Shift-work disorder - myCME.com

Figure 2 Shift-related factors likely to affect attrition in the emergency medical professions
Risk of accidents of
self-harm at work, eg,
percutaneous injury
Insomnia
Increased risk of comorbidities,
eg, GI disorders, CVD,
depression, and cancer
Risk of traffic accidents,
particularly during the commute
home from work
Shift-related factors
leading to high rates of
attrition in the medical
professions
On-call stress
Excessive sleepiness
Sleep deprivation
Reductions in social
interactions, particularly time
with the family
CVD, cardiovascular disease; GI, gastrointestinal.
Studies of patients with insomnia of unspecified
etiology reveal the extent of the cost burden of this
symptom. An observational US study found that average
6-month total costs (ie, direct and indirect costs) were
approximately $1253 higher for an adult (age 18–64
years) with insomnia than for a matched control without
insomnia. 94
A recently reported Canadian study highlighted the
large contribution of indirect costs to the total costs associated
with insomnia. 95 Direct costs included those
for doctors’ visits, transportation to the visits, and prescription
and over-the-counter drugs. Indirect costs associated
with insomnia included those for lost productivity
and job absenteeism; these accounted for 91% of
all costs. On average, the total annual costs incurred by a
patient with insomnia syndrome (defined as those who
used a sleep-promoting agent ≥3 nights per week and/
or were dissatisfied with sleep, had insomnia symptoms
≥3 nights per week for ≥1 month, and experienced
psychological distress or daytime impairment) 95 were
C$5010 (C$293 direct and C$4717 indirect). For a patient
with insomnia symptoms, average annual total
costs were calculated to be C$1431 (C$160 direct and
C$1271 indirect). By comparison, a good sleeper (ie, a
study subject who reported being happy with his or her
sleep, did not report symptoms of insomnia, and did not
use sleep-promoting medication) was found to incur
average annual costs of C$421. 95
More detailed assessment is required of the costs
incurred specifically in patients with SWD, but there is
clearly an economic rationale for early diagnosis and
treatment of the symptoms of SWD.
Summary
What is clear from this review is that, while information
on shift work is relatively abundant, data concerning
SWD are meager. For example, epidemiologic data on
SWD are sparse, in part because many investigators in
studies of shift workers do not take the seemingly logical
step of assessing SWD in their subjects. However, differentiating
between shift workers who experience transient
symptoms associated with adapting to a new shift
schedule and individuals with SWD is complex and may
lead to underrecognition of this condition. Similarly,
there are few data on the comorbidities experienced by
individuals diagnosed with SWD and further studies are
warranted. The increased risk of illness demonstrated
by shift-working individuals may be even greater in patients
with SWD due to their intrinsic—and poorly understood—vulnerability
to the effects of shift work.
The studies described here show that the burden of
SWD is multifactorial, and it includes impairment of patients’
relationships and health and reduces their efficiency
at work. 6 Again, there are very few data on the economic
burden of SWD, although reduced productivity and the
cost of accidents in the workplace and while driving are
likely to be high. Additional research is needed in this area.
Shift workers, including public service workers, must
make difficult decisions during times of day when they
Supplement to The Journal of Family Practice • Vol 59, No 1 / January 2010 S