Prevalence of sleep disorders among first responders for medical emergencies: A meta-analysis

Predictors of Ever Using Marijuana Among US First Responders

OBJECTIVE

Estimate ever using marijuana in a sample of US career first responders.

METHODS

Health survey cohort data collected between 2018 and 2024 from employed and retired US first responders were analyzed for frequency of ever using marijuana. Binary logistic regression models estimated the association between ever using marijuana and first responder demographics, employment status, and risky health behaviors.

RESULTS

Among 1310 current/retired first responders, 15.3% reported ever using marijuana (80.0% seldom, 18.0% often, and 2.0% always). Currently employed firefighter/paramedic/emergency medical technicians had the highest (45.5%), whereas Battalion/EMS/Deputy/Fire Chiefs had the lowest use (3.0%). First responders who binge drink (adjusted odds ratio [aOR] = 1.45; 95% confidence interval [CI]: 1.03-2.03; P = 0.033), former-smoker (aOR = 2.42; 95% CI: 1.68-3.47; P < 0.001), or current-smokers (aOR = 3.61; 95% CI: 1.01-12.93; P = 0.049), and were retired (aOR = 1.85; 95% CI: 1.20-2.87) were significantly more likely to report ever using marijuana.

CONCLUSIONS

Ever using marijuana was highest among those rank firefighter/paramedics/emergency medical technician and significantly associated with binge drinking, retirement, and smoking behaviors.

Sleep disorder risk, perceived control over sleep, and mental health symptoms in paramedicine students

Paramedics commonly experience both poor sleep and mental health symptoms. Clarifying whether sleep or mental health symptoms are a challenge prior to commencement of employment is important, as early prevention and intervention initiatives during training could support these workers. Paramedicine students (n=53) were included, with sleep disorder screening (obstructive sleep apnea, insomnia and restless legs syndrome), and mental health outcomes (depressive symptoms: Patient Health Questionnaire-9, and anxiety symptoms: General Anxiety Disorder-7). Data were analysed using robust regression models, adjusted for age, sex, and shift work status. Meeting criteria for a sleep disorder (n=21) was associated with higher scores for anxiety (8.2 [95% CI: 5.9-10.5] v 4.6, [3.4-5.8]) and depressive symptoms (11.1 [8.6-13.6] v 4.4 [3.1-5.7)] compared to those who did not meet the criteria for a sleep disorder (n=32). Depressive symptoms were lower in those with perceived control over sleep (5.2 [3.2-7.2] v 9.8 [7.7-11.8]). There was no interaction between sleep disorder risk and perceived control over sleep on mental health symptoms. Investigation and management of factors contributing to low perceived control over sleep, together with early screening and management of sleep disorders, are likely to be important priorities to support paramedic student wellbeing prior to commencing shift work.

Exploring the Relationship between Sleep Pattern and Quality of Life in the Middle-aged Population Based on Fuzzy-set Qualitative Comparative Analysis

This study aims to investigate the effects of 7 factors (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medications, and daytime dysfunction), as measured by the Pittsburgh Sleep Quality Index, on the quality of life (QOL) in middle-aged individuals. A total of 194 middle-aged individuals aged 45 to 59 years participated in this study. The Chinese version of the medical outcomes study 36-item short-form health survey and the Pittsburgh Sleep Quality Index were used to assess the QOL and sleep quality, respectively. The relationship between sleep patterns and QOL was analyzed using fuzzy-set qualitative comparative analysis. Improvement in sleep disturbances and reduction in the use of sleeping medications are necessary conditions for enhancing QOL. Two configurations of sleep patterns positively influence QOL: the "sufficiency type" with high level of sleep duration, non-sleep disturbances, and non-daytime dysfunction as core conditions; and the "efficiency type" with high habitual sleep efficiency and non-daytime dysfunction as core conditions. Three configurations of sleep patterns negatively influence QOL: the "low-quality type" with non-high-level subjective sleep quality, sleep duration, and habitual sleep efficiency as core conditions; the "barrier type" with high level of sleep disturbances, non-high-level sleep latency, and non-high-level subjective sleep quality/sleep duration as core conditions; and the "drug-based type" with high level of use of sleeping medications and subjective sleep quality as core conditions. Using the fuzzy-set qualitative comparative analysis method, this study initially reveals that the influence of sleep patterns on QOL in middle-aged individuals is a holistic effect combining multiple elements. This deepens and enriches the understanding of the relationship between sleep patterns and QOL and expands new perspectives for more in-depth research on how to improve the QOL of middle-aged individuals through sleep interventions.

Sleep Differences in Firefighters: Barracks vs. Home

It has been shown that the firefighter occupation leads to poor sleep quality and sleep architecture. Disturbed sleep in these occupations can lead to deleterious outcomes including a series of chronic diseases and illnesses such as CVD.

