Clinical presentation of shift workers to a sleep clinic

The purpose of this study was to assess the relationship between shift work (SW) history and symptom severity in a sleep clinic population.

A retrospective chart review of 1,275 employed adult patients referred to a sleep disorders clinic was performed. Patients were categorized as working day shift, fixed evening or night shift, or rotating shifts. Sleep-related symptoms were assessed across three domains-sleepiness, insomnia, and apnea-related symptoms.

The distribution of work shift was 69% day shift, 8% fixed evening or night shift, and 23% rotating shifts. In general, sleepiness and insomnia symptoms were greatest in fixed shift workers. In analyses adjusted for age, sex, education, race, BMI, habitual sleep duration, marital status, education level, alcohol intake, and smoking history, fixed shift workers were 4.8 times (95% CI, 1.9-12.5) more likely to report sleep onset difficulties, 3.3 times (95% CI, 1.2-9.1) more likely to report excessive caffeine intake, and 1.8 times (95% CI, 1.1-3.0) more likely to report drowsy driving as compared to day shift workers. In contrast, rotating shift workers reported more difficulty with sleep onset (OR 2.7; 95% CI, 1.3-5.6) relative to day shift workers. No relationship between work shift and apnea-related symptoms was identified.

Among patients referred to a sleep disorders clinic, shift workers and in particular fixed shift workers have greater difficulties with sleep onset, drowsy driving, and excessive caffeine intake. Given the presence of effective treatments for SW-related sleep symptoms, these findings suggest an underutilization of sleep medicine specialists for the care of patients with symptoms related to SW.