Andrew P. Hall

The occupational impact of sleep quality and insomnia symptoms

While the importance of assessing the occupational consequences of insomnia is emphasized in clinical nosologies and research guidelines, there is little consensus on which aspects of occupational performance should be assessed, the most methodologically justifiable measures of insomnia and work performance, and how outcomes should be reported. The present review was designed to summarize and methodologically critique the assessment of those aspects of occupational performance most impacted by (or most frequently associated with) insomnia symptoms. The 30 studies which met the review inclusion criteria broadly addressed six domains of occupational functioning: absenteeism; workplace accidents; productivity; punctuality; job satisfaction and career progression. Collectively, study outcomes support the conclusions that insomnia symptoms: are consistently associated with excess absenteeism; elevate accident risk in the workplace; reduce subjectively experienced workplace productivity (at least in the shorter term); inhibit career progression; and can degrade job satisfaction. Study outcomes do not support the conclusion that people with insomnia are significantly less punctual than other workers. The overall value of the occupational sleep-health literature, however, is limited by a lack of comparability among studies. In particular, there is a clear need to standardize definitions of sleep and occupational outcomes, and to recognize the confounding influence of health variables on occupational performance and sleep.

Risk of Narcolepsy after AS03 Adjuvanted Pandemic A/H1N1 2009 Influenza Vaccine in Adults: A Case-Coverage Study in England

STUDY OBJECTIVES An increased risk of narcolepsy has been observed in children following ASO3-adjuvanted pandemic A/H1N1 2009 (Pandemrix) vaccine. We investigated whether this risk extends to adults in England. METHODS Six adult sleep centers in England were visited between November 2012 and February 2014 and vaccination/clinical histories obtained from general practitioners. Suspected narcolepsy cases aged older than 17 y were selected. The risk of narcolepsy following Pandemrix was calculated using cases diagnosed by the time of the center visits and those with a diagnosis by November 30, 2011 after which there was increased awareness of the risk in children. The odds of vaccination in cases and in matched population data were compared using a case-coverage design. RESULTS Of 1,446 possible cases identified, most had onset before 2009 or were clearly not narcolepsy. Of the 60 remaining cases, 20 were excluded after expert review, leaving 40 cases with narcolepsy; 5 had received Pandemrix between 3 and 18 mo before onset. All the vaccinated cases had cataplexy, two received a diagnosis by November 2011 and two were aged 40 y or older. The odds ratio for vaccination in cases compared to the population was 4.24 (95% confidence interval 1.45-12.38) using all cases and 9.06 (1.90-43.17) using cases with a diagnosis by November 2011, giving an attributable risk of 0.59 cases per 100,000 doses. CONCLUSIONS We found a significantly increased risk of narcolepsy in adults following Pandemrix vaccination in England. The risk was lower than that seen in children using a similar study design.

An Investigation into the Relationship Between Sleep-Disordered Breathing, the Metabolic Syndrome, Cardiovascular Risk Profiles, and Inflammation Between South Asians and Caucasians Residing in the United Kingdom

BACKGROUND The aim of this study was to determine the prevalence of sleep-disordered breathing (SDB) in a South Asian and a Caucasian population and to compare the cardiovascular risk factors in those with SDB within these ethnic groups and determine if SDB is independently associated with the metabolic syndrome and markers of inflammation. METHODS A total of 1,598 participants within a U.K. multiethnic population underwent an oral glucose tolerance test, completed the Berlin Sleep Questionnaire, and provided anthropometric data and fasting bloods. Metabolic syndrome was classified according to National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS The prevalence of SDB was 28.3% and did not differ between the two ethnic groups. South Asians with SDB had a higher body fat percentage (38.4±10% vs. 35.6±9%, P=0.016), glycosylated hemoglobin (5.6±0.5% vs. 5.6±0.5%, P=0.001) and lower high-density lipoprotein cholesterol (1.21±0.23 mmol/L vs. 1.29±0.34 mmol/L, P=0.002) compared to Caucasians with SDB, who were older (59.6±8.6 years vs. 50.4±10.3 years, P<0.001) and had higher systolic blood pressure (139.8±18.5 mmHg vs. 131.7±18.6 mmHg, P<0.001). SDB was associated with metabolic syndrome after adjustment for age, gender, ethnicity, and waist circumference (odds ratio=1.54, 95% confidence interval 1.12-2.09, P=0.01). There was no independent association between SDB and markers of inflammation. CONCLUSION The relationship between SDB and metabolic syndrome is not driven via the inflammatory pathway. The prevalence of SDB is significantly higher in those with metabolic syndrome although these South Asians had a greater cardiovascular disease (CVD) risk profile the relationship is independent of ethnicity. Routine screening for SDB within primary/secondary care may have a role in the prevention of CVD and type 2 diabetes mellitus.

Sleep and type 2 diabetes mellitus

Man has always had a fascination with sleep; ancient philosophers considered it to be a state somewhere between life and death, though were more fascinated by dreams and their interpretation. We all know when we have had a good or bad night’s sleep and recognise that feeling of tiredness when sleep is required. However, it is easy to imagine sleep as a period of simple dormancy, the quiescent part of our daily lives, analogous to putting one’s computer or television in a standby mode. The neurological characteristics of sleep were not properly examined and described until the 1960s.1 We now understand it to be a dynamic process essential for life and health. Recently, it has become apparent that sleep quality and quantity can impact upon a number of metabolic, immune and hormonal processes including energy regulation and glycaemic control.2–5

The Loughborough Occupational Impact of Sleep Scale (LOISS): a new instrument for research and clinical practice

Despite the emphasis placed on occupational impairment as a consequence of most sleep disorders, there is currently no standardized measure for quantifying the occupational impact of sleep quality at the individual level. Using existing scales, a comprehensive literature review, and focus groups to generate items, as well as psychometric analyses to reduce items, these analyses describe the development of a scale to assess workplace performance in relation to sleep quality. In a survey of 222 employees aged 20 to 64 years, the resulting 19-item instrument (the Loughborough Occupational Impact of Sleep Scale [LOISS]) showed satisfactory levels of reliability, effective discrimination between “good” and “poor” sleepers, and an interpretable 2-factor structure. LOISS provides a practical tool for population screening and clinical assessment.