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

Can Work Engagement Be a Resource for Reducing Workaholism's Undesirable Outcomes? A Multiple Mediating Model Including Moderated Mediation Analysis

This study aimed to explore a possible process explaining the relationship between workaholism and sleep disorders, including two mediators: work-family conflict and emotional exhaustion. Moreover, since a possible buffering role of work engagement was recently proposed against the detrimental effects of workaholism, the aim was to examine the moderating role of work engagement in the relationship between workaholism and several outcomes such as work-family conflict, emotional exhaustion, and sleep disorders. Two models were tested using conditional process analysis for testing direct and indirect effects on a sample of 395 employees: (1) a serial multiple mediation model, and (2) the same serial multiple mediation model including the moderating role of work engagement. Results showed a significant mediating effect of both work-family conflict and emotional exhaustion. Moreover, work engagement moderated the relationship between workaholism and work-family conflict and the relationship between workaholism and emotional exhaustion. This work contributes to the understanding of the process underlying the relationship between workaholism and sleep disorders and to the literature reporting the possible protective role of work engagement on the negative outcomes of workaholism. Practical implications are also discussed.

Resilience in medical doctors: a systematic review

INTRODUCTION

Resilience can be difficult to conceptualise and little is known about resilience in medical doctors.

AIMS

This systematic review discusses the existing literature on influences on resilience levels of medical doctors.

METHODS

The bibliographic databases PubMed, MEDLINE, EMBASE and PsycINFO were searched from 2008 to November 2018 using keyword search terms resilience* AND ("medical physician*" OR doctor* OR surgeon* OR medical trainee* or clinician*).

RESULTS

Twenty-four studies were deemed eligible for inclusion. A narrative synthesis was performed. The following influences on resilience in doctors were identified: demographics, personality factors, organisational or environmental factors, social support, leisure activities, overcoming previous adversity and interventions to improve resilience.

CONCLUSIONS

Resilience is not limited to a doctor's own personal resource. Published studies also highlight the influence of other modifiable factors.

Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments

Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan-a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development, and treatment of depression.

Sleep Quality among Police Officers: Implications and Insights from a Systematic Review and Meta-Analysis of the Literature

Poor sleep is associated with bad health outcomes, worse wellbeing and decreases in performance, productivity and safety at work. Police officers are exposed to several risk factors including extended work schedules, shift work, occupational stress, dangerous and traumatic events and can, as such, develop sleep problems. The aim of the present study was to analyze the sleep quality among police officers. A systematic literature search, in PubMed/MEDLINE, PsycINFO, Scopus, ISI/Web of Science (WoS) and the Cochrane Library was conducted. Original articles, published in English, French, Italian, Spanish and Portuguese, the primary objective of which was the evaluation of the quality of sleep through the Pittsburgh Sleep Quality Index (PSQI) in Police Forces, were selected. From an initial sample of 1,149 studies, 13 articles were included in the meta-analysis (3,722 police officers). The pooled prevalence of bad sleep quality in police officers was 51% [95%CI 42⁻60%]. The pooled global score of the PSQI was 5.6 [95%CI 5.0⁻6.3], corresponding to a low average quality. At the meta-regressions, statistically significant associations could be found for work seniority (in terms of years of service) and being on shift. The poor quality of sleep in police officers could have negative consequences for workers' health and for the safety of third parts. The implementation of health and sleep hygiene promotion programs in police forces is strongly recommended.

SleepOMICS: How Big Data Can Revolutionize Sleep Science

Sleep disorders have reached epidemic proportions worldwide, affecting the youth as well as the elderly, crossing the entire lifespan in both developed and developing countries. "Real-life" behavioral (sensor-based), molecular, digital, and epidemiological big data represent a source of an impressive wealth of information that can be exploited in order to advance the field of sleep research. It can be anticipated that big data will have a profound impact, potentially enabling the dissection of differences and oscillations in sleep dynamics and architecture at the individual level ("sleepOMICS"), thus paving the way for a targeted, "one-size-does-not-fit-all" management of sleep disorders ("precision sleep medicine").

Idoneit al lavoro in operatore dei corpi di polizia in trattamento per OSAS

A policeman who has been ill with OSAS for 10 years is in optimal CPAP therapy. During this time, the overall assessment of his work activities was excellent and he had no traffic accidents or accidents at work. Concerning his work as a policeman, the Medical Commission of 1st instance considered him unfit to work. Conversely, the Medical Commission of 2nd instance declared him fit to work. In the adult general population, the prevalence of moderate and severe OSAS is more than 20%. It is therefore likely that there are many policemen affected by OSAS and the number of requests for assessments of fitness to work in those with OSAS will increase. It is a priority: (i) to integrate the training course of the medical staff of the Police Forces and the Armed Forces with updates on OSAS; (ii) to delete OSAS from the list of chronic diseases for which night shift work is not indicated.

