Shift Work Disorder - Survey of prevalence in Emergency medicine workers in India
Background:Proportion of shift workers has taken a leap in the last 2 decades. Prevalence of Shift Work Disorder (SWD) is reported at 10-20% in the general population. Emergency Physicians (EP) & nurses are an important subset of the population whose health and wellbeing impacts morbidity and mortality of the rest of the population. This study aims to examine the prevalence of symptoms of SWD & its association with demographics, shift work patterns, sleep cycles, sleep hygiene, daytime sleepiness, personal health, occupational complaints & job satisfaction while covertly raising awareness about the same in the emergency medicine community.
Methods:A cross sectional survey of nurses and doctors working in emergency departments of atleast 12 major urban hospitals across India was conducted during October 2016 – March 2017. Peer validated questionnaire with standard scales, descriptive & objective questions was emailed only to individuals who were known to be working in Emergency departments as nurses and doctors. This convenience-sample of email addresses was obtained through personal and professional contacts of the researcher. Those who volunteered responses were included in the study. No identifying information was collected. Those who reported diagnosed sleeping disorders were excluded from the analysis. For analysis, responses were divided into 2 groups – those who reported symptoms of SWD and those who did not. With aid of a professional biostatistician, these 2 groups were then compared for unique characteristics and statistically significant variables using t test, chi square test, odds ratio and logistic regression wherever applicable. Considering estimated prevalence of 10% based on available literature, a sample size of 139 positive participants was required for 95% confidence interval(CI).
Results:Response rate was 62% (216/350). Mean age of participants was (31.76 +/- 7.72) years with equal representation of both genders. More than a quarter of participants (27%) (For 95%CI 0.211 – 0.329) reported having symptoms indicative of SWD. Women are 3 times more likely than males to have SWD(p=0.0416)(OR=3.006, 95%CI 1.043-8.665). Those who reported symptoms of SWD also reported higher Sleep Hygiene Index(SHI) scores (p<0.0001 for SHI score>26) & Epworth Sleepiness scale(ESS) scores (p=0.015). People with SWD reported lower mean job satisfaction scores (p=0.037) & are more likely to be using sleeping aids.(p=0.0014)(OR=1.19, 95%CI -1.011-1.405.) No statistically significant association could be established between SWD and age, number of weekly night shifts, years of experience, health & occupational complaints, substance use & morningness/eveningness.
Conclusions & discussion:Though, prevalence of symptoms of SWD in Emergency medicine workers is reportedly higher than the general population, this may be misleading as adequate sample size was not achieved. Subjects reporting to having symptoms of SWD objectively reported excessive daytime sleepiness thus potentially affecting all daily activities & walks of life. Lower job satisfaction scores reported by these subjects may support this claim. It can be hypothesised that shift work leads to unhealthy sleep hygiene which may be a major factor in development of symptoms of SWD. This can also mean that raising awareness on the subject itself may be sufficient in limiting the issue to a great extent.