PURPOSE

The aims were (1) to quantify firefighters' sleep via polysomnography, (2) to identify differences between sleeping in the barracks versus sleeping at home, and (3) to compare firefighter data to age-matched normative data. We expected significant differences between both the home and the barrack conditions as well as significant differences when both conditions were compared to normative data.

METHODS

10 male firefighters completed 3 nights of polysomnography recordings (SleepProfilerTM (Advanced Brain Monitoring, Carlsbad, CA, USA)) counterbalanced in both their own beds or barracks. A one-way rmANOVA statistical analysis was used to determine differences in sleep values with a Bonferroni correction if a significant difference was found with significance set at p < 0.05.

RESULTS

Three important variables, cortical arousals (p < 0.05), autonomic activations (p < 0.01), and spindle duration (p < 0.01), had differences that were statistically significant between sleep at home or in the barracks, with sleep in the barracks being more disturbed. Clinical differences were also observed between the home and barrack conditions and all sleep results were more deleterious when compared to normative data.

CONCLUSIONS

The data demonstrates that firefighters show poor sleep quality and heavily impacted sleep architecture. This may be due to the effects of rotating shifts and occupational stress on the sleep-wake cycle. These results, when compared to age-matched normative data, show clinical manifestations of disturbed sleep in the firefighter population.

Types and Contributors to Occupational Fatigue

Although fatigue is commonly experienced in many highly demanding occupations (e.g., military, first responders, etc.), it is poorly defined. Fatigue can strongly affect occupational performance by negatively influencing the ability to interact with the world by altering the capacity to think, move, feel, see, and speak. The first step in fatigue risk management strategies is to establish a context. The context of this narrative review is to specifically describe and discuss the 6 overarching types of occupational fatigue: cognitive, physical, burnout, emotional, visual, and vocal fatigue, and how each affects varying occupations. Furthermore, fatigue type can be influenced by several intrinsic factors, such as sleep deprivation, circadian alignment, ultradian process, sleep homeostasis, and health factors. Similarly, extrinsic factors influence fatigue, such as workload, shift work, and environmental issues. Understanding the types and contributors to occupational fatigue may help clarify the context of occupational fatigue and serve to guide future occupational fatigue management.

The Effect of Shift Work on Sleep Patterns of Paramedics in Saudi Arabia

Purpose

Shift work poses significant sleep health challenges for paramedics, affecting their ability to respond effectively in emergencies. This study aimed to evaluate the impact of shift work on sleep parameters among paramedics in Saudi Arabia, identifying key factors influencing insomnia.

Patients and Methods

A cross-sectional, online survey was conducted, gathering data on sociodemographic characteristics, work-related factors, sleep duration, and insomnia among paramedics in Saudi Arabia. The Athens Insomnia Scale was used to define insomnia. The association between shift work and sleep parameters was examined. Predictors of insomnia were identified through logistic regression models by inspecting the adjusted odds ratio (aOR).

Results

1076 Saudi paramedics were included, most of whom were 26-35 years old, males, married, had a Bachelor's degree, worked in hospital-based settings for private agencies in rural areas, and had 6-10 years of experience. Occupational stress was reported by 52.96% of paramedics. All shift work characteristics (working hours, number of shifts, work schedule, and off-work days) were significantly associated with insomnia (p=0.0001). The multivariate regression revealed that work setting (aOR=18.71, p=0.02), coffee consumption (aOR=36.83, p=0.01), work schedule (aOR=21.93, p=0.01), and time to bed (aOR=0.01, p=0.01), sleep duration (aOR=0.03, p=0.03), and occupation stress (aOR=9.31, p=0.001) were predictors for insomnia.

Conclusion

Our findings underscores the need for targeted interventions to mitigate the adverse effects of shift work on sleep health among paramedics.

Sleep Habits and Disturbances Among Tunisian Adults: A Cross-Sectional Online Survey

Background

Sleep quality and disturbances have gained heightened scholarly attention due to their well-established association with both mental and physical health. This study aims to assess sleep-wake habits and disturbances in Tunisian adults.

Methodology

This cross-sectional study employed an online questionnaire to assess 3074 adults ≥ 18 years. Primary outcomes, including sleep quality, daytime vigilance, mood, and subjective well-being, were measured using validated questionnaires [the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Patient Health Questionnaire (PHQ)-9, and the World Health Organisation-Five Well-Being Index (WHO-5)].

Results

Less than two-thirds (n= 1941; 63.1%) of participants were females and the mean age was 36.25±13.56. The prevalence of poor sleep quality was 53.8% when defined as a PSQI > 5. The prevalence of insomnia, short sleep duration, long sleep duration, EDS, severe depression, and poor well-being were 14.5%, 34.7%, 12.3%, 32.4%, 7.4%, and 40.2%, respectively. Some factors were associated with an increased likelihood of poor sleep quality, including female gender, chronic hypnotics use, internet use close to bedtime, daily time spent on the internet >3 hours, smoking, university- level education, nocturnal work, severe depression, impaired well-being status, insomnia, and EDS.

