Excessive Daytime Sleepiness and Safety Performance: Comparing Proactive and Reactive Approaches

Estimated prevalence of obstructive sleep apnea by occupation and industry in England: a descriptive study

Study Objectives

Obstructive sleep apnea (OSA) can induce excessive sleepiness, causing work-related injuries and low productivity. Most individuals with OSA in the United Kingdom are undiagnosed, and thus, theoretically, workplace screening, might by identifying these individuals improve both their individual health and overall productivity. However, the prevalence of OSA in different workplaces is unclear. This study aimed to estimate the prevalence of OSA by industries and occupations in England.

Methods

The Health Survey for England 2019 dataset was combined with Sleep Heart Health Study dataset. We applied multiple imputation for the combined dataset to estimate OSA in the English population aged 40-64. We estimated the pooled prevalence of OSA by both industry and occupation by separating samples by Standard Industry Classification and Standard Occupation Classification.

Results

The overall OSA prevalence estimated by imputation for ages 40-64 was 17.8% (95% CI = 15.9% to 19.9%). Separating those samples into industrial/occupational groups, the estimated prevalence of OSA varied widely by industry/occupation. Descriptive analysis revealed that the estimated prevalence of OSA was relatively higher in the Accommodation and food, Public administration and defence; compulsory social security, Construction industries, and Protective service occupations, health and social care associate professionals, and skilled construction and building trades occupations.

Conclusions

In England in 2019, Accommodation and food, Public administration and defence; compulsory social security, Construction industries, and Protective service occupations, health and social care associate professionals, and skilled construction and building trades occupations showed a relatively higher prevalence of OSA indicating that they may be target populations for workplace screening.

Psychometric properties of the Persian version of Proactive-Safety Role Orientation questionnaire (PRO-SAFE)

BACKGROUND

Participation and initiative of workers are effective in promoting safety in the workplace. Proactive-Safety Role Orientation questionnaire (PRO-SAFE) is a proper tool to evaluate the psychological drivers that support the proactive orientation of individuals toward workplace safety. This study was conducted to translate and measure the psychometric properties of the Persian version of PRO-SAFE.

METHODS

The PRO-SAFE was translated into Persian using procedures for translation and cross-cultural adaptation. To collect data, 252 employees of a steel complex were selected. To measure the validity of the questionnaire, face, content, convergent, and construct validity was utilized. The questionnaire's reliability was evaluated by assessing its internal consistency.

RESULTS

The mean of the content validity index and content validity ratio was equal to 0.83 and 0.85, respectively. We found a positive correlation between PRO-SAFE and safety behavior dimensions (r = 0.372 to 0.792, P < 0.001). Confirmatory factor analysis showed the Persian version of the PRO-SAFE questionnaire had an excellent six-factor model consistent with the original questionnaire. Cronbach's alpha of the Persian version of the PRO-SAFE questionnaire was obtained between 0.717 to 0.880.

CONCLUSIONS

The Persian version of the PRO-SAFE questionnaire was found to have appropriate psychometric properties, indicating that it can be confidently used as a valid tool for assessing proactive role orientation toward safety management among Iranian employees.

The effects of a Total Worker Health intervention on workplace safety: Mediating effects of sleep and supervisor support for sleep

We tested the effects of a randomized controlled trial Total Worker Health intervention on workplace safety outcomes. The intervention targeted employee sleep at both the supervisor-level (e.g., sleep-specific support training) and employee-level (e.g., sleep tracking and individualized sleep feedback). The intervention components were developed using principles of the Total Worker Health approach and the theory of triadic influence for health behaviors. We hypothesized that employees in the treatment group would report greater safety compliance, safety participation, and safety motivation, and would be less likely to experience a work-related accident or injury following the intervention through improvements in sleep quantity and quality, as well as increased perceptions of supervisors' support for sleep. It was theorized that the indirect effects of the intervention on workplace safety outcomes via sleep mediators operated through a resource pathway, whereas the supervisor support for sleep mediator operated through an exchange pathway. Results broadly revealed that employees in the treatment group, compared to those in the control group, reported greater workplace safety behaviors and safety motivation, and reduced workplace accidents and injuries 9 months post-baseline, through lower dissatisfaction with sleep, reduced sleep-related impairments, and greater supervisor support for sleep 4 months post-baseline. Intervening on sleep and supervisor support for sleep in an integrated Total Worker Health framework can have a positive impact on workplace safety. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Oxygen resaturation rate is significantly associated with objectively assessed excessive daytime sleepiness in suspected obstructive sleep apnoea patients

INTRODUCTION

Commonly utilised metrics such as the apnoea-hypopnoea index show limited correlation to excessive daytime sleepiness (EDS). Oxygen desaturation parameters show better predictive power, however oxygen resaturation parameters have not yet been investigated. Oxygen resaturation may represent increased cardiovascular fitness and thus we hypothesized that a higher resaturation rate would be protective against EDS.

METHODS

Oxygen saturation parameters were computed via ABOSA software for adult patients referred for polysomnography and multiple sleep latency test in Israel Loewenstein hospital 2001-2011. EDS was defined as a mean sleep latency (MSL) below 8 min.

