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Screening for Sleep Disorders

Sleep disorders and sleep problems affect as many as 40% of Australian adults at any one time. Many people have undiagnosed sleep disorders that may affect workplace alertness, productivity and safety.

Research has shown:

  • Up to 40% of active duty police officers and 37% of firefighters are at risk of at least one major sleep disorder, primarily obstructive sleep apnoea (OSA), and that the risk of a sleep disorder is also associated with a higher risk of chronic disease, particularly depression and anxiety.
  • Approximately 40% of truck drivers are at high risk of OSA.
  • Insomnia is associated with a two-fold increase in workplace injuries, even when controlled for other comorbid conditions. Productivity is also significantly affected by insomnia in lost work performance, due to presenteeism (low on-the-job performance), with an average of around eight days of lost work performance per person. The American Insomnia Survey estimated the prevalence of insomnia at 23% of the workforce.
  • Drivers with untreated OSA are up to five times more likely to have a motor vehicle crash. In Australia, heavy vehicle drivers diagnosed with OSA were more than three times more likely to crash than those without OSA and more than six times likely to crash if they had not completed fatigue management training.
  • The odds of having a workplace accident is doubled in workers with OSA, and having any reported sleep problems saw an increased risk of being injured at work by 62%, with 13% of injuries attributable to sleep problems.
  • About 1.5 million Australians who are shift workers are particularly vulnerable to sleepiness related accidents and injuries, with around a 30% increased risk of having an accident on a night shift compared to a day shift, increasing to 25% after four consecutive night shifts. Many high-profile workplace accidents have happened at night and illustrate the potentially catastrophic impact of occupational errors on the public.

What does it really cost?

As well as costing us our health and in some cases, our lives, the financial cost of accidents and reduced productivity to business due to sleepiness and sleep disorders is enormous. In 2010, the Sleep Health Foundation’s ‘Reawakening Australia’ report stated that the indirect (non-healthcare) costs associated with sleep disorders and conditions was $4.3 billion a year, including $3.1 billion in lost productivity due to premature workforce separation and mortality, and absenteeism. Obstructive Sleep Apnoea (OSA) accounted for about 60% of these costs. The total health system cost for conditions attributed to sleep disorders was estimated to be $544 million in 2010 with $408.5 million attributed to OSA, $118.7 million to insomnia and $16.9 million due to Restless Legs Syndrome.

In the US, each insomnia-related injury is estimated to cost an average of $32,000, significantly higher than other accidents and injuries, and account for a disproportionate proportion of the losses due to accidents (7% of accidents but 24% of the cost). In fact, insomnia-related workplace accidents and errors have a combined value of US $31.1 billion, and the reduced presenteeism associated with insomnia is estimated to cost the US economy $63 billion per year.

What can be done?

When individuals are advised to visit their doctor for assistance, it can create barriers for them in receiving treatment. As such, workplaces are ideal in helping to identify undiagnosed disorders. Programs can be conducted in the workplace in a confidential manner and arranged to account for any logistical, health insurance, or licensing concerns to ensure that workers are not penalised for participating. While each workplace will find its own best practice model, they should all address the same underlying principles – to identify workers who may be at risk of a clinical sleep disorder and referring them for formal evaluation, diagnosis and treatment. Examples and benefits of successful sleep disorder screening, referral and treatment programs are included in this section. Such programs will improve workplace alertness, safety and productivity and employee health and wellbeing.