Cost-effectiveness strategies in OSAS management: a short review

Obstructive sleep apnoea (OSAS) is an underdiagnosed chronic disease with a high prevalence in adults. It is becoming a significant social problem, since it is associated with a worsening in quality of life and increase in mortality. The cost-effectiveness ratio of diagnostic and therapeutic management of OSAS is a strategic issue to counteract the expected increasing demand of objective testing. OSAS patients with any clinical evidence of comorbidities must be studied using simplified and less expensive systems such as Home Sleep Testing (HST). On the other hand, Sleep Laboratory Polysomnography (PSG) is the gold standard to manage OSAS patients with comorbidities. It should be pointed out that the use of HST can lead to incorrect diagnosis in poorly selected OSAS subjects. This short review discusses various topics for the proper diagnosis and treatment of OSAS in view of epidemiological factors and results in terms of costs and social benefit of the disease. Whatever the strategy chosen and/or the organisational model adopted for managing OSAS, it cannot and should not take into account only cost-effectiveness. Long-term prospective studies evaluating cost-effectiveness ratios and outcomes of OSAS treatment of hospital management models versus home care models are needed.

Relationship between Sleep Disorders and Health Related Quality of Life-Results from the Georgia SOMNUS Study

The extent to which sleep disorders are associated with impairment of health-related quality of life (HRQoL) is poorly described in the developing world. We investigated the prevalence and severity of various sleep disorders and their associations with HRQoL in an urban Georgian population. 395 volunteers (20–60 years) completed Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, STOP-Bang questionnaire, Insomnia Severity Index, Beck Depression Inventory-Short Form, and Short Form Health Survey (SF-12). Socio-demographic data and body mass index (BMI) were obtained. The prevalence of sleep disorders and their association with HRQoL was considerable. All SF-12 components and physical and mental component summaries (PCS, MCS) were significantly lower in poor sleepers, subjects with daytime sleepiness, apnea risk, or insomnia. Insomnia and apnea severity were also associated with lower scores on most SF-12 dimensions. The effect of insomnia severity was more pronounced on MCS, while apnea severity—on PCS. Hierarchical analyses showed that after controlling for potential confounding factors (demographics, depression, BMI), sleep quality significantly increased model’s predictive power with an R² change (ΔR²) by 3.5% for PCS (adjusted R² = 0.27) and by 2.9% for MCS (adjusted R² = 0.48); for the other SF-12 components ΔR² ranged between 1.4% and 4.6%. ESS, STOP-Bang, ISI scores, all exerted clear effects on PCS and MCS in an individual regression models. Our results confirm and extend the findings of studies from Western societies and strongly support the importance of sleep for HRQoL. Elaboration of intervention programs designed to strengthen sleep-related health care and thereof HRQoL is especially important in the developing world.

Low Income as a Vulnerable Factor to the Effect of Noise on Insomnia

OBJECTIVE

The present study aimed to examine the potential mediating effect of income level on the association between noise exposure and insomnia.

METHODS

706 individuals were evaluated in conjunction with 2014 noise map data from Seoul, South Korea. Cross-sectional analysis was performed to examine differences in noise level according to household income, while three separate logistic regression models were used to examine factors influencing insomnia. Odds ratios (ORs) were calculated after adjusting for depression, anxiety, auditory acuity and noise sensitivity in the first model. Analyses were adjusted for sociodemographic variables in the second model, lifestyle factors and medical illnesses in the third model.

RESULTS

Noise level was significantly associated with an increased risk of insomnia in the low-income group, although no such association was observed in the high-income group. Groups exposed to >60 dB of noise (Lden; day-evening-night equivalent) exhibited a 1.79-fold increase in the incidence of insomnia relative to those exposed to <50 dB. The result was significant after adjusting sociodemographic variables, although not significant when adjusted for lifestyle factors and medical illnesses.

CONCLUSION

Individuals with low income may be more vulnerable to the deleterious effects of noise exposure on health. Various aspects including income should be considered to ascertain the influence of noise on insomnia.

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.

An International Study on the Determinants of Poor Sleep Amongst 15,000 Users of Connected Devices

BACKGROUND

Sleep is a modifiable lifestyle factor that can be a target for efficient intervention studies to improve the quality of life and decrease the risk or burden of some chronic conditions. Knowing the profiles of individuals with poor sleep patterns is therefore a prerequisite. Wearable devices have recently opened new areas in medical research as potential efficient tools to measure lifestyle factors such as sleep quantity and quality.

OBJECTIVES

The goal of our research is to identify the determinants of poor sleep based on data from a large population of users of connected devices.

METHODS

We analyzed data from 15,839 individuals (13,658 males and 2181 females) considered highly connected customers having purchased and used at least 3 connected devices from the consumer electronics company Withings (now Nokia). Total and deep sleep durations as well as the ratio of deep/total sleep as a proxy of sleep quality were analyzed in association with available data on age, sex, weight, heart rate, steps, and diastolic and systolic blood pressures.

