Sleep and Breathing

, Volume 16, Issue 1, pp 149–162 | Cite as

The prevalence of sleep problems in emergency medical technicians

  • Ronald G. Pirrallo
  • Catherine C. LoomisEmail author
  • Roger Levine
  • B. Tucker Woodson
Original Article



To investigate the prevalence, demographic, and work associations of self-reported sleep complaints in US emergency medical technicians (EMTs)


The mailed 2005 Longitudinal Emergency Medical Technician Attributes and Demographics Study (LEADS) questionnaire was distributed to selected EMTs that included 35 sleep-related questions. Questions were adapted from previously validated sleep medicine surveys, including the Epworth Sleepiness Scale (ESS), and were used to estimate the prevalence of different sleep problems. These sleep problems were analyzed in relation to demographic, health, satisfaction, and workplace characteristics. Responses of individuals who were not working as EMTs were used as a comparison group.


Sleep problems in working EMTs were more prevalent than in a comparison group. Seventy percent of working EMTs had at least one sleep problem. The most common sleep problem was a risk of long sleep onset disorder (50%). EMTs with tiredness-related work difficulties were more than 50% as likely to report this problem. The prevalence of excessive daytime sleepiness (ESS > 10) was 36%; 6% of the EMTs had an ESS > 16. EMTs reporting tiredness-related work difficulties were more than twice as likely to have ESS scores >10 and more than three times as likely to ESS scores >16. Symptom-defined risk of sleep apnea was present in 5%. Risks of sleep onset and maintenance disorder problems were more prevalent among those who worked longer shifts and had longer work weeks and were associated with poorer job satisfaction and poorer health.


Severe sleep problems and severe sleepiness at a level that may contribute to health and job issues are common in US EMTs. Although breathing disorders are common, behaviorally related sleep issues are more prevalent. These data support an increased focus on sleep onset and maintenance disorders.


Insomnia Obstructive sleep apnea Excessive daytime sleepiness Emergency medical technician Sleep disorders Prevalence 



This study was supported in part by the National Highway Traffic Safety Administration (NHTSA) with in-kind contributions by the National Registry of Emergency Medical Technicians (NREMT). The article does not, however, necessarily reflect the views of NHTSA or NREMT. The authors thank the many nationally registered emergency medical technicians who have completed surveys for the LEADS project. Additionally, the authors thank Humberto A. Battistini, MD for his assistance with the study design.

Conflict of interest

This study was supported in part by the National Highway Traffic Safety Administration (NHTSA), through a technical assistance contract with Dr. Levine. The other authors have no financial conflicts of interest.


