SHIFT WORK DISORDER - myCME.com

figure Questions to ask patients who present with insomnia and/or ES(as assessed by an ESS score ≥10)Does your occupation requireyou to work shifts?YESNoWhen sleeping, do you feeldiscomfort in your legsor jerk them involuntarily?When sleeping, do you feeldiscomfort in your legsor jerk them involuntarily?NoYesYesNoDo you snore orDo you snore orexperience episodes ofexperience episodes ofchoking during sleep?No/Don't know YesPatients may have restlesslegs syndrome—Check serum ferritin and considera trial of a dopamine agonistYeschoking during sleep?No/Don't knowDo you have a dry, sorethroat on waking?Do you have a dry, sorethroat on waking?No Yes Yes NoHave your ES and/or insomniapersisted for ≥1 month?Patient may have obstructive sleepapnea—Refer to a sleep specialistfor polysomnographyNoYesPatient does not have SWD butexperiences impairment whenworking shifts—Suggest improvementsin sleep hygienePatient may have SWD—Review sleephygiene and consider trial of therapyPatient’s symptoms may be dueto other causes eg, a mood disorder,stimulant or sedative medications,or substance abuse—Further assessment is requiredES, excessive sleepiness; ESS, Epworth Sleepiness Scale; SWD, shift-work disorder.These questions aim to aid in differentiating between common sleep/wake disorders in shift-working patients who present with sleepiness or have trouble sleepingand should not be viewed as an exhaustive or definitive list of potential questions or potential diagnoses.Risk factors for SWDVulnerability to SWD is dependent on certain predisposingand precipitating factors, including shift characteristics,circadian preference, job satisfaction, andsusceptibility to sleep disturbance (see “The characterizationand pathology of circadian rhythm sleep disorders”on page S12 of this supplement). The effects ofsome physiological and lifestyle factors, such as age andgender, on an individual’s propensity to develop SWDhave not been well quantified to date.Shift type and patternNight-shift workers are reportedly most susceptible toSWD, with an estimated 32.1% of this group experiencingsymptoms that meet the minimum diagnostic criteria forSWD compared with 26.1% of rotating-shift workers. 6 Arecent study by Waage and others 7 found that 23.3% of oilrig swing-shift workers (2 weeks working 12-hour day/night shifts followed by 4 weeks off) met ICSD-2 criteriafor SWD. The relatively high prevalence of SWD in nightshiftworkers is thought to be due to exposure to lightduring rest periods and dark during the hours when theworkers are attempting to be most productive. 6 Morningshiftworkers are more susceptible to SWD than eveningshiftworkers, as delaying sleep appears to be more easilyachieved than attempting to advance the rest period. 8Supplement to The Journal of Family Practice • Vol 59, No 1 / January 2010 S19