RESULTS

1629 patients (75% male, 53% obese, median age of 54 years) were included for analysis. The average desaturation event nadir was 90.4% and resaturation rate 0.59%/second. Median MSL was 9.6 min, and 606 patients met criteria for EDS. Patients who were younger, female, and with larger desaturations had significantly higher resaturation rates (p < 0.001). In multivariate models, adjusted for age, sex, body mass index, and average desaturation depth, resaturation rate showed a significant negative correlation with MSL (z-score standardised beta, -1 (95%CI -0.49, -1.52)), and significantly increased odds ratio (OR) of EDS (OR, 1.28 (95%CI 1.07, 1.53)). The beta associated with resaturation rate was larger, though non-significantly, than that of desaturation depth (difference 0.36 (95% CI -1.34, 0.62), p = 0.470).

CONCLUSION

Oxygen resaturation parameters show significant associations with objectively assessed EDS independent of desaturation parameters. Thus, resaturation and desaturation parameters may reflect differing underlying mechanistic pathways and both be considered novel and appropriate markers for assessing sleep-disordered breathing and associated outcomes.

Psychomotor Vigilance Performance in Participants with Excessive Daytime Sleepiness in Obstructive Sleep Apnea or Narcolepsy Compared with SAFTE-FAST Model Predictions

INTRODUCTION

Excessive daytime sleepiness (EDS) associated with narcolepsy or obstructive sleep apnea (OSA) can impair vigilance/attention. Solriamfetol, a dopamine/norepinephrine reuptake inhibitor, is approved to treat EDS associated with narcolepsy (75-150 mg/day) or OSA (37.5-150 mg/day). The analysis reported here explored the use of the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model (used in transport industries to model performance based on accumulated sleep and circadian variability) as a substitute for healthy controls using psychomotor vigilance task (PVT) data collected during clinical studies.

METHODS

Data were analyzed from two phase 2 studies of solriamfetol in adults with OSA (NCT02806895, EudraCT 2015-003930-28) or narcolepsy (NCT02806908, EudraCT 2015-003931-36). Participants were randomly assigned 1:1 to solriamfetol 150 mg/day (3 days) followed by 300 mg/day (4 days), or placebo (7 days), then crossed over to the other treatment. Actual task effectiveness scores were calculated from average PVT inverse reaction time (pre-dose; 2 h post-dose; 6 h post-dose). Actigraphy-derived sleep intervals were used in SAFTE to determine modeled healthy control task effectiveness scores.

RESULTS

In participants with OSA (N = 31) on placebo or solriamfetol, actual and modeled healthy control task effectiveness did not differ at any time point. In participants with narcolepsy (N = 20) on placebo, actual task effectiveness at 2 h post-dose was lower than modeled healthy control task effectiveness (nominal P = 0.03), a difference not present with solriamfetol. There was no main effect of solriamfetol on actual or modeled healthy control task effectiveness across time points.

CONCLUSION

This study represents a novel application of the SAFTE biomathematical model to approximate healthy controls in sleep disorder research and provides valuable lessons that may optimize future research. Future studies should perform a priori power analyses for model-tested outcomes and use sleep measures that capture sleep fragmentation characteristic of sleep disorders for sleep input (e.g., total sleep time rather than time in bed).

TRIAL REGISTRATION

NCT02806895, EudraCT 2015-003930-28: A Randomized, Double-Blind, Placebo-Controlled, Crossover On-Road Driving Study Assessing the Effect of JZP-110 on Driving Performance in Subjects With Excessive Sleepiness Due to Obstructive Sleep Apnea. NCT02806908, EudraCT 2015-003931-36: A Randomized, Double-Blind, Placebo-Controlled, Crossover On-Road Driving Study Assessing the Effect of JZP-110 on Driving Performance in Subjects With Excessive Sleepiness Due to Narcolepsy.

Digital Addiction and Sleep

In 2020, the World Health Organization formally recognized addiction to digital technology (connected devices) as a worldwide problem, where excessive online activity and internet use lead to inability to manage time, energy, and attention during daytime and produce disturbed sleep patterns or insomnia during nighttime. Recent studies have shown that the problem has increased in magnitude worldwide during the COVID-19 pandemic. The extent to which dysfunctional sleep is a consequence of altered motivation, memory function, mood, diet, and other lifestyle variables or results from excess of blue-light exposure when looking at digital device screens for long hours at day and night is one of many still unresolved questions. This article offers a narrative overview of some of the most recent literature on this topic. The analysis provided offers a conceptual basis for understanding digital addiction as one of the major reasons why people, and adolescents in particular, sleep less and less well in the digital age. It discusses definitions as well as mechanistic model accounts in context. Digital addiction is identified as functionally equivalent to all addictions, characterized by the compulsive, habitual, and uncontrolled use of digital devices and an excessively repeated engagement in a particular online behavior. Once the urge to be online has become uncontrollable, it is always accompanied by severe sleep loss, emotional distress, depression, and memory dysfunction. In extreme cases, it may lead to suicide. The syndrome has been linked to the known chronic effects of all drugs, producing disturbances in cellular and molecular mechanisms of the GABAergic and glutamatergic neurotransmitter systems. Dopamine and serotonin synaptic plasticity, essential for impulse control, memory, and sleep function, are measurably altered. The full spectrum of behavioral symptoms in digital addicts include eating disorders and withdrawal from outdoor and social life. Evidence pointing towards dysfunctional melatonin and vitamin D metabolism in digital addicts should be taken into account for carving out perspectives for treatment. The conclusions offer a holistic account for digital addiction, where sleep deficit is one of the key factors.