Research references

Re-awakening Australia. The economic cost of sleep disorders in Australia, 2010; Sleep Health Foundation.

http://sleephealthfoundation.org.au/pdfs/news/Reawakening%20Australia.pdf

Barger LK, O'Brien CS, Rajaratnam SM, Qadri S, Sullivan JP, Wang W, Czeisler CA, Lockley SW. Implementing a sleep health education and sleep disorders screening program in fire departments: A comparison of methodology. J Occup Environ Med. 2016; 58(6):601-9.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4883642/[FREE ARTICLE]

Barger LK, Rajaratnam SM, Wang W, O'Brien CS, Sullivan JP, Qadri S, Lockley SW, Czeisler CA; Harvard Work Hours Health and Safety Group. Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. J Clin Sleep Med. 2015; 11(3):233-40.

http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29921[FREE ARTICLE]

Folkard S, Lombardi DA. Modeling the impact of the components of long work hours on injuries and "accidents". Am J Ind Med. 2006; 49(11):953-63.

https://www.ncbi.nlm.nih.gov/pubmed/16570251

Garbarino S, Guglielmi O, Sanna A, Mancardi GL, Magnavita N. Risk of occupational accidents in workers with Obstructive Sleep Apnea: Systematic review and meta-analysis. Sleep. 2016; 39(6):1211-8.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4863208/[FREE ARTICLE]

Howard ME, Desai AV, Grunstein RR, Hukins C, Armstrong JG, Joffe D, Swann P, Campbell DA, Pierce RJ. Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. Am J Respir Crit Care Med. 2004; 170(9):1014-21.

https://www.ncbi.nlm.nih.gov/pubmed/15317672

Kessler RC, Berglund PA, Coulouvrat C, Hajak G, Roth T, Shahly V, Shillington AC, Stephenson JJ, Walsh JK. Insomnia and the performance of US workers: results from the America insomnia survey. Sleep. 2011; 34(9):1161-71. Erratum in: Sleep. 2011; 34(11):1608. Sleep. 2012; 35(6):725.

https://www.ncbi.nlm.nih.gov/pubmed/21886353

Kessler RC, Berglund PA, Coulouvrat C, Fitzgerald T, Hajak G, Roth T, Shahly V, Shillington AC, Stephenson JJ, Walsh JK. Insomnia, comorbidity, and risk of injury among insured Americans: results from the America Insomnia Survey. Sleep. 2012; 35(6):825-34.

https://www.ncbi.nlm.nih.gov/pubmed/22654202

Rajaratnam SM, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O'Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA; Harvard Work Hours, Health and Safety Group. Sleep disorders, health, and safety in police officers. JAMA. 2011; 306(23):2567-78.

https://www.ncbi.nlm.nih.gov/pubmed/22187276

Rajaratnam SM, Howard ME, Grunstein RR. Sleep loss and circadian disruption in shift work: health burden and management. Med J Aust. 2013; 199(8):S11-5.

https://www.ncbi.nlm.nih.gov/pubmed/24138359

Schwartz DA, Vinnikov D, Blanc PD. Occupation and Obstructive Sleep Apnea: A Meta-Analysis .J Occup Environ Med. 2017; 59(6):502-508.

https://www.ncbi.nlm.nih.gov/pubmed/28598928

Shahly V, Berglund PA, Coulouvrat C, Fitzgerald T, Hajak G, Roth T, Shillington AC, Stephenson JJ, Walsh JK, Kessler RC. The associations of insomnia with costly workplace accidents and errors: results from the America Insomnia Survey. Arch Gen Psychiatry. 2012; 69(10):1054-63.

https://www.ncbi.nlm.nih.gov/pubmed/23026955

Sharwood LN, Elkington J, Stevenson M, Grunstein RR, Meuleners L, Ivers RQ, Haworth N, Norton R, Wong KK. Assessing sleepiness and sleep disorders in Australian long-distance commercial vehicle drivers: self-report versus an “at home” monitoring device. Sleep. 2012;35:469–75.

https://www.ncbi.nlm.nih.gov/pubmed/22467984

Tregear S, Reston J, Schoelles K, Phillips B. Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med. 2009; 5(6):573-81.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2792976/[FREE ARTICLE]

Uehli K, Mehta AJ, Miedinger D, Hug K, Schindler C, Holsboer-Trachsler E, Leuppi JD, Künzli N. Sleep problems and work injuries: a systematic review and meta-analysis. Sleep Med Rev. 2014; 18(1):61-73.

http://www.smrv-journal.com/article/S1087-0792(13)00008-7/fulltext[FREE ARTICLE]