Conclusion

The high prevalence of sleep-wake disturbances among Tunisian adults emphasizes the need for an appropriate screening strategy for high-risk groups. Individuals with unhealthy habits and routines were significantly more likely to experience these kinds of disturbances. Consequently, there is a pressing need for educational programs on sleep to foster healthier sleep patterns.

Bidirectional correlation between gastroesophageal reflux disease and sleep problems: a systematic review and meta-analysis

Objectives

Gastroesophageal reflux disease (GERD) and sleep problems are highly prevalent among the general population. Both them are associated with a variety of psychiatric disorders such as depression and anxiety, which is highlighting an underexplored connection between them. This meta-analysis aims to explore the association between sleep problems and GERD.

Methods

We conducted a comprehensive search on PubMed, Cochrane Library, Embase, and Web of Science, using Medical Subject Headings (MeSH) and keywords, covering articles from the inception of the databases until August 2023. Stata statistical software, version 14.0, was utilized for all statistical analyses. A fixed-effects model was applied when p > 0.1 and I2 ≤ 50%, while a random-effects model was employed for high heterogeneity (p < 0.1 and I2 > 50%). Funnel plots and Egger's test were used to assess publication bias.

Results

Involving 22 studies, our meta-analysis revealed that insomnia, sleep disturbance, or short sleep duration significantly increased the risk of GERD (OR = 2.02, 95% CI [1.64-2.49], p < 0.001; I2 = 66.4%; OR = 1.98, 95% CI [1.58-2.50], p < 0.001, I2 = 50.1%; OR = 2.66, 95% CI [2.02-3.15], p < 0.001; I2 = 62.5%, respectively). GERD was associated with an elevated risk of poor sleep quality (OR = 1.47, 95% CI [1.47-1.79], p < 0.001, I2 = 72.4%), sleep disturbance (OR = 1.47, 95% CI [1.24-1.74], p < 0.001, I2 = 71.6%), or short sleep duration (OR = 1.17, 95% CI [1.12-1.21], p < 0.001, I2 = 0).

Conclusion

This meta-analysis establishes a bidirectional relationship between four distinct types of sleep problems and GERD. The findings offer insights for the development of innovative approaches in the treatment of both GERD and sleep problems.

Sleep and cardiovascular disease

This review centres around the recent evidence in examining the intersection of sleep and cardiovascular disease (CVD). Sleep in this review will be further subdivided to consider both sleep quantity and quality along and will also consider some of the more common sleep disorders, such as insomnia and obstructive sleep apnoea, in the context of CVD. Sleep disorders have been further explored in several specific populations which are both at risk of sleep disorders and CVD. Secondly, the review will present some of the risk factors for CVD that are affected by sleep and sleep disorders which include hypertension, diabetes, and obesity. It will also examine the potential underlying mechanisms including inflammation, appetite control, endocrine, and genetic processes that are affected by sleep and sleep disorders leading to increased risk of CVD development. In addition, we will consider the observed bi-directional relationships between sleep and cardiovascular risk factors. For example, obesity, a risk factor for CVD can be affected by sleep, but in turn can increase the risk of certain sleep disorder development which disrupts sleep, leading to further risk of obesity development and increased CVD risk. Finally, the review will explore emerging evidence around lifestyle interventions that have included a sleep component and how it impacts the management of CVD risk factor. The need for increased awareness of the health effects of poor sleep and sleep disorders will be discussed alongside the need for policy intervention to improve sleep to facilitate better health and well-being.

Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review

Fatigue in emergency first responders (EFRs) is known to affect performance abilities and safety outcomes for both patients and EFRs. The primary aim of this review was to determine the main contributors to occupation-induced fatigue in EFRs and its subsequent impacts. Following the PRIMSA checklist, academic databases (Medline, Embase, CINAHL, and SPORTDiscus) were searched using key terms with results subjected to inclusion and exclusion criteria. Populations of interest were firefighters, paramedics, or emergency call centre personnel. Of the 5633 records identified, 43 studies, which reported on 186 unique measures from a total population of 6373 participants, informed the review. Synthesis revealed fatigue was caused by lack of sleep during the shift and consistent poor sleep quality which negatively impacted cognitive function, alertness, and physical and mental health while increasing safety-compromising behaviours and injuries. Both subjective and objective assessments of fatigue are necessary for effective risk management in EFRs. EFRs that are consistently fatigued are at a greater risk of poor physical and mental health, reduced cognitive function, and increased injuries. No studies reported on fatigue in emergency call centre personnel, highlighting a literature gap. Funding was provided by the Australian Capital Territory Emergency Services Agency. Preregistration was filed in OSF: osf.io/26f3s.