Mulgrew A T, Ryan C F, Fleetham J A, Cheema R, Fox N, Koehoorn M, Fitzgerald J M, Marra C, Ayas N T
Department of Medicine and Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada.
Sleep Med. 2007 Dec;9(1):42-53. doi: 10.1016/j.sleep.2007.01.009. Epub 2007 Sep 6.
Many patients with obstructive sleep apnea (OSA) participate in the work force. However, the impact of OSA and sleepiness on work performance is unclear.
To address this issue, we administered the Epworth Sleepiness Scale (ESS), the Work Limitations Questionnaire (WLQ), and an occupational survey to patients undergoing full-night polysomnography for the investigation of sleep-disordered breathing. Of 498 patients enrolled in the study, 428 (86.0%) completed the questionnaires. Their mean age+/-standard deviation (SD) was 49+/-12 years, mean body mass index (BMI) was 31+/-7 kg/m(2) mean apnea hypopnea index (AHI) was 21+/-22 events/h, and mean ESS score was 10+/-5. Subjects worked a mean of 39+/-18 h per week. The first 100 patients to complete the survey were followed up at two years.
In the group as a whole, there was no significant relationship between severity of OSA and the four dimensions of work limitation. However, in blue-collar workers, significant differences were detected between patients with mild OSA (AHI 5-15/h) and those with severe OSA (AHI>30/h) with respect to time management (limited 23.1% of the time vs. 43.8%, p=0.05) and mental/personnel interactions (17.9% vs. 33.0%, p=0.05). In contrast, there were strong associations between subjective sleepiness (as assessed by the ESS) and three of the four scales of work limitation. That is, patients with an ESS of 5 had much less work limitation compared to those with an ESS 18 in terms of time management (19.7% vs. 38.6 %, p<0.001), mental-interpersonal relationships (15.5% vs. 36.0%, p<0.001) and work output (16.8% vs. 36.0%; p<0.001). Of the group followed up, 49 returned surveys and 33 who were using continuous positive airway pressure (CPAP) showed significant improvements between the initial and second follow-up in time management (26% vs. 9%, p=0.0005), mental-interpersonal relationships (16% vs. 11.0%, p=0.014) and work output (18% vs. 10%; p<0.009).
We have demonstrated a clear relationship between excessive sleepiness and decreased work productivity in a population referred for suspected sleep-disordered breathing. Screening for sleepiness and sleep-disordered breathing in the workplace has the potential to identify a reversible cause of low work productivity.
许多阻塞性睡眠呼吸暂停（OSA）患者仍在工作。然而，OSA和嗜睡对工作表现的影响尚不清楚。
为解决这一问题，我们对接受整夜多导睡眠图检查以调查睡眠呼吸障碍的患者进行了爱泼华嗜睡量表（ESS）、工作限制问卷（WLQ）和职业调查。在纳入研究的498例患者中，428例（86.0%）完成了问卷调查。他们的平均年龄±标准差（SD）为49±12岁，平均体重指数（BMI）为31±7kg/m²，平均呼吸暂停低通气指数（AHI）为21±22次/小时，平均ESS评分为10±5分。受试者平均每周工作39±18小时。对完成调查的前100例患者进行了为期两年的随访。
在整个研究组中，OSA严重程度与工作限制的四个维度之间没有显著关系。然而，在蓝领工人中，轻度OSA（AHI 5 - 15/小时）患者与重度OSA（AHI>30/小时）患者在时间管理方面（受限时间分别为23.1%和43.8%，p = 0.05）以及心理/人际互动方面（分别为17.9%和33.0%，p = 0.05）存在显著差异。相比之下，主观嗜睡（通过ESS评估）与工作限制的四个量表中的三个之间存在密切关联。也就是说，ESS评分为5分的患者在时间管理（19.7%对38.6%，p<0.001）、心理人际关系（15.5%对36.0%，p<0.001）和工作产出（16.8%对36.0%；p<0.001）方面的工作限制比ESS评分为18分的患者少得多。在接受随访的患者中，49例返回了调查问卷，33例使用持续气道正压通气（CPAP）的患者在首次随访和第二次随访之间，在时间管理（26%对9%，p = 0.0005）、心理人际关系（16%对11.0%，p = 0.014）和工作产出（18%对10%；p<0.009）方面有显著改善。
我们已经证明，在因疑似睡眠呼吸障碍而转诊的人群中，过度嗜睡与工作效率下降之间存在明确关系。在工作场所筛查嗜睡和睡眠呼吸障碍有可能发现工作效率低下的一个可逆转原因。