  1. 1.
    Banks S, Dinges DF (2007) Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med 3:519–528PubMedGoogle Scholar
  2. 2.
    Belenky G, Wesensten NJ, Thorne DR, Thomas ML, Sing HC, Redmond DP, Russo MB, Balkin TJ (2003) Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose-response study. J Sleep Res 12:1–12PubMedCrossRefGoogle Scholar
  3. 3.
    Van Dongen HPA, Maislin G, Mullington JM, Dinges DF (2003) The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 26:117–126PubMedGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention (2008) Perceived insufficient rest or sleep—four states, 2006. MMWR 57:200–203Google Scholar
  5. 5.
    Philibert I (2005) Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep 28:1392–1402PubMedGoogle Scholar
  6. 6.
    Hartenbaum N, Collop N, Rosen IM, Phillips B, George CFP, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL, Rosekind MR (2006) Sleep apnea and commercial motor vehicle operators: statement from the joint Task Force of the American College of Chest Physicians, American College of Occupational and Environmental Medicine, and the National Sleep Foundation. J Occup Environ Med 48:S4–S37PubMedCrossRefGoogle Scholar
  7. 7.
    Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer FE, Czeisler CA (2006) Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med 3:e487PubMedCrossRefGoogle Scholar
  8. 8.
    Institute of Medicine (1999) To err is human: building a safer health system. In: Kohn LT, Corrigan JM, Donaldson MS (eds) Committee on Quality of Healthcare in America. National Academies Press, WashingtonGoogle Scholar
  9. 9.
    Chien KL, Chen PC, Hsu HC, Su TC, Sung FC, Chen MF, Lee YT (2010) Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: report from a community-based cohort. Sleep 33:177–184PubMedGoogle Scholar
  10. 10.
    Watanabe M, Kikuchi H, Tanaka K, Takahashi M (2010) Association of short sleep duration with weight gain and obesity at 1-year follow-up: a large-scale prospective study. Sleep 33:161–167PubMedGoogle Scholar
  11. 11.
    Brown WE, Dickison PD, Misselbeck WJA, Levine R (2002) Longitudinal Emergency Medical Technician Attribute and Demographic Study (LEADS): an interim report. Prehosp Emerg Care 6:433–439PubMedCrossRefGoogle Scholar
  12. 12.
    Dawson DE, Brown WE, Harwell TS (2003) Assessment of nationally registered emergency medical technician certification training in the United States: the LEADS project. Longitudinal Emergency Medical Technician Attributes Demo-graphic Study. Prehosp Emerg Care 7:114–119PubMedCrossRefGoogle Scholar
  13. 13.
    Brown WE, Dawson D, Levine R (2003) Compensation, benefits, and satisfaction: the Longitudinal Emergency Medical Technician Demographic Study (LEADS) project. Prehosp Emerg Care 7:357–362PubMedCrossRefGoogle Scholar
  14. 14.
    Piccirillo JF, Gates GA, White DL, Schectman KB (1998) Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol Head Neck Surg 118:833–844PubMedCrossRefGoogle Scholar
  15. 15.
    Maislin G, Pack AI, Kribbs NB, Smith PL, Schwartz AR, Kline LR, Schwab RJ, Dinges DF (1995) A survey screen for prediction of apnea. Sleep 18(3):158–166PubMedGoogle Scholar
  16. 16.
    Garbarino S, De Carli F, Nobili L, Masciallino B, Squarcia S, Penco MA, Beelke M, Ferrillo F (2002) Sleepiness and sleep disorders in shift workers: a study on a group of Italian police officers. Sleep 25(6):642–647Google Scholar
  17. 17.
    Weaver EM, Woodson BT, Witsell DL, Stewart MG, Smith TL, Yueh B, Hannley MT (2007) UPPP and subjective sleep apnea outcomes: the SLEEP study. Otolaryngol Head Neck Surg 137(Suppl 2):P67CrossRefGoogle Scholar
  18. 18.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  19. 19.
    Johns MW (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep 15:376–381PubMedGoogle Scholar
  20. 20.
    National Center for Education Statistics (2002) Statistical Standards, Standard 4-4-2, Guideline 4-4-2E. Washington, DC: U.S. Department of Education. Retrieved from, November 11, 2010.
  21. 21.
    Pirrallo RG, Levine R, Dickison PD (2005) Behavioral health risk factors of United States emergency medical technicians: the LEADS project. Prehospital and Disaster Medicine 20:235–242PubMedGoogle Scholar
  22. 22.
    Sucher MA, Waxler JL (2006) EMS providers and system roles. In: Brennan JA, Krohmer JR (eds) Principles of EMS systems. Jones and Bartlett, Sudbury, MA, pp 302–312Google Scholar
  23. 23.
    Johns MW (2000) Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the epworth sleepiness scale: failure of the MSLT as a gold standard. J Sleep Res 9:5–11PubMedCrossRefGoogle Scholar
  24. 24.
    Colten HR, Altevogt BM (eds) (2006) Sleep problems and sleep deprivation: an unmet public health problem, Institute of Medicine. National Academies Press, WashingtonGoogle Scholar
  25. 25.
    Barger LK, Cade BE, Ayas NT, Cronin JW, Rosner B, Speizer FE, Czeisler CA (2005) Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 352:125–134PubMedCrossRefGoogle Scholar
  26. 26.
    Drake CL, Roehrs T, Richardson G, Walsh JK, Roth T (2004) Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep 27:1453–1462PubMedGoogle Scholar
  27. 27.
    Van Der Ploeg E, Kleber RJ (2003) Acute and chronic job stressors among ambulance personnel: predictors of health symptoms. Occup Environ Med 60(Suppl 1):i40–i46PubMedCrossRefGoogle Scholar
  28. 28.
    Sterud T, Hem E, Ekeberg O, Lau B (2008) Health problems and help-seeking in a nationwide sample of operational Norwegian ambulance personnel. BMC Public Health [serial online] 8. Accessed 4 July 2010.
  29. 29.
