Symptoms of sleep disorders are common among healthcare workers, especially those who work night and split shifts. So found a Cleveland Clinic sleep disorders screening initiative using an electronic survey, which a majority of respondents found valuable, leading some to seek treatment. The study describing the screening instrument and its findings was recently published in Sleep Medicine (2020;73:181-186).
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“Sleep disorders not only harm an individual’s health in multiple ways, but they also can lead to impaired work functioning among healthcare providers and create a financial burden for a healthcare organization,” says the study’s senior author, Nancy Foldvary-Schaefer, DO, Director of Cleveland Clinic’s Sleep Disorders Center. “Developing effective screening initiatives for sleep disorders is important for identifying how organizations can best help their employees address this problem.”
Sleep disorders common and underdiagnosed
Sleep disorders — including obstructive sleep apnea (OSA), excessive daytime sleepiness and insomnia — are common in the U.S. and can have particularly severe consequences among healthcare workers. Greater burnout, poorer job performance and adverse safety outcomes have been attributed to sleep problems in this population.
However, sleep disorders often go undiagnosed, with many people being unaware of the potential effects of poor sleep.
The current study was designed, Dr. Foldvary-Schaefer explains, to estimate the prevalence of undiagnosed sleep disorders or their symptoms among healthcare employees and assess the utility of an electronically delivered sleep disorder screening survey and treatment recommendations for those with abnormal results.
Study design and findings
The study team created a sleep disorder screening instrument that was made available to more than 50,000 Cleveland Clinic caregivers via internal electronic communications between April 2016 and June 2017. Among the 2,851 who completed the initial survey, 86% worked day shifts, 5% evening shifts and 9% night shifts. Median sleep duration was 6 hours.
The following scales were assessed, with results immediately provided to each respondent:
- Epworth Sleepiness Scale to measure daytime sleepiness; 30.7% had abnormal scores
- Insomnia Severity Scale to screen for insomnia; 27.5% had moderate to severe symptoms
- STOP questionnaire to assess OSA risk; 36.9% scored as high risk
Three to six months after the first survey, a follow-up email survey was sent to assess the value of the initial screen, with 484 (17%) responding. This second survey revealed that 92% deemed the sleep screening to be valuable. Additionally, respondents were asked whether they took any actions after receiving an abnormal score from the screen — specifically, discussing the problem with a healthcare provider, enrolling in online cognitive behavioral therapy for insomnia, scheduling a sleep study or sleep consultation, or other action. Of 199 respondents to that question, 58% reported taking some action, with more than a quarter of those scheduling a sleep study or sleep consultation.
Electronic screening yields results
Dr. Foldvary-Schaefer highlights the following lessons from this study:
- Many healthcare workers experience sleep disorder symptoms. Nearly one-third of this sample had daytime sleepiness, more than one-quarter reported symptoms of insomnia and more than one-third screened positive for high-risk OSA. These rates are within the ranges reported by other studies of healthcare employees and the general population, Dr. Foldvary-Schaefer notes, adding that this is not reassuring. “Sleep disorders are common and carry potentially large ramifications in critical workplaces like healthcare institutions,” she says.
- Evening- and night-shift workers are at highest risk. Night-shift workers reported getting significantly less sleep than day- or evening-shift workers and were most likely to have abnormal scores on the Epworth Sleepiness Scale. Evening- and night-shift workers scored more poorly on the Insomnia Severity Score than those working the day shift.
- Healthcare workers may be more inclined to address identified health problems. Among respondents indicating they had previously been diagnosed with OSA, nearly half reported using positive airway pressure therapy; among that group, more than 90% reported treatment adherence of at least four hours nightly. These rates are higher than expected based on other published studies.
- Electronic screening for sleep disorder symptoms is feasible. Although response rates were low — typical of other healthcare worker surveys — a large majority of respondents who completed the entire survey felt it was valuable, and many took action to address identified sleep issues.
“Our study indicates that a substantial number of healthcare workers suffer from symptoms of a sleep disorder,” says Dr. Foldvary-Schaefer. “This means they could be putting their own health and their patients’ health at risk. It is incumbent upon institutions to reach out to their employees to address this problem, and electronic screening instruments are a viable method for doing so.”
She adds that the findings from this work led to development of a mobile app, “Sleep by Cleveland Clinic” — now available in Apple’s App Store — that enables users to assess their risk of sleep disorders and provides resources to promote better sleep.