Excessive sleepiness related to shift work has a severely negative effect on safety and quality of life, but health care providers rarely initiate discussions with patients about shift work disorder, according to survey results.

MINNEAPOLIS—In a survey of shift workers with excessive sleepiness, more than one third of respondents reported dozing off while driving within the past month.Diminished quality of life and compromised care of dependents also were common problems, researchers reported at the 25th Anniversary Meeting of the Associated Professional Sleep Societies.
The researchers presented findings from two studies involving surveys on shift work disorder, a circadian rhythm disorder characterized by excessive sleepiness at nighttime and insomnia in the daytime among shift workers. One study analyzed self-reports about the quality of life among shift workers with symptoms consistent with shift work disorder. The other study analyzed shift workers’ responses about recognition of shift work disorder and health care professionals’ responses about diagnosis of the disorder. The studies were presented by Candace Anderson, formerly of Cephalon, Inc. in Frazer, Pennsylvania and currently of Auxilium in Malvern, Pennsylvania, and Sharon Paik and Lauren Sylvester, both of Ipsos Health in Norwalk, Connecticut.
Sleepiness and Quality of Life
The quality-of-life study included responses from 260 shift workers who showed functional impairment on one of the Sheehan Disability Scale (SDS) domains. Of the workers, 103 had been diagnosed with shift work disorder and 157 had excessive sleepiness but no shift work disorder diagnosis. A priori recruitment quotas called for 100 patients diagnosed with shift work disorder and 150 patients with excessive sleepiness but no diagnosis of shift work disorder.
The respondents’ scores on the Epworth Sleepiness Scale (ESS), the Karolinska Sleepiness Scale, and the SDS indicated that shift work affected them negatively, regardless of whether they had a shift work disorder diagnosis. Thirty-seven percent of respondents reported dozing while driving, and more than 10% reported being injured at work due to sleepiness. In addition, 87.1% reported poor concentration or attention at work, 69% reported mistakes at work, and 43% reported compromised care of dependents due to sleepiness.
Shift work also negatively affected quality-of-life attributes for respondents with or without shift work disorder diagnoses. Among all respondents, more than half (80% of those with a diagnosis and 38% of those without a diagnosis) reported using a prescription medication at some time in the past to stay awake long enough to accomplish daily tasks. In addition, respondents frequently reported that shift work had affected their energy levels (72% of respondents), social lives (64%), mood (63%), and ability to fall asleep (63%). On a 10-point scale in which 1 indicated “not serious at all” and 10 indicated “extremely serious,” the mean ratings for the impacts of excessive sleepiness and insomnia on quality of life were 7.0 and 6.3, respectively.
“The negative consequences of shift work are both severe and limiting for those suffering, showing a need to help shift workers improve their functionality and wakefulness to ensure the safety of themselves and those around them,” the researchers concluded.
Recognition and Diagnosis of Shift Work Disorder
The recognition and diagnosis study analyzed responses from the same 260 shift workers and from 673 health care professionals, including physicians, physician assistants, nurses, and nurse practitioners.
Half of the workers reported that a physician had diagnosed them with comorbid anxiety, while 45% reported a depression diagnosis and 30% reported an insomnia diagnosis. Sixty-five percent of workers with a shift work disorder diagnosis and 55% without a diagnosis reported that shift work had caused them to experience both excessive sleepiness and insomnia. Among shift workers without a diagnosis, 23% did not believe that they experienced excessive sleepiness, even though they scored 10 or higher on the ESS and their SDS scores indicated functional impairment.
Forty-five percent of the shift workers said that they had discussed excessive sleepiness symptoms associated with their work schedule with a physician. Workers with a shift work disorder diagnosis were more than three times more likely than those without a diagnosis to report such a discussion (77% vs 25%). Of all the workers who reported a discussion with a physician, 82% reported initiating the discussion and only 13% reported that the physician had initiated it.
The health care professionals estimated that, on average, clinicians fail to detect shift work disorder in 67% of patients who have the disorder. They suggested that the disorder is often masked by such comorbidities as depression, insomnia, chronic fatigue syndrome, and obstructive sleep apnea.
“The results of this study suggest that there is a need for greater recognition and education of the symptoms of shift work disorder for shift workers and health care providers,” the researchers concluded. “The findings here provide an important opportunity to improve the diagnosis and management of shift work disorder.”

—Jack Baney

Measuring the Consequences of Shift Work Disorder