Obstructive Sleep Apnea Syndrome (OSAS), metabolic syndrome and mental health in small enterprise workers. feasibility of an Action for Health

Sleep in Residents: A Comparison between Anesthesiology and Occupational Medicine Interns

Sleep deprivation is a significant risk to the health and judgment of physicians. We wanted to investigate whether anesthesiology residents (ARs) who work only one night shift per week have different physical and mental health from occupational medicine residents (OMRs) who do not work at night. A total of 21 ARs and 16 OMRs attending a university general hospital were asked to wear an actigraph to record sleep duration, heart rate and step count and to complete a questionnaire for the assessment of sleep quality, sleepiness, fatigue, occupational stress, anxiety, depression and happiness. ARs had shorter sleep duration than OMRs; on average, they slept 1 h and 20 min less (p < 0.001). ARs also had greater daytime sleepiness, a higher heart rate and lower happiness than OMRs. These results should be interpreted with caution given the cross-sectional nature of the study and the small sample size, but they are an incentive to promote sleep hygiene among residents.

Sleep problems are related to commuting accidents rather than to workplace accidents

Background

This study aimed to verify the relationships between sleep problems and both commuting and workplace accidents in workers of both sexes.

Methods

The study was carried out with a sample of workers (n = 2993; 50.2% female) from the Chilean Quality of Life Survey (ENCAVI) 2015–2016, while the rates of both workplace and commuting accidents were extracted from the statistics of the Superintendence of Social Security (SUSESO 2015; 180,036 and 52,629 lost-time accidents, respectively).

Results

Chilean workers sleep less than the rest of the people in the country (M_W = 7.14 vs. M_O = 7.33; t (6789) = − 5.19; p < .001), while the Chilean people as a whole sleep less compared to those of other countries (7.24 h per day). Likewise, it was found that sleep problems are more strongly related to commuting than to workplace accidents. In this vein, sleep quantity can explain 24% of the variance in commuting accidents’ rates (Stepwise Method; R² = .30, F (1.14) = 5.49, p < .05; β = −.55, p < .05), by using aggregated data with all types of commuting roles (driver of a vehicle, a passenger of public or private transport, or as a pedestrian).

Conclusions

Our findings show that sleep quantity has a more robust relationship with commuting than workplace accidents, a neglected issue so far. Future prevention programs should emphasize sleep hygiene and focus on commuting to and from work.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10737-5.

Sleep Health Promotion in the Workplace

Poor sleep and sleepiness in the workplace are associated with accidents. A workplace sleep health promotion program was implemented in an Italian police unit. Of the 242 police officers in the unit, 218 (90%) agreed to take part in the program. A crossover trial was made in which the police officers were divided into two groups that performed sleep health promotion activities in the first and second year, respectively. The first group of officers showed significant sleep improvements at the end of the first year, while the second group had similar or worse parameters than at baseline. At follow-up, a significant improvement in the quantity and quality of sleep was reported in both groups. Sleep improvements at follow-up were associated with a marked reduction in the frequency of accidents at work and near-misses. Before the intervention, sleepiness was the best predictor of injuries (aOR 1.220; CI95% 1.044–1.426) and near-misses (aOR 1.382; CI95% 1.182–1.615). At follow-up, when sleep conditions had improved, insomnia symptoms were the most significant predictors of work accidents (aOR 13.358; CI95% 2.353–75.818). Sleep health promotion can be useful in police officers.

Effect of positive end-expiratory pressure ventilation on plasma nitric oxide, endothelin-1 and vascular celladhesion molecule-1 levels in patients undergoing uvulopalatopharyngoplasty

BACKGROUND

During uvulopalatopharyngoplasty (UPPP), cardiovascular adverse events may occur which can be harmful to patients.

OBJECTIVE

To evaluate the effect of the protective ventilation strategy on the function of vascular endothelial cells.

