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More Than 40% of Police Officers Have Sleep Disorders
By: MICHELE G. SULLIVAN, Clinical Psychiatry News Digital Network
FROM JAMA
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Major Finding: Sleep disorders among police officers increase the risk of their falling asleep while driving by five times, and are associated with a 49% increase in safety errors, a 25% increase in uncontrolled anger, and a 35% increase in citizen complaints.
Data Source: A prospective observational study of nearly 5,000 North American police officers.
Disclosures: Dr. Rajaratnam reported numerous financial relationships with pharmaceutical and medical device companies. The study was sponsored by National Institute of Justice and the Centers for Disease Control and Prevention.
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Some Employers Already Addressing Safety Issues
Nearly half of North American police officers might be suffering from a sleep disorder that could interfere with the safe execution of their duties.
A survey of nearly 5,000 officers found that 40.4% of them screened positive for a sleep disorder, most of these undiagnosed. Those officers with a sleep disorder were significantly more likely to commit administrative errors, lose their temper with citizens, and even fall asleep while driving, Shantha M.W. Rajaratnam, Ph.D., and colleagues reported in the Dec. 21 issue of JAMA.
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"Almost half [reported] having fallen asleep while driving" and about one-quarter said that this occurs one to two times per month, said Dr. Rajaratnam of Brigham and Women’s Hospital, Boston. "This is despite police officers apparently recognizing the dangers associated with drowsy driving." In a different survey of North American police officers, almost 90% regarded drowsy driving to be as dangerous as drunk driving, the investigators noted (JAMA 2011;306:2567-78).
The team conducted an online and in-person survey of 4,957 police officers, 97% of whom were based in the United States and 3% in Canada. The subjects responded to a variety of questionnaires that screen for sleep disorders, including obstructive sleep apnea, insomnia, restless legs syndrome, narcolepsy, and cataplexy. The survey also screened for shift-work disorder. Subjects provided basic health information, as well as information about alcohol intake and feelings of emotional burnout. They then completed monthly surveys for the next 2 years, with an accumulation of 15, 735 surveys.
The mean age of the cohort was 38.5 years; 82.3% were male. More than half (58%) reported their health as very good or excellent. However, 79.3% of the respondents were overweight or obese, and 33.5% were obese.
Most were patrol officers (66.5%), followed by managers (15%), criminal investigators (8.2%), and other job positions. Only 38% reported never having night-shift work; the rest worked overnight from once per month to nearly every shift.
Of the entire cohort, 2,003 (40.4%) screened positive for at least one sleep disorder. Obstructive sleep apnea was the most commonly identified problem, affecting 1,666 (33.6%) of the subjects. The next most commonly identified problem was moderate to severe insomnia, found in 281 (6.5%).
Other findings were shift-work disorder (269), restless legs syndrome (70), and narcolepsy with cataplexy (16).
The group with shift-work disorder represented 14% of those who worked overnight hours, the investigators noted. However, they said, if they applied the International Classification of Sleep Disorders–2 criteria for shift work disorder (excessive wake-time sleepiness or insomnia), then 1,004 (53.9%) of the police officers who worked night shifts screened positive.
The investigators found some significant associations between sleep disorders and health/safety outcomes. Those with a positive screen were almost three times as likely to report depression (odds ratio, 2.75) and emotional job burnout (OR, 2.87), and almost five times as likely to report having fallen asleep while driving after work (OR, 4.64). Of the entire cohort, 2,276 (46%) reported having fallen asleep while driving (56.9% at least once a month, and 13.5% once or twice a week).
VIEW ON THE NEWS
Some Employers Already Addressing Safety Issues
The study by Dr. Rajaratnam and colleagues points up the importance of a healthy and well-rested public safety force, Michael A. Grandner, Ph.D., and Dr. Allan I. Pack wrote in an accompanying editorial (JAMA 2011;306:2616-7).
The paper showed that inadequate sleep was related to a wide variety of both personal health problems and public safety. "Not only are police officers at high risk of having an undiagnosed sleep disorder, but the sleep disorder may have a detrimental effect on the officer’s health, productivity, and job performance," they noted.
Most officers in the study were aware of their personal and performance problems, but they had no idea that a sleep disorder was a key factor. Fortunately, the authors wrote, sleep problems can be corrected with adequate therapy – if they are diagnosed.
Some agencies already have recognized this problem and have taken steps to address it. "In the occupational arena, some employers are developing proactive educational programs, and a few are initiating programs for mandatory screening for common sleep disorders such as sleep apnea," wrote Dr. Grandner and Dr. Pack. "This is likely to be the most effective approach, but employees may have concerns that if they are found to have a sleep disorder, their employment will be adversely affected."
Indeed, some groups seem reluctant to introduce any type of screening and treatment program, despite having identified sleep issues as a major contributor to employee – and thus public – health.
"For example, in 2008 a medical expert panel created by the Federal Motor Carrier Safety Administration (responsible for the safety of commercial vehicles) gave recommendations on screening for sleep apnea, although to date the agency has not implemented any of the recommendations, which included provisions for sleep disorder screening and restrictions placed on those with untreated sleep apnea."
The situation is widespread and needs immediate attention for the health and safety of all, they said.
"As a matter of public safety, this study illustrates that the public at large may also be at risk when police officers are impaired in performing their duties because of sleep deprivation or an untreated sleep disorder.
"Now, the question is what police departments will do with this new information."
Dr. Grandner is a postdoctoral fellow at the center for sleep and respiratory neurobiology and Dr. Pack is the director of the center for sleep and circadian neurobiology, both at the University of Pennsylvania, Philadelphia. Both declared that they had no financial conflicts with regard to the study.
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