Shift-work disorder - myCME.com

Shift-work disorder
the other potentially causative conditions. (Examples
of how mood disorders and other sleep/wake disorders
can be differentiated from SWD appear below.)
Mood disorders and sleep/wake disorders often
present in the primary care setting and can at first seem
indistinguishable. For example, patients with ES as a result
of a sleep/wake disorder may superficially appear
to have depression, as a lack of energy, poor memory,
reduced concentration, and a loss of interest in life
are common features of both ES and mood disorders.
In such instances, asking the patient about his or her
sleep habits and the use of simple depression questionnaires
such as the Patient Health Questionnaire-9
(www.patient.co.uk/showdoc/40025272/) are vital to
avoid misdiagnosis and prescription of inappropriate
medication.
ES is also a symptom of the sleep/wake disorders
obstructive sleep apnea (OSA) and restless legs syndrome
(RLS), which are commonly reported in shift
workers. 26,27 Patients with OSA have poor quality sleep,
as they experience repeated full or partial blockages of
their airway, resulting in snoring and episodes of choking
or gasping during sleep. 28 Recurrent partial or complete
obstruction of the upper airway leads to repeated
arousals and disturbed sleep, which can cause ES. 29,30
Night-shift work has been shown to aggravate OSA, 31
possibly due to the increased potential for weight gain
and metabolic disturbance in this population 24 ; overweight
and metabolic syndrome are risk factors for and
comorbidities associated with OSA. 28 It is imperative
that patients with suspected OSA are referred to a sleep
specialist as well as counseled about appropriate therapies
and lifestyle changes. 32
RLS may develop in shift workers due to low serum
iron levels induced by chronic sleep deprivation. 33 Patients
with symptoms of RLS should have their serum
ferritin levels checked and, if found to be