Shift-work disorderContents and FacultyThe social and economicburden of shift-work disorder. . . . . . . . . . . . . . . . . . . . . . . . . . S3Larry Culpepper, md, mphDepartment of Family MedicineBoston University Medical CenterBoston, MassachusettsThe characterization and pathologyof circadian rhythm sleep disorders.. . . . . . . . . S12Christopher L. Drake, PhDHenry Ford HospitalSleep Disorders and Research CenterDetroit, MichiganRecognition of shift-workdisorder in primary care.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S18Jonathan R. L. Schwartz, MdUniversity of Oklahoma Health Sciences CenterINTEGRIS Sleep Disorders Center of OklahomaOklahoma City, OklahomaManaging the patientwith shift-work disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S24Michael J. Thorpy, MdDirector of the Sleep-Wake Disorders CenterMontefiore Medical CenterBronx, New YorkDisclosuresDr Culpepper reports that he serves as a consultantto AstraZeneca, Eli Lilly and Company,Pfizer Inc, Wyeth, sanofi-aventis, and TakedaPharmaceuticals North America, Inc, and onthe speakers bureau of Wyeth.Dr Drake reports that he has received researchsupport from Cephalon, Inc., Takeda PharmaceuticalsNorth America, Inc, and Zeo, Inc.,and has served on the speakers bureaus ofCephalon, Inc., and as a consultant to sanofiaventis.Dr Schwartz reports that he serves as aconsultant to and on the speakers bureaus ofAstraZeneca, Boehringer Ingelheim Pharmaceuticals,Inc., Cephalon, Inc., Pfizer Inc,Sepracor Inc., Takeda Pharmaceuticals NorthAmerica, Inc, and GlaxoSmithKline.Dr Thorpy reports that he serves as aconsultant to and on the speakers bureaus ofCephalon, Inc., and Jazz Pharmaceuticals, Inc.SupportSupport for the publication of this supplementwas provided by Cephalon, Inc. Editorial assistancewas provided by Anthemis ConsultingLtd and supported by Cephalon, Inc.DisclaimerThe opinions expressed herein are those ofthe authors and do not necessarily representthose of Cephalon, Inc., or the publishers. Anyprocedures, medications, or other courses ofdiagnosis or treatment discussed or suggestedby the authors should not be used byclinicians without evaluation of their patients’conditions and possible contraindicationsor dangers in use, review of any applicablemanufacturer’s product information, and <strong>com</strong>parisonswith the re<strong>com</strong>mendations of otherauthorities. Content may include productinformation that is inconsistent with or outsidethe approved labeling for these productsin the United States. Before prescribing anymedication, you must familiarize yourself withthe manufacturer’s product information.This material was submitted by AnthemisConsulting Ltd on behalf of the authors. It hasbeen edited and peer reviewed by The Journalof Family Practice.Cover Image © Linda FrichtelCopyright © 2010 Dowden Health MediaS January 2010 / Vol 59, No 1 • Supplement to The Journal of Family Practice
The social and economic burdenof shift-work disorderLarry Culpepper, MD, MPHDepartment of Family MedicineBoston University Medical CenterBoston, MassachusettsPractice re<strong>com</strong>mendationsy Shift-work disorder (SWD) and its definingsymptoms can negatively affect health,quality of life, and work performance. Thegravity of these consequences necessitatesvigilance for the symptoms of SWD byprimary care physicians (SOR: B).y The threshold for treatment interventionfor emergency service workers, such asfirefighters, who make crucial decisionsunder shift-work conditions and who areexperiencing SWD should be lower thanfor shift workers in general (SOR: B).y The economic costs of untreatedSWD are likely to be high. Earlydiagnosis and treatment of SWD mayreduce these costs in addition to reducingthe human burden of this circadianrhythm sleep disorder (SOR: C).Dr Culpepper reports that he serves as a consultantto AstraZeneca, Eli Lilly and Company, PfizerInc, Wyeth, sanofi-aventis, and Takeda PharmaceuticalsNorth America, Inc, and on the speakersbureau of Wyeth.Shift work is a fundamental <strong>com</strong>ponent of working patternsacross the US workforce and is therefore an integral part ofthe lifestyle of a large proportion of the population. However,shift workers are at risk of developing the circadian rhythm sleepdisorder shift-work disorder (SWD), a clinically recognized conditionthat develops in some individuals who work at night, start workearly in the morning (4 to 7 am), or work according to a rotatingshiftschedule. SWD is more severe than—and distinct from—thesleep disturbances <strong>com</strong>monly associated with shift work. Providedother sleep/wake disorders can be discounted, SWD is diagnosedby the presence of excessive sleepiness (ES) and/or insomnia for≥1 month during which the individual is performing shift work. 1Shift work poses a serious public health risk, as it can impairan individual’s ability to perform effectively and may leadto occupational or traffic accidents. Furthermore, shift work hasnumerous negative health effects and infringes on an individual’sability to sleep, eat normally, exercise, and develop relationships.However, SWD is underrecognized in the clinical setting, 2and data regarding its epidemiology and etiology are scarce inthe scientific literature. Published information regarding shiftwork in general has therefore been used as the foundation forinforming the clinical <strong>com</strong>munity on the potential burden ofSWD. It is incumbent on primary care physicians to be vigilantfor SWD in shift workers, make an accurate diagnosis, and initiateappropriate treatment in order to relieve—and prevent—theacute consequences and long-term health sequelae of this disorder,as well as to ensure public safety.This supplement describes the burden of SWD, discussesthe current understanding of the processes that cause this andother circadian rhythm sleep disorders, and describes the recognitionand available management strategies for SWD. This articlereviews the prevalence of SWD and examines the scale of itssocial and economic burden, including associated <strong>com</strong>orbidities.In the second article, Dr Chris Drake explains the causes ofSWD and other circadian rhythm sleep disorders by describingthe circadian and homeostatic systems and detailing how lifestylefactors, individual susceptibility, morbidity, and genetic<strong>com</strong>ponents can result in circadian rhythm pathology.Supplement to The Journal of Family Practice • Vol 59, No 1 / January 2010 S
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