SHIFT WORK DISORDER - myCME.com

Shift-work disorderthe other potentially causative conditions. (Examplesof how mood disorders and other sleep/wake disorderscan be differentiated from SWD appear below.)Mood disorders and sleep/wake disorders oftenpresent in the primary care setting and can at first seemindistinguishable. For example, patients with ES as a resultof a sleep/wake disorder may superficially appearto have depression, as a lack of energy, poor memory,reduced concentration, and a loss of interest in lifeare common features of both ES and mood disorders.In such instances, asking the patient about his or hersleep habits and the use of simple depression questionnairessuch as the Patient Health Questionnaire-9(www.patient.co.uk/showdoc/40025272/) are vital toavoid misdiagnosis and prescription of inappropriatemedication.ES is also a symptom of the sleep/wake disordersobstructive sleep apnea (OSA) and restless legs syndrome(RLS), which are commonly reported in shiftworkers. 26,27 Patients with OSA have poor quality sleep,as they experience repeated full or partial blockages oftheir airway, resulting in snoring and episodes of chokingor gasping during sleep. 28 Recurrent partial or completeobstruction of the upper airway leads to repeatedarousals and disturbed sleep, which can cause ES. 29,30Night-shift work has been shown to aggravate OSA, 31possibly due to the increased potential for weight gainand metabolic disturbance in this population 24 ; overweightand metabolic syndrome are risk factors for andcomorbidities associated with OSA. 28 It is imperativethat patients with suspected OSA are referred to a sleepspecialist as well as counseled about appropriate therapiesand lifestyle changes. 32RLS may develop in shift workers due to low serumiron levels induced by chronic sleep deprivation. 33 Patientswith symptoms of RLS should have their serumferritin levels checked and, if found to be