13 decrease in the score of cynicism (95%CI,−0.21 to −0.04, p = 3.73e-03). Sensitivity analysis demonstrated that the results were robust to the choice of estimation models, as well as unmeasured confounding. Stratification analysis demonstrated that the associations of sleep quality with job burnout were largely heterogeneous for male and female workers. This study implicated that good sleep quality benefits the workers in relief of job burnout. Further research may be warranted in support of a definite causal relationship and intervention strategy.

Associations between sleep disturbances, mental health outcomes and burnout in firefighters, and the mediating role of sleep during overnight work: A cross-sectional study

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.

Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta-analysis

Lifestyle interventions addressing diet, exercise-training, sleep hygiene, and/or tobacco/alcohol cessation are recommended in the management of obstructive sleep apnoea (OSA). Yet their effectiveness on this condition still requires further research. This systematic review and meta-analysis was aimed at establishing (a) the effectiveness of lifestyle interventions on apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), excessive daytime sleepiness (EDS), and secondary OSA measures among adults, and (b) which intervention characteristics may drive the greatest improvements. A systematic search of studies was conducted using CINAHL, ProQuest, Psicodoc, Scopus, and Web of Science, from inception to April 2018. Standardized mean differences were calculated using the inverse variance method and random-effects models. The meta-analyses of 13 randomized controlled trials and 22 uncontrolled before-and-after studies (1420 participants) revealed significant reductions on AHI (d = -0.61 and -0.46, respectively), ODI (d = -0.61 and -0.46) and EDS (d = -0.41 and -0.49). Secondary OSA outcomes were also improved after interventions. However, effectiveness of interventions differed depending on their components, OSA severity, and gender. Thus, until future research further supports the differential effectiveness among lifestyle interventions on OSA, those addressing weight loss through diet and exercise-training may be the most effective treatments for male patients with moderate-severe OSA.

Determinants of sleepiness in obstructive sleep apnea

STUDY OBJECTIVES

Significant interindividual variability in sleepiness is observed in clinical populations with obstructive sleep apnea (OSA). This phenomenon is only partially explained by the apnea-hypopnea index (AHI). Understanding factors that lead to sleepiness is critical to effective management of patients with OSA. We examined demographic and other factors associated with sleepiness in OSA.

METHODS

Prospective study of 283 patients with newly diagnosed OSA by polysomnography (AHI ≥ 5 per hour). Subjective sleepiness (Epworth Sleep Scale [ESS] ≥ 11) and objective sleepiness (psychomotor vigilance task [PVT] mean lapse ≥ 2) were assessed.

RESULTS

Participants were classified into four groups (1: sleepy by ESS and PVT, 2: sleepy by PVT only, 3: sleepy by ESS only, and 4: nonsleepy reference group) and compared by generalized logit model. Shorter daily sleep duration by actigraphy and less morningness were associated with higher risk of sleepiness (Odds ratio [OR] = 0.52, 95% confidence interval [CI] 0.33-0.82 and OR = 0.89, CI 0.80-0.98, respectively). African-American race was associated with sleepiness (group 1, OR = 8.8, CI 2.8-27.3; group 2, OR = 16.6, CI 3.3-83.6; and group 3, OR = 3.3, CI 1.0-10.1). IL-6 level was higher in groups 1 and 3 (OR = 1.9, CI 1.0-3.4 and OR 2.0, CI 1.1-3.7, respectively).

CONCLUSIONS

African-American race, short sleep duration, chronotype, and increased proinflammatory cytokine IL-6 level were associated with sleepiness in OSA. These findings will inform future investigations determining mechanisms of sleepiness in OSA.

Clinical consequences and economic costs of untreated obstructive sleep apnea syndrome

Objective

To provide an overview of the healthcare and societal consequences and costs of untreated obstructive sleep apnea syndrome.

Data sources

PubMed database for English-language studies with no start date restrictions and with an end date of September 2014.

Methods

A comprehensive literature review was performed to identify all studies that discussed the physiologic, clinical and societal consequences of obstructive sleep apnea syndrome as well as the costs associated with these consequences. There were 106 studies that formed the basis of this analysis.

Conclusions

Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death. These consequences result in significant economic burden. Both, the health and societal consequences and their costs can be decreased with identification and treatment of sleep apnea.

Implications for practice

Treatment of obstructive sleep apnea syndrome, despite its consequences, is limited by lack of diagnosis, poor patient acceptance, lack of access to effective therapies, and lack of a variety of effective therapies. Newer modes of therapy that are effective, cost efficient and more accepted by patients need to be developed.