DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20181208

Prevalence and determinants of excessive daytime sleepiness among resident doctors at a tertiary care institution in India

Siddalingaiah H. S., David F. Mastin, Bruce D. Moore, W. Jeff Bryson, Chandrakala D., Amarjeet Singh

Abstract


Background: Modern socio-occupational settings, especially medical settings, often involve shift work, long work hours, and concomitant maladaptive sleep habits. These factors may result in daytime sleepiness, an increase in the prevalence of sleep disorders, and/or an exacerbation of existing sleep disorders in the contemporary workforce. Aim was to measure the prevalence and determinants of excessive daytime sleepiness (EDS) among medical residents at a Tertiary Care Institution in India.

Methods: A cross-sectional study was designed and a list of all enrolled medical residents was obtained (N=430). The eligible subjects (N=428) were interviewed and administered the study instruments. The information on socio-demographics and sleep-related factors were collected using the sleep assessment proforma. The Epworth sleepiness scale (ESS) was used to measure excessive daytime sleepiness (EDS) and the sleep hygiene index (SHI) was used to measure sleep hygiene. Data were analyzed with appropriate statistical methods.

Results: A total of 350 residents responded (82%). The prevalence of EDS and Maladaptive sleep hygiene were 47.4% and 85.5% respectively. A positive association was found between EDS and weekly work hours, SHI score, sleep duration, sleep quality, midnight awakenings, clinical stream, and rotating shift work. Coffee intake and smoking within 4 hours of bedtime, restless legs and allergies had weak association with EDS.

Conclusions: EDS and unhygienic sleep were highly prevalent among resident doctors. The factors associated with EDS were mainly related to work, sleep quantity, sleep quality and sleep hygiene which are amenable to suitable modifications by behavioural change communications, awareness programs and by administrative actions.

 


Keywords


Excessive daytime sleepiness, Sleep hygiene, Work hours, Sleep quality, Shift work

Full Text:

PDF

References


Whitney CW, Enright PL, Newman AB, Bonekat W, Foley D, Quan SF. Correlates of daytime sleepiness in 4578 elderly persons: the Cardiovascular Health Study. Sleep. 1998;21(1):27-36.

Newman AB, Spiekerman CF, Enright P, Lefkowitz D, Manolio T, Reynolds CF, et al. Daytime sleepiness predicts mortality and cardiovascular disease in older adults. The Cardiovascular Health Study Research Group. J Am Geriatr Society. 2000;48(2):115-23.

Haas DC, Foster GL, Nieto FJ, Redline S, Resnick HE, Robbins JA, et al. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation. 2005;111(5):614-21.

Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565-71.

Lavie P. Mortality in sleep apnoea syndrome: a review of the evidence. Eur Respir Rev. 2007;16:203-10.

Marshall NS, Wong KK, Liu PY, Cullen SR, Knuiman MW, Grunstein RR. Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep. 2008;31(8):1079-85.

Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al. Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep. 2008;31(8):1071-8.

Siddalingaiah HS, Singh A, Lal V. Excessive Daytime Sleepiness: prevalence, pattern and determinants among PGIMER Junior Resident doctors. Chandigarh: Post Graduate Institute of Medical Education and Research; 2009.

Mastin DF, Siddalingaiah HS, Singh A, Lal V. Excessive Daytime Sleepiness, Sleep Hygiene, and Work Hours Among Medical Residents in India. J Trop Psychol. 2012;2:4.

Xiao Q, Signorello LB, Brinton LA, Cohen SS, Blot WJ, Matthews CE. Sleep duration and breast cancer risk among black and white women. Sleep Med. 2016;20:25-9.

Siddalingaiah HS. Sleep problems: an emerging public health issue. Int J Community Med Public Health. 2017;4(12):4386-8.

Siddalingaiah HS, Chandrakala D, Singh A. Sleep pattern, sleep problems and comorbidities among resident doctors at a tertiary care institution in India: a cross sectional study. Int J Community Med Public Health. 2017;4(12):4477-84.

Powell NB, Schechtman KB, Riley RW, Li K, Troell R, Guilleminault C. The road to danger: the comparative risks of driving while sleepy. The Laryngoscope. 2001;111(5):887-93.

Suzuki K, Ohida T, Kaneita Y, Yokoyama E, Uchiyama M. Daytime sleepiness, sleep habits and occupational accidents among hospital nurses. J Advanced Nursing. 2005;52(4):445-53.

Pandi-Perumal SR, Verster JC, Kayumov L, Lowe AD, Santana MG, Pires ML, et al. Sleep disorders, sleepiness and traffic safety: a public health menace. Braz J Med Biol Res. 2006;39(7):863-71.

Costa G. Shift work and breast cancer. Giornale italiano di medicina del lavoro ed ergonomia. 2010;32(4):454-7.

Erren TC. Shift work, cancer and "white-box" epidemiology: Association and causation. Epidemiologic perspectives & innovations: EP+I. 2010;7:11.

Humans IWGotEoCRt. Painting, firefighting, and shiftwork. IARC monographs on the evaluation of carcinogenic risks to humans / World Health Organization, International Agency for Research on Cancer. 2010;98:9-764.

Savvidis C, Koutsilieris M. Circadian rhythm disruption in cancer biology. Molecular Med. 2012;18:1249-60.

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5.

Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the Sleep Hygiene Index. J Behav Med. 2006;29(3):223-7.

Bryson WJ, Mastin DF. Sleep hygiene predictors of excessive daytime sleepiness and poor subjective sleep quality. J of Psychological Pract. 2013;18:88-104.

Howard SK, Gaba DM, Rosekind MR, Zarcone VP. The risks and implications of excessive daytime sleepiness in resident physicians. Acad Med. 2002;77(10):1019-25.

Tsuno N, Jaussent I, Dauvilliers Y, Touchon J, Ritchie K, Besset A. Determinants of excessive daytime sleepiness in a French community-dwelling elderly population. J Sleep Res. 2007;16(4):364-71.

Siddalingaiah HS, Chaudhuri A, Chandrakala D, Singh A. Excessive daytime sleepiness and its determinants: do they have a pattern with study semesters among postgraduate medical resident doctors? Int J Community Med Public Health. 2017;5(1):382.

Kaur G, Singh A. Excessive daytime sleepiness and its pattern among Indian college students. Sleep medicine. 2017;29:23-8.

Souza JC, Magna LA, Reimao R. Excessive daytime sleepiness in Campo Grande general population, Brazil. Arq Neuropsiquiatr. 2002;60(3):558-62.

Joo S, Shin C, Kim J, Yi H, Ahn Y, Park M, et al. Prevalence and correlates of excessive daytime sleepiness in high school students in Korea. Psychiatry Clin Neurosci. 2005;59(4):433-40.

Kaur G, Sharma V, Singh A. Association of sleep quality with general health: an Indian college students study. Int J Med Sci Public Health. 2015;4(12):1767.

Horne J. Is there a sleep debt? Sleep. 2004;27(6):1047-9.

Pagel JF. Excessive daytime sleepiness. Am Fam Physician. 2009;79(5):391-6.

Sandia National Laboratories, Sandia Corporation. Health Benefits employee Services. HBE preventive health sleep assessment form California Lockheed Martin; 2007. Available at: http//hbe.sandia.gov. Accessed on 3 June 2017.

Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376-81.

Miletin MS, Hanly PJ. Measurement properties of the Epworth sleepiness scale. Sleep medicine. 2003;4(3):195-9.