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Shift-work disorder Contents and Faculty The social and economic burden of shift-work disorder. . . . . . . . . . . . . . . . . . . . . . . . . . S3 Larry Culpepper, md, mph Department of Family Medicine Boston University Medical Center Boston, Massachusetts The characterization and pathology of circadian rhythm sleep disorders.. . . . . . . . . S12 Christopher L. Drake, PhD Henry Ford Hospital Sleep Disorders and Research Center Detroit, Michigan Recognition of shift-work disorder in primary care.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S18 Jonathan R. L. Schwartz, Md University of Oklahoma Health Sciences Center INTEGRIS Sleep Disorders Center of Oklahoma Oklahoma City, Oklahoma Managing the patient with shift-work disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S24 Michael J. Thorpy, Md Director of the Sleep-Wake Disorders Center Montefiore Medical Center Bronx, New York Disclosures 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. Dr Drake reports that he has received research support from Cephalon, Inc., Takeda Pharmaceuticals North America, Inc, and Zeo, Inc., and has served on the speakers bureaus of Cephalon, Inc., and as a consultant to sanofiaventis. Dr Schwartz reports that he serves as a consultant to and on the speakers bureaus of AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Cephalon, Inc., Pfizer Inc, Sepracor Inc., Takeda Pharmaceuticals North America, Inc, and GlaxoSmithKline. Dr Thorpy reports that he serves as a consultant to and on the speakers bureaus of Cephalon, Inc., and Jazz Pharmaceuticals, Inc. Support Support for the publication of this supplement was provided by Cephalon, Inc. Editorial assistance was provided by Anthemis Consulting Ltd and supported by Cephalon, Inc. Disclaimer The opinions expressed herein are those of the authors and do not necessarily represent those of Cephalon, Inc., or the publishers. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested by the authors should not be used by clinicians without evaluation of their patients’ conditions and possible contraindications or dangers in use, review of any applicable manufacturer’s product information, and comparisons with the recommendations of other authorities. Content may include product information that is inconsistent with or outside the approved labeling for these products in the United States. Before prescribing any medication, you must familiarize yourself with the manufacturer’s product information. This material was submitted by Anthemis Consulting Ltd on behalf of the authors. It has been edited and peer reviewed by The Journal of Family Practice. Cover Image © Linda Frichtel Copyright © 2010 Dowden Health Media S January 2010 / Vol 59, No 1 • Supplement to The Journal of Family Practice
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
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Armodafinil for Treatment of Excess
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The Epidemiology and Diagnosis of I
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CIRCADIAN RHYTHM SLEEP DISORDERS Pr
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Table 2— AASM Levels of Recommend
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3.2.1.1 Both the Morningness-Evenin
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Five studies used one of the newer
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4.4 Advanced Sleep Phase Disorder B
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Table 1—Subject Demographics n M:
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Scale. 28 The simple reaction time
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Median RT (msec) 1600 A 1400 1200 1
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10 Mentally A Exhausted Sharp Score
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Current Treatment Options in Neurol
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398 Sleep Disorders and sleep loss,
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400 Sleep Disorders Table 1. Treatm
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402 Sleep Disorders Standard dosage
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404 Sleep Disorders Standard proced
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406 Sleep Disorders Caffeine Melato
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408 Sleep Disorders Wake-promoting
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410 Sleep Disorders night shift: ad
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