Prevalence of Respiratory Disorders during Sleep among Subjects of Methadone Maintenance Therapy Program

BACKGROUND

Respiratory disorders during sleep are considered a health problem affecting the life quality. There is some evidence indicating the higher prevalence of apnea in substance-dependent patients. However, there is no information on the prevalence of the disease in people under methadone maintenance therapy (MMT). Therefore, the present study was designed to estimate the disease rate in these patients and consider the relationship of the increasing risk of apnea with some psychiatric problems.

METHODS

Study group included 152 individuals under the MMT program. Baseline data were collected with the interview, and patients were considered using the STOP-BANG questionnaire to evaluate the risk of apnea. Furthermore, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HDRS) tests were performed for all participants. Data were analyzed using SPSS software.

FINDINGS

Based on the STOP-BANG score categories, 37.5%, 40.1%, and 22.4% of patients indicated low, intermediate, and high risk of apnea, respectively. Moreover, severe daytime sleepiness, fatigue, depression, and anxiety were observed in 5.3%, 5.5%, 6.0%, and 21.1% of participants, respectively. Sex (P = 0.007) and daytime sleepiness (P = 0.048) were significantly different between low and high-risk groups of apnea after adjustment. Besides, age (P < 0.001) and fatigue (P = 0.007) were factors predicting the STOP-BANG score.

CONCLUSION

These findings revealed the higher prevalence of apnea in MMT patients compared to the general population of Iran and rising of the risk of apnea along with an increase in age and fatigue score. However, attention to the sleep disorders in MMT is a prominent factor that should be considered as a route of therapy.

Efficacy of pillar implants to reduce snoring and daytime sleepiness

OBJECTIVE

To measure the efficacy of pillar implants in reducing snoring.

MATERIALS AND METHODS

A total of 30 adult patients who underwent pillar implants were assessed preoperatively and at 1, 3, 6 and 12 months after the implantation. Improvement was measured using snoring frequency, visual analog scale for snoring loudness, and Epworth sleepiness scale for daytime sleepiness.

RESULTS

The mean snoring frequency, loudness and Epworth score were reduced from 6.9, 9.2 and 7.4 at the baseline to 5, 5.9 and 5.6, respectively, at 12 months postoperatively (all p < 0.03). The partial implant extrusion rate was 6.7%.

CONCLUSION

We suggest that a pillar implant procedure should be considered before proceeding to more morbid surgeries in patients with snoring and daytime sleepiness.

Factors Associated with Poor Quality of Sleep in Construction Workers: A Secondary Data Analysis

This study aimed to explore factors associated with poor quality of sleep in construction workers. This study was cross-sectional, correlational in design and used secondary data from fatigue instrument development study. We analyzed the data from 206 participants aged over 19 years who worked at construction sites for more than 6 months. We used multivariate binary logistic regression to identify the factors associated with poor quality of sleep. We classified the two sleep quality groups based on the Pittsburgh Sleep Quality Index (PSQI) score, and almost 63% of them were classified as the poor quality of sleep group. Based on multivariate binary logistic regression (Cox and Snell R2 = 0.317, Nagelkerke R2 = 0.429), the poor quality of sleep group tended to sleep for a shorter duration before the working day, and not only showed lower sleep latency and higher levels of daytime dysfunction and discomfort in daily life, but also had more chronic disease, depressive symptoms, and higher physical fatigue. Our study findings support that there are many modifiable factors associated with poor sleep and a high rate of poor quality of sleep occurred in construction workers. Thus, clinicians should consider providing diverse options for applying interventions to ensure better sleep, fatigue management, and depression prevention in construction workers after considering their unique characteristics.

Let’s get back to work: Preventive biological cycle management of COVID-19 in the workplace

BACKGROUND: The primary response to the coronavirus (COVID-19) pandemic has been to minimize social contact through lockdown measures. The closure of non-essential businesses to tackle the spread of the coronavirus has had negative consequences for the global economy, production, and employment. OBJECTIVE: To outline how known occupational health principles can be used for preventative management of the coronavirus in workplaces to support resumption of work. METHODS: A discussion of current knowledge of COVID-19, the cost of the lockdown strategy, and preventative biological cycle management. RESULTS: The evidence-based literature indicates that biological cycle management can control the risk of coronavirus infection, provide a suitable and sufficient exit strategy from lockdown, and support getting employees back to work. Adherence to personal protective equipment standards has been insufficient, indicating a need for workplace investment and education. CONCLUSION: Imposed restrictions on workplace operations can be lifted without compromising worker health and safety when a workplace commits to practicing the three principles of biological cycle management.