RESULTS

With respect to the deep/total sleep duration ratio used as a proxy of sleep quality, we have observed that those at risk of having a poor ratio (≤0.40) were more frequently males (odds ratio [OR]_{female vs male}=0.45, 95% CI 0.38-0.54), younger individuals (OR_{>60 years vs 18-30 years}=0.47, 95% CI 0.35-0.63), and those with elevated heart rate (OR_{>78 bpm vs ≤61 bpm}=1.18, 95% CI 1.04-1.34) and high systolic blood pressure (OR_{>133 mm Hg vs ≤116 mm Hg}=1.22, 95% CI 1.04-1.43). A direct association with weight was observed for total sleep duration exclusively.

CONCLUSIONS

Wearables can provide useful information to target individuals at risk of poor sleep. Future alert or mobile phone notification systems based on poor sleep determinants measured with wearables could be tested in intervention studies to evaluate the benefits.

Attention deficit hyperactivity disorder symptom severity and sleep problems in adult participants of the Netherlands sleep registry

BACKGROUND

We examined whether current overall attention deficit hyperactivity disorder (ADHD), inattention, or hyperactivity symptom severities are associated with the current presence and persistent history of sleep problems.

METHODS

N = 942 participants of the Netherlands Sleep Registry filled out online several validated questionnaires. Regression analyses were performed to assess the association between (1) current overall ADHD symptom severity and the current presence of sleep problems, (2) current ADHD symptom-severity groups and the persistent history of sleep problems, and (3) current inattention or hyperactivity symptom severities and the current presence of sleep problems.

RESULTS

(1) Current overall ADHD symptom severity was associated with the odds of suffering from probable obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), insomnia disorder (ID) with predominant difficulties initiating sleep (DIS) and maintaining sleep (DMS), but not with the odds of suffering from narcolepsy or ID with predominant early-morning awakening (EMA). Current overall ADHD symptom severity was also associated with an extreme evening chronotype but not with short sleep. (2) The group with the most severe current ADHD symptoms was more likely to have a history of persistent OSAS, RLS, and ID. (3) The severity of symptoms of hyperactivity, but not of inattention, was specifically associated with probable RLS, PLMD, ID with DIS or DMS, and short sleep. Inattention symptom severity was only related to the probability of being an extreme evening chronotype.

CONCLUSION

ADHD severity, especially the severity of hyperactivity, is associated with the current presence and persistent history of sleep problems.

Change of sleep quality from pre- to 3 years post-solid organ transplantation: The Swiss Transplant Cohort Study

BACKGROUND

Poor sleep quality (SQ) is common after solid organ transplantation; however, very little is known about its natural history. We assessed the changes in SQ from pre- to 3 years post-transplant in adult heart, kidney, liver and lung recipients included in the prospective nation-wide Swiss Transplant Cohort Study. We explored associations with selected variables in patients suffering persistent poor SQ compared to those with good or variable SQ.

METHODS

Adult single organ transplant recipients enrolled in the Swiss Transplant Cohort Study with pre-transplant and at least 3 post-transplant SQ assessment data were included. SQ was self-reported pre-transplant (at listing), then at 6, 12, 24 and 36 months post-transplant. A single SQ item was used to identify poor (0-5) and good sleepers (6-10). Between organ groups, SQ was compared via logistic regression analysis with generalized estimating equations. Within the group reporting persistently poor SQ, we used logistic regression or Kaplan-Meier analysis as appropriate to check for differences in global quality of life and survival.

RESULTS

In a sample of 1173 transplant patients (age: 52.1±13.2 years; 65% males; 66% kidney, 17% liver, 10% lung, 7% heart) transplanted between 2008 and 2012, pre- transplant poor SQ was highest in liver (50%) and heart (49%) recipients. Overall, poor SQ decreased significantly from pre-transplant (38%) to 24 months post-transplant (26%) and remained stable at 3 years (29%). Patients reporting persistently poor SQ had significantly more depressive symptomatology and lower global quality of life.

CONCLUSION

Because self-reported poor SQ is related to poorer global quality of life, these results emphasize the need for further studies to find suitable treatment options for poor SQ in transplant recipients.

An update on the safety of psychostimulants for the treatment of attention-deficit/hyperactivity disorder

INTRODUCTION

Methylphenidate is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate has a well-established evidence base for treating ADHD, its long-term benefits are unclear. Areas covered: Physical adverse effects, psychiatric adverse events and brain development Expert opinion: Some physical adverse events have been described (e.g. sleep disturbances, growth reduction, loss of appetite), although most are of transient nature. Psychiatric adverse events seem more related to the diagnosis ADHD itself, and not stimulant treatment. Concluding, short-to-mid-term use (i.e., up to 2 years) stimulants are relatively safe, but much less is known about longer-term efficacy and safety of these drugs.