METHODS

Forty obstructive apnea syndrome (OSA) patients who underwent uvulopalatopharyngoplasty (UPPP) were enrolled. Patients were randomly divided into the control group (group C, PEEP = 0 cm H2O) and PEEP group (group P, PEEP = 5 cm H2O). Each group (n= 20) received intermittent volume controlled ventilation (VCV) with tidal volume 6 ml/kg of the predicted body weight, I:E 1:2, rate titrated for ETCO2 35-45, FiO2 0.7. Blood from the radial artery was sampled for blood gas analysis at four time points: the fifth minute of inhaling pure oxygen (T0), after tracheal intubation (T1), at the end of the operation (T2), and 20 minutes after extubation (T3). Three ml of arterial blood was retained, preserved at -20∘C after serum isolation, and plasma nitric oxide (NO), endothelin-1 (ET-1) and vascular celladhesion molecule-1 (VCAM-1) levels were determined by enzyme linked immunosorbent assay (ELISA).

RESULTS

Compared with group C, plasma ET-1 at T3 decreased in group P, and plasma NO levels at T2 and T3 increased (P< 0.05). Compared with samples collected at T0, plasma VCAM-1 levels at T1, T2 and T3 increased in group C, while plasma VCAM-1 levels at T2 and T3 decreased in group P (P< 0.05). Compared with group C, plasma VCAM-1 levels T2 and T3 decreased in group P (P< 0.05).

CONCLUSIONS

Positive end-expiratory pressure (PEEP) ventilation has a protective effect on vascular endothelial cell function in patients during UPPP.

Association of Anxiety and Depression in Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Background: Obstructive sleep apnea (OSA) has been associated with mental disorders, but the strength of this association is unknown. The aim of our study was to investigate the association among OSA, depression, and anxiety in adults and to quantitatively summarize the results. Methods: A literature search in Medline, PubMed, PsycInfo, Scopus, and Web of Science was conducted. Seventy-three articles were selected for study. Results: The pooled prevalence of depressive and anxious symptoms in OSA patients was 35% (95% CI, 28-41%) and 32% (95% CI, 22-42%), respectively. Conclusions: The association between OSA, anxiety, and depression indicates the value of an early diagnosis and personalized treatment of OSA to improve mental disorders conditioning compliance to therapy. These conditions share a probably bidirectional relationship.

Sleep problems are a strong predictor of stress-related metabolic changes in police officers. A prospective study

OBJECTIVE

Previous studies have shown that workers chronically exposed to occupational stress have an increased risk of metabolic syndrome (MetS) and sleep problems (SPs). The purpose of this study was to verify whether SPs mediate the relationship between stress and MetS.

METHOD

A 5-year prospective cohort study included 242 police officers from a rapid response unit engaged exclusively in maintaining law and order. Perceived stress levels were measured repeatedly with the demand-control-support and the effort-reward-imbalance questionnaires; insomnia symptoms were assessed with the Pittsburgh Sleep Quality Index; excessive daytime sleepiness was measured using the Epworth Sleepiness Scale. MetS and its components were evaluated at baseline and at follow-up.

RESULTS

During 5-year follow-up period, 26 new cases of MetS were identified. Both occupational stress and SPs were significantly related to incident cases of MetS. Insomnia symptoms showed a highly significant association with MetS (aOR 11.038; CI95% 2.867-42.493). Mediation analysis confirmed that SPs mediate the relationship between stress and MetS. A reciprocal relationship was found between job stress and SPs. Work-related stress was a significant predictor of insomnia symptoms, short sleep duration, sleep dissatisfaction, and sleepiness. Compared to the reference group, police officers with SPs at baseline had significantly higher odds of reporting high stress at follow-up.

CONCLUSION

SPs play a mediating role in the relationship between occupational stress and MetS. Prevention of MetS must include the control of stress factors and an increase in the resilience of workers, but correct sleep hygiene is also an essential factor.

