Shift work disorder: an overlooked issue

PowerPoint PresentationDani Mirnik, Marjan Bilban, Leja Dolenc Grošelj
B E R L I N 2 0 2 0
Multidisciplinary workup
Case report
• 37 y.o. F pastry chef
• referral: regular medical check-up at OHP; no other diseases; without th.
• working in shifts: morning / afternoon, irregular pattern (5-6 years)
• 2 years: severe excessive day sleepiness, falling asleep multiple times during the day
• no hallucinations during waking up, no paralyses during awakening
• family history: twin brother healthy
• clinical status: normal
Neurological assessment
polysomnography night and day recording with multiple sleep latency test:
- normal sleep architecture: (N1 = 6%; N2 = 56%, N3 = 25%, REM = 13%)
- sleep latency: normal
- AHI index – normal; SaO2 = 96% (no values under 90%)
- no parasomnias and motor-behavioural episodes
MSLT:
Neurological assessment
• day shifts: regular sleep between 22.00 – 05.00
• afternoon shifts: shorter sleep, following disturbed sleep wake pattern
Wrist actigraphy
AFTERNOON SHIFT
AFTERNOON SHIFT
FREE DAY
FREE DAY
insomnia sy.
sleep delay
Darien I. The international classification of sleep disorders (ICSD-3). American Academy of Sleep Medicine. 2014.
Diagnostics criteria
Does the patient complain of insomnia or excessive sleepiness?
Is the complaint associated with impairment of social, occupational or other areas of functioning?
Is the complaint temporally associated with a shift work schedule?
Have the symptoms and associated shift work schedule lasted at least 3 months?
Sleep log and actigraphy monitoring for at least 14 days demonstrate a disturbed sleep and wake pattern.
Is the sleep disturbance better explained by another current sleep disorder, medical, or neurological disorder, medication use, or substance abuse disorder?
YES
comorbid with other disorder(s)
Shift Work Disorder Darien I. The international classification of sleep disorders (ICSD-3). American Academy of Sleep Medicine. 2014.
Diagnostic tools
• sleep diaries / actigraphy
Shift Work Disorders Screening Questionnaire (SWDSQ)
• comorbidities: other sleep disorders, psychiatric and endocrine diseases
• chronotype/circadian phase: Morningness-Eveningness Questionnaire (MEQ), Munich Chronotype
Questionnaire (MCTQ and MCTQshift), DLMO (dim-light melatonin onset)
Clinical management
• melatonin for daytime sleep
• anchor sleep
armodafinil)
• caffeine
• planned naps
• caffeine naps
Circadian alignment • timed use of melatonin as a chronobiotic • match extreme chronotypes with respective work
shift
• timed exposure to darkness (or use of light-
blocking glasses)
Prevalence
• > 20% of EU workforce engaged in some form of shift work
• 10%–30% of the shift worker population estimated to be affected by SWD (10-
60%)
• SWD has been poorly diagnosed and most likely under-recognized in primary care settings
• lack of validated instruments
Back to our patient
• diagnose = shift work disorder
• recommendation: day time shift only for a trial period of 3 months
• no medications
• improvment of symptoms after 3 months
Future challenges / aims
with SWD
• improved tools and biomarkers for measuring circadian disruption and misalingnment
• systemic clinical guidelines for assessment and management SWD
Thank you for your attention [email protected]