Shift-work disorder - myCME.com

The social and economic burden
of shift-work disorder
Larry Culpepper, MD, MPH
Department of Family Medicine
Boston University Medical Center
Boston, Massachusetts
Practice recommendations
y Shift-work disorder (SWD) and its defining
symptoms can negatively affect health,
quality of life, and work performance. The
gravity of these consequences necessitates
vigilance for the symptoms of SWD by
primary care physicians (SOR: B).
y The threshold for treatment intervention
for emergency service workers, such as
firefighters, who make crucial decisions
under shift-work conditions and who are
experiencing SWD should be lower than
for shift workers in general (SOR: B).
y The economic costs of untreated
SWD are likely to be high. Early
diagnosis and treatment of SWD may
reduce these costs in addition to reducing
the human burden of this circadian
rhythm sleep disorder (SOR: C).
Dr Culpepper reports that he serves as a consultant
to AstraZeneca, Eli Lilly and Company, Pfizer
Inc, Wyeth, sanofi-aventis, and Takeda Pharmaceuticals
North America, Inc, and on the speakers
bureau of Wyeth.
Shift work is a fundamental component of working patterns
across the US workforce and is therefore an integral part of
the lifestyle of a large proportion of the population. However,
shift workers are at risk of developing the circadian rhythm sleep
disorder shift-work disorder (SWD), a clinically recognized condition
that develops in some individuals who work at night, start work
early in the morning (4 to 7 am), or work according to a rotatingshift
schedule. SWD is more severe than—and distinct from—the
sleep disturbances commonly associated with shift work. Provided
other sleep/wake disorders can be discounted, SWD is diagnosed
by the presence of excessive sleepiness (ES) and/or insomnia for
≥1 month during which the individual is performing shift work. 1
Shift work poses a serious public health risk, as it can impair
an individual’s ability to perform effectively and may lead
to occupational or traffic accidents. Furthermore, shift work has
numerous negative health effects and infringes on an individual’s
ability to sleep, eat normally, exercise, and develop relationships.
However, SWD is underrecognized in the clinical setting, 2
and data regarding its epidemiology and etiology are scarce in
the scientific literature. Published information regarding shift
work in general has therefore been used as the foundation for
informing the clinical community on the potential burden of
SWD. It is incumbent on primary care physicians to be vigilant
for SWD in shift workers, make an accurate diagnosis, and initiate
appropriate treatment in order to relieve—and prevent—the
acute consequences and long-term health sequelae of this disorder,
as well as to ensure public safety.
This supplement describes the burden of SWD, discusses
the current understanding of the processes that cause this and
other circadian rhythm sleep disorders, and describes the recognition
and available management strategies for SWD. This article
reviews the prevalence of SWD and examines the scale of its
social and economic burden, including associated comorbidities.
In the second article, Dr Chris Drake explains the causes of
SWD and other circadian rhythm sleep disorders by describing
the circadian and homeostatic systems and detailing how lifestyle
factors, individual susceptibility, morbidity, and genetic
components can result in circadian rhythm pathology.
Supplement to The Journal of Family Practice • Vol 59, No 1 / January 2010 S