Sleep and Mental Health in Truck Drivers: Descriptive Review of the Current Evidence and Proposal of Strategies for Primary Prevention

Background: Professional truck drivers (TDs) are exposed to stressful working (and living) conditions and are vulnerable. They report physical and mental health problems and psychological distress more frequently than the general population and their problems can affect safety on the roads. Actions to improve TDs’ health and reduce the risks of (co-)morbidity or unsafe driving are imperative. Methods: The published studies dealing with the TDs’ sleep habits and mental health were reviewed to define the scenario and organize the preventive strategies proposed thus far. Results: Awareness among TDs of the high risk for health and safety due to (often co-existing) untreated sleep and mental health problems is critical. Alcohol and prescribed or illicit drugs are often misused to compensate for depression, anxiety, job strain, fatigue, and social isolation. Polypharmacy and dependence increase the chance of unsafe behaviors on the road. The TDs’ access to healthcare services is scant, and participation in industry-sponsored wellness programs is limited. Conclusions: Primary prevention is a first unavoidable step to deal with sleep and mental health problems. Educational programs, online support and tele-health assessment/monitoring would help improve the well-being, safety and health of professional TDs and increase safety on the road.

Obstacles and Future Prospects: Considerations on Health Promotion Activities for Older Workers in Europe

The ageing of workers is one of the most important issues for occupational health and safety in Europe. The ageing of the active population means that health promotion is a necessity rather than a mere option. This review considers barriers and perspectives for workplace health promotion for older workers. Lack of awareness on the part of management and inflexibility in the occupational health and safety system appear to be major barriers. To overcome these, it will be necessary to disseminate knowledge regarding the effectiveness of health promotion actions for older workers, encourage greater involvement on the part of social partners, recover resources by replacing medical consumerism and bureaucratic practices, adopt an integrated approach combining the prevention of occupational risks and the promotion of healthy lifestyles, and recognize subsidiarity and the ability of working communities to regulate themselves.

Sleep quality, obstructive sleep apnea, and psychological distress in truck drivers: a cross-sectional study

PURPOSE

Sleep disorders are highly prevalent in truck drivers. The aim of this study is to evaluate the prevalence of self-reported obstructive sleep apnea (OSA) and poor sleep quality in truck drivers, and to analyze the relationship between sleep problems and mental health.

METHODS

A total of 526 male truck drivers (mean age 45.9; DS 9.4) responded to a questionnaire about risk factors for OSA (STOP-Bang), sleep quality perception (Pittsburg sleep questionnaire inventory, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS), and psychological disorders (general health questionnaire, GHQ-12).

RESULTS

It was found that 51.1% of the drivers were at risk of OSA, 17.3% had bad sleep quality, and 8.9% had excessive daytime sleepiness (EDS). The association between psychological distress, OSA (OR = 1.67; CI 95% 0.99-2.83; p = 0.057), bad sleep quality (OR = 2.58; CI 95% 1.52-4.37; p < 0.001), and EDS (OR = 1.65; CI 95% 0.83-3.30; p = 0.151) was assessed.

CONCLUSIONS

The high prevalence of sleep problems, especially suspected OSA, and low quality of sleep in truck drivers can worsen the general and psychological wellbeing of the workers. Educational programs focusing on sleep hygiene and behavioral interventions are needed to promote adequate sleep habits and improve individual and public health.

Associations among inflammation, mental health, and quality of life in adults with metabolic syndrome

BACKGROUND

Metabolic syndrome (MetS), a pro-inflammatory state, has become increasingly common worldwide and is a major risk factor for type 2 diabetes mellitus and cardiovascular disease. Recently, studies on the relationships among inflammation, mental health, quality of life, and other diseases have been conducted.

METHODS

We investigated the relationship between serum high-sensitivity C-reactive protein (hs-CRP) levels, as an indicator of inflammation, and the quality of life and psychiatric symptoms of Korean adults with MetS. The analysis used data from the Korean National Health and Nutrition Examination Survey, a cross-sectional survey of Korean civilians conducted from January to December 2015. Data from 1600 participants were analyzed in this study. Quality of life was assessed using the EuroQol 5-dimension (EQ-5D) instrument.

