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The prevalence of sleep problems in emergency medical technicians

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Abstract

Purpose

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

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Banks S, Dinges DF (2007) Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med 3:519–528

    PubMed  Google Scholar 

  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 12:1–12

    Article  PubMed  Google Scholar 

  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 26:117–126

    PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention (2008) Perceived insufficient rest or sleep—four states, 2006. MMWR 57:200–203

    Google Scholar 

  5. Philibert I (2005) Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep 28:1392–1402

    PubMed  Google Scholar 

  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–S37

    Article  PubMed  Google Scholar 

  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:e487

    Article  PubMed  Google Scholar 

  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, Washington

    Google Scholar 

  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 33:177–184

    PubMed  Google Scholar 

  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 33:161–167

    PubMed  Google Scholar 

  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 6:433–439

    Article  PubMed  Google Scholar 

  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 7:114–119

    Article  PubMed  Google Scholar 

  13. Brown WE, Dawson D, Levine R (2003) Compensation, benefits, and satisfaction: the Longitudinal Emergency Medical Technician Demographic Study (LEADS) project. Prehosp Emerg Care 7:357–362

    Article  PubMed  Google Scholar 

  14. Piccirillo JF, Gates GA, White DL, Schectman KB (1998) Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol Head Neck Surg 118:833–844

    Article  PubMed  CAS  Google Scholar 

  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):158–166

    PubMed  CAS  Google Scholar 

  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):642–647

    Google Scholar 

  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):P67

    Article  Google Scholar 

  18. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    PubMed  CAS  Google Scholar 

  19. Johns MW (1992) Reliability and factor analysis of the Epworth sleepiness scale. Sleep 15:376–381

    PubMed  CAS  Google Scholar 

  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 http://nces.ed.gov/StatProg/2002/std4_4.asp, November 11, 2010.

  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 20:235–242

    PubMed  Google Scholar 

  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 302–312

    Google Scholar 

  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 9:5–11

    Article  PubMed  CAS  Google Scholar 

  24. Colten HR, Altevogt BM (eds) (2006) Sleep problems and sleep deprivation: an unmet public health problem, Institute of Medicine. National Academies Press, Washington

    Google Scholar 

  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 352:125–134

    Article  PubMed  CAS  Google Scholar 

  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 27:1453–1462

    PubMed  Google Scholar 

  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–i46

    Article  PubMed  Google Scholar 

  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. http://www.biomedcentral.com/1471-2458/8/3. Accessed 4 July 2010.

  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 19:251–258

    Article  PubMed  Google Scholar 

  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 626–647

    Chapter  Google Scholar 

  31. Raediker B, Janssen D, Schomann C (2006) Extended working hours and health. Chronobiol Int 23:1305–1316

    Article  PubMed  Google Scholar 

  32. Elliot DL, Kuehl KS (2007) Effects of sleep deprivation on fire fighters and EMS responders. International Association of Fire Chiefs. http://www.iafc.org/associations/4685/files/progsSleep_SleepDeprivationReport.pdf. Accessed 4 July 2010

  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 62:227–230

    PubMed  CAS  Google Scholar 

  34. Sutton DA, Moldofsky H, Badley EM (2001) Insomnia and health problems in Canadians. Sleep 24:665–670

    PubMed  CAS  Google Scholar 

  35. Young T, Palta M, Dempsey J (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  36. Fahy RF (2005) U.S. firefighter fatalities due to sudden cardiac death, 1995-2004. National Fire Protection Association. http://www.nfpa.org/assets/files/PDF/OSCardiacDeath.pdf. Accessed 4 July 2010.

  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 31:1071–1078

    PubMed  Google Scholar 

  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 31:1079–1085

    PubMed  Google Scholar 

  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 296:1055–1062

    Article  PubMed  CAS  Google Scholar 

  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):1063–1070

    Article  PubMed  CAS  Google Scholar 

  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 449:116–127

    Google Scholar 

  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):19–29

    Google Scholar 

  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):7–18

    Google Scholar 

  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 336:488–491

    Article  Google Scholar 

  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):250–258

    Article  PubMed  Google Scholar 

  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):155–164

    Article  PubMed  Google Scholar 

  47. Institute of Medicine (2006) Emergency medical services at the crossroads. National Academies Press, Washington

    Google Scholar 

  48. Abrishami A, Khajehdehi A, Chung F (2010) A systematic review of screening questionnaires for obstructive sleep apnea. Can J Anaesth 57(5):423–438

    Article  PubMed  Google Scholar 

  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):812–821

    Article  PubMed  Google Scholar 

  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 58:55–60

    Article  PubMed  CAS  Google Scholar 

  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):563–571

    PubMed  Google Scholar 

  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 41–54

    Google Scholar 

  53. Curtin R, Presser S, Singer E (2005) Changes in telephone survey nonresponse over the past quarter century. Publ Opin Q 69:87–98

    Article  Google Scholar 

  54. Groves R (2006) Nonresponse rates and nonresponse error in household surveys. Public Opin Q 70:646–675

    Article  Google Scholar 

  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, VA

    Google Scholar 

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI, 53226, USA

    Ronald G. Pirrallo

  2. Restorative Sleep, L.L.C, 11649 North Port Washington Rd., Ste. 109, Mequon, WI, 53092, USA

    Catherine C. Loomis

  3. American Institutes for Research, 2800 Campus Drive, Suite 200, San Mateo, CA, 94403, USA

    Roger Levine

  4. Division of Sleep Medicine, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Ave, Milwaukee, WI, 53226, USA

    B. Tucker Woodson

Authors
  1. Ronald G. Pirrallo
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  2. Catherine C. Loomis
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  3. Roger Levine
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  4. B. Tucker Woodson
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Corresponding author

Correspondence to Catherine C. Loomis.

Appendices

Appendix A: 2005 LEADS sleep survey

Appendix B: definition of sleep problems

Sleep-disordered breathing

Respondent answered yes to: “Have you ever been told that you stop breathing while you are asleep?” (Q4)

and

“In the last 12 months, have you ever been told that you snore while you are asleep?” (Q22)

Risk of sleep apnea

Respondent answered yes to the two questions above (Q4 and Q22) for sleep-disordered breathing.

and

Received an Epworth Sleepiness Scale total score ≥10 (Q3).

Excessive daytime sleepiness

Respondent received an Epworth Sleepiness Scale total score ≥10 (Q3).

Extremely Excessive Daytime Sleepiness

Respondent received an Epworth Sleepiness Scale total score ≥16 (Q3).

Snoring

Respondent answered the question, “How often have you been told that your snoring disturbs others?” (Q23) with a response of “usually”, “almost always”, or “always”.

Risk of long sleep onset disorder

Respondent indicated it takes more than 60 min, on average, to fall asleep (Q1).

or

Answered the question, “In the last 4 weeks, how often did you have trouble falling asleep at night?” (Q6) with a response of “sometimes”, “usually”, “almost always”, or “always”.

Risk of sleep maintenance disorder

Respondent answered the question, “If you wake up during the night, how long does it take you to get back to sleep?” (Q2) with a response of “30 min or longer”

and

Answered the question, “In the last 4 weeks, how often did you wake up (once or more) during the night?” (Q5) with a response of “usually”, “almost always”, or “always”.

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Pirrallo, R.G., Loomis, C.C., Levine, R. et al. The prevalence of sleep problems in emergency medical technicians. Sleep Breath 16, 149–162 (2012). https://doi.org/10.1007/s11325-010-0467-8

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  • DOI: https://doi.org/10.1007/s11325-010-0467-8

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