    Aasa U, Brulin C, Angquist KA, Barnekow-Bergkvist M (2005) Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel. Scand J Caring Sci 19:251–258PubMedCrossRefGoogle Scholar
  30. 30.
    Partinen M, Hublin C (2005) Epidemiology of sleep disorders. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 4th edn. Elsevier, Philadelphia, pp 626–647CrossRefGoogle Scholar
  31. 31.
    Raediker B, Janssen D, Schomann C (2006) Extended working hours and health. Chronobiol Int 23:1305–1316PubMedCrossRefGoogle Scholar
  32. 32.
    Elliot DL, Kuehl KS (2007) Effects of sleep deprivation on fire fighters and EMS responders. International Association of Fire Chiefs. Accessed 4 July 2010
  33. 33.
    Hall M, Buysee DJ, Nowell PD, Nofzinger EA, Houck P, Reynolds CF, Kupfer DJ (2000) Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosom Med 62:227–230PubMedGoogle Scholar
  34. 34.
    Sutton DA, Moldofsky H, Badley EM (2001) Insomnia and health problems in Canadians. Sleep 24:665–670PubMedGoogle Scholar
  35. 35.
    Young T, Palta M, Dempsey J (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235PubMedCrossRefGoogle Scholar
  36. 36.
    Fahy RF (2005) U.S. firefighter fatalities due to sudden cardiac death, 1995-2004. National Fire Protection Association. Accessed 4 July 2010.
  37. 37.
    Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin Sleep Cohort. Sleep 31:1071–1078PubMedGoogle Scholar
  38. 38.
    Marshall NS, Wong KKH, Liu PY, Cullen SRJ, Knuiman MW, Grunstein RR (2008) Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 31:1079–1085PubMedGoogle Scholar
  39. 39.
    Ayas NT, Barger LK, Cade BE, Hashimoto DM, Rosner B, Cronin JW, Speizer FE, Czeisler CA (2006) Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA 296:1055–1062PubMedCrossRefGoogle Scholar
  40. 40.
    Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler CA (2006) Interns' compliance with accreditation council for graduate medical education work-hour limits. JAMA 296(9):1063–1070PubMedCrossRefGoogle Scholar
  41. 41.
    Lockley SW, Landrigan CP, Barger LK, Czeisler CA, Harvard Work Hours Health and Safety Group (2006) When policy meets physiology: the challenge of reducing resident work hours. Clin Orthop Relat Res 449:116–127Google Scholar
  42. 42.
    Landrigan CP, Czeisler CA, Barger LK, Ayas NT, Rothschild JM, Lockley SW, Harvard Work Hours Health and Safety Group (2007) Effective implementation of work-hour limits and systemic improvements. Joint Comm J Qual Patient Saf 33(11 Suppl):19–29Google Scholar
  43. 43.
    Lockley SW, Barger LK, Ayas NT, Rothschild JM, Czeisler CA, Landrigan CP, Harvard Work Hours Health and Safety Group (2007) Effects of health care provider work hours and sleep deprivation on safety and performance. Joint Comm J Qual Patient Saf 33(11 Suppl):7–18Google Scholar
  44. 44.
    Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP (2008) Rates of medication errors among depressed and burnt out residents: prospective cohort study. Br Med J 336:488–491CrossRefGoogle Scholar
  45. 45.
    Landrigan CP, Fahrenkopf AM, Lewin D, Sharek PJ, Barger LK, Eisner M, Edwards S, Chiang VW, Wiedermann BL, Sectish TC (2008) Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. Pediatrics 122(2):250–258PubMedCrossRefGoogle Scholar
  46. 46.
    Barger LK, Lockley SW, Rajaratnam SM, Landrigan CP (2009) Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Curr Neurol Neurosci Rep 9(2):155–164PubMedCrossRefGoogle Scholar
  47. 47.
    Institute of Medicine (2006) Emergency medical services at the crossroads. National Academies Press, WashingtonGoogle Scholar
  48. 48.
    Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 57(5):423–438PubMedCrossRefGoogle Scholar
  49. 49.
    Chung F, Yegneswaran B, Liao P, Chung SA, Vairavanathan S, Islam S, Khajehdehi A, Shapiro CM (2008) STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 108(5):812–821PubMedCrossRefGoogle Scholar
  50. 50.
    Fong SY, Ho CK, Wing YK (2005) Comparing MSLT and ESS in the measurement of excessive daytime sleepiness in obstructive sleep apnoea syndrome. J Psychosom Res 58:55–60PubMedCrossRefGoogle Scholar
  51. 51.
    Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L, Reis SE, Matthews KA (2008) Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/ polysomnographic measures in a community sample. J Clin Sleep Med 4(6):563–571PubMedGoogle Scholar
  52. 52.
    de Leeuw E, de Heer W (2002) Trends in household survey nonresponse: a longitudinal and international comparison. In: Groves R, Dillman D, Eltinge J, Little R (eds) survey nonresponse. Wiley, New York, pp 41–54Google Scholar
  53. 53.
    Curtin R, Presser S, Singer E (2005) Changes in telephone survey nonresponse over the past quarter century. Publ Opin Q 69:87–98CrossRefGoogle Scholar
  54. 54.
    Groves R (2006) Nonresponse rates and nonresponse error in household surveys. Public Opin Q 70:646–675CrossRefGoogle Scholar
  55. 55.
    Levine R (2003) LEADS survey results: comparisons of state and nationally registered EMTs and scope of practice findings. Presentation at the National Association of State Directors of Emergency Medicine Annual Meeting, Arlington, VAGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Ronald G. Pirrallo
    • 1
  • Catherine C. Loomis
    • 2
    Email author
  • Roger Levine
    • 3
  • B. Tucker Woodson
    • 4
  1. 1.Department of Emergency MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Restorative Sleep, L.L.CMequonUSA
  3. 3.American Institutes for ResearchSan MateoUSA
  4. 4.Division of Sleep Medicine, Department of Otolaryngology and Communication SciencesMedical College of WisconsinMilwaukeeUSA

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