RESULTS

Serum hs-CRP levels showed a significant inverse correlation with the EQ-5D index of the overall quality of life. High serum hs-CRP levels were positively associated with mobility problems and suicidal ideation in adults with MetS (multivariate-adjusted odds ratio [OR] 1.66, 95% confidence interval [CI] 1.03-2.66, p = 0.036; and multivariate-adjusted OR 2.48, 95% CI 1.23-4.99, p = 0.011).

CONCLUSIONS

These findings suggest that the elevated inflammatory status in MetS is associated with decreased quality of life and mental health problems. Further prospective studies are needed to confirm the impact of inflammation on the quality of life and mental health of adults with MetS.

Sleep, Health and Wellness at Work: A Scoping Review

Many occupational factors may interfere with sleep. Sleep disturbances can, in turn, endanger the health and safety of workers. This rapid review of the literature identifies the main factors that alter the quantity and quality of sleep, indicates the effects these alterations have on the wellbeing of workers and suggests some health promotion measures.

Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

Risk of Occupational Accidents in Workers with Obstructive Sleep Apnea: Systematic Review and Meta-analysis

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is the single most important preventable medical cause of excessive daytime sleepiness (EDS) and driving accidents. OSA may also adversely affect work performance through a decrease in productivity, and an increase in the injury rate. Nevertheless, no systematic review and meta-analysis of the relationship between OSA and work accidents has been performed thus far.

METHODS

PubMed, PsycInfo, Scopus, Web of Science, and Cochrane Library were searched. Out of an initial list of 1,099 papers, 10 studies (12,553 participants) were eligible for our review, and 7 of them were included in the meta-analysis. The overall effects were measured by odds ratios (OR) and 95% confidence intervals (CI). An assessment was made of the methodological quality of the studies. Moderator analysis and funnel plot analysis were used to explore the sources of between-study heterogeneity.

RESULTS

Compared to controls, the odds of work accident was found to be nearly double in workers with OSA (OR = 2.18; 95% CI = 1.53-3.10). Occupational driving was associated with a higher effect size.

CONCLUSIONS

OSA is an underdiagnosed nonoccupational disease that has a strong adverse effect on work accidents. The nearly twofold increased odds of work accidents in subjects with OSA calls for workplace screening in selected safety-sensitive occupations.

COMMENTARY

A commentary on this article appears in this issue on page 1171.

Engagement in Health and Safety at the Workplace

Dramatic changes in the age structure of the population have led to a rise in the age of retirement. An ageing working population may be a problem for companies and for their health and safety services that must face the long-term management of active, chronically ill workers. For sustainability reasons the discipline of occupational medicine must be replaced by occupational health, which not only combats occupational diseases, but actively works to promote the health of older workers. More in general, occupational health has a strong interest in promoting engagement in professional activities. Shifting from a reactive to a proactive logic will take time and require a big effort on the part of employers, employees and health and safety staff in order to develop participatory ergonomics and best health promotion practices in the workplace.

Work Stress and Metabolic Syndrome in Police Officers. A Prospective Study

OBJECTIVE

The aim of this longitudinal study was to evaluate the association between occupational stress and metabolic syndrome (MetS) in a rapid response police unit.

METHOD

Work-related stress was continuously monitored during the 5-year period with both the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models. Blood pressure, body mass index (BMI), waist circumference, triglycerides, HDL-cholesterol, and fasting blood glucose were measured at baseline in January 2009, and in January 2014. 234 out of 290 police officers (81%) completed the follow-up.

RESULTS

The majority of police officers had high stress levels. At follow-up, police officers in the highest quartile of stress had significantly higher mean levels of triglycerides, and lower levels of HDL-cholesterol than their colleagues in the lowest quartile. Police officers with high stress had an increased adjusted risk of developing MetS (aOR = 2.68; CI95% = 1.08-6.70), and hypertriglyceridemia (aOR = 7.86; CI95 = 1.29-48.04). Demand and Effort were significant predictors of MetS.

CONCLUSION

Our study supports the hypothesis that work-related stress induces MetS, particularly through its effects on blood lipids. Future longitudinal studies with continuous monitoring of stress levels will definitively confirm this hypothesis.

Occupational Medicine and Hygiene: applied research in Italy

The goal of Occupational Medicine and Hygiene is that of ensuring safety, health and well-being at workplaces, mainly assessing and preventing existing occupational risks. Scientific research in this field can provide useful arguments and further evidence upon which effective, efficient and sustainable policies and preventive measures have to be chosen and applied by the occupational physician in work-life. This paper summarizes four original studies, conducted in different professional settings across Italy, focusing on critical items, such as stress and violence, biological risks and sleep hygiene. The knowledge obtained can be useful to orientate proper preventive programs aimed at improving workplace health.

Work-Related Psychological Injury Is Associated with Metabolic Syndrome Components in Apparently Healthy Workers

Objective

The aim of this study was to evaluate the association between psychological damage caused by common occupational trauma and metabolic syndrome (MES).

Method

571 workers from 20 small Italian companies were invited to fill in the Psychological Injury Risk Indicator (PIRI) during their routine medical examination at the workplace.

Results

Compared to workers with no psychological injury, workers with a high PIRI score had a significantly increased risk of having at least one metabolic syndrome component (adjusted hazards ratio, 1.8; 95% confidence interval, 1.2 to 2.6). There was a significant increase in the risk of hypertriglyceridemia in male workers (OR 2.53 CI95% 1.03-6.22), and of hypertension in female workers (OR 2.45 CI95% 1.29-4.66).

Conclusion

Psychological injury related to common occupational trauma may be a modifiable risk factor for metabolic syndrome.

Obstructive sleep apnea risk and psychological health among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) cohort study

INTRODUCTION

This study assessed associations of depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) study.

METHOD

A total of 1,035 patients participated. ARES™ score ≥6 defined high OSA risk. Moderate depression was defined by a CES-D score ≥16. Moderate anxiety was measured by a BAI score ≥16.

RESULTS

The mean age was 62 ± 14 years; 70% were female. A total of 93% were diagnosed with hypertension; 61%, diabetes; and 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease; and 10% had a stroke. Logistic regression analysis, adjusting for age and gender, showed that patients with depression had nearly two-fold increased odds of being at risk for OSA (OR 1.75, 95% CI 1.02-2.98, p < 0.05). Patients with anxiety had three-fold increased odds of being at risk for OSA (OR 3.30, 95% CI 2.11-5.15, p < 0.01). After adjusting for marital status and income, patients with anxiety had a 6% increase in OSA risk (OR 1.06, 95% CI 1.04-1.09, p < 0.05), but depression was no longer significant.

CONCLUSION

Our results suggest that non-Hispanic blacks with metabolic syndrome who experience anxiety and/or depression should be screened for OSA.

No evidence for metabolic syndrome and lipid profile differences in patients suffering from bipolar I disorder with and without suicide attempts

OBJECTIVE

The aim of the present study was to provide further evidence of (1) metabolic syndrome and blood lipid profile differences between suicide attempting and non-attempting patients with bipolar disorder (BPD) I and to assess these differences (2) as a function of acute depressive or manic phase.

METHODS

Fifty inpatients (mean age: 36.14 years 48% males) with BPD I took part in the study. After recruitment, patients were clustered in four groups: 13 suicide attempters (SAs) assessed during a manic phase, 12 SAs assessed during a depressive phase, 15 non-SAs assessed during a manic phase, and 10 non-SAs assessed during a depressive phase. Body mass index (BMI), metabolic syndrome, blood pressure, blood lipids (cholesterol, high- and low-density lipids, and triglyceride), and fasting blood sugar were assessed.

RESULTS

Neither metabolic syndrome, blood lipid values, fasting blood sugar, nor BMI or blood pressure differed between the SAs and non-SAs, or between patients in an acute manic phase and those in a depressed phase. The overall prevalence of metabolic syndrome was 26.0%.

CONCLUSION

Among patients with BPD I neither the occurrence of metabolic syndrome nor lipid values or fasting blood sugar are reliable biomarkers of suicidal behavior during either acute depressive or manic phase.