Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Postgrad Med. 2011 Sep;123(5):96-105. doi: 10.3810/pgm.2011.09.2464.
A significant proportion of the workforce in industrialized countries (16%) are employed as shift workers. These workers may be susceptible to shift work disorder (SWD), a circadian rhythm sleep disorder, particularly those who work at night or on early-morning shifts. Shift work disorder remains an underdiagnosed and undertreated problem among this population. Patients with SWD have difficulty initiating sleep and waking up. Often, these patients have excessive sleepiness during their work shift. Shift work disorder has been associated with decreased productivity, impaired safety, diminished quality of life, and adverse effects on health. Several tools have been validated to assess excessive daytime sleepiness and are often used to assess excessive nighttime sleepiness, such as that experienced in patients with SWD, including the Epworth Sleepiness Scale and the Multiple Sleep Latency Test. The criteria for diagnosing SWD as established by the American Academy of Sleep Medicine (AASM) and published in the International Classification of Sleep Disorders-Second Edition (ICSD-2) were most recently updated in 2005 and thus do not contain newer agents approved for use in patients with SWD. The symptoms of SWD can be treated using behavioral, prescription, and nonprescription therapies. Current treatment guidelines suggest nonpharmacologic interventions, such as exercise and exposure to light. In addition, medications that contain melatonin or caffeine may have clinical benefits in some patients with SWD. However, modafinil and armodafinil are approved by the US Food and Drug Administration to improve wakefulness in patients with excessive sleepiness associated with SWD, and recent data suggest a clinical benefit. The use of these therapies can significantly improve sleep, performance, and quality of life for patients with SWD.
在工业化国家，相当一部分劳动力（16%）从事轮班工作。这些工人可能容易患上轮班工作睡眠障碍（SWD），一种昼夜节律睡眠障碍，尤其是那些上夜班或早班的工人。在这一人群中，SWD 仍然是一种未被充分诊断和治疗的问题。患有 SWD 的患者难以入睡和醒来。这些患者在工作班次期间经常过度嗜睡。SWD 与生产力下降、安全受损、生活质量下降以及对健康的不良影响有关。已经有一些工具被验证用于评估日间过度嗜睡，并且常用于评估 SWD 患者的夜间过度嗜睡，例如嗜睡量表（Epworth Sleepiness Scale）和多次睡眠潜伏期测试（Multiple Sleep Latency Test）。美国睡眠医学学会（AASM）制定的 SWD 诊断标准，并发表在国际睡眠障碍分类-第二版（ICSD-2）中，最近一次更新是在 2005 年，因此不包含新批准用于 SWD 患者的药物。SWD 的症状可以通过行为、处方和非处方疗法来治疗。目前的治疗指南建议采用非药物干预措施，如运动和暴露在光线下。此外，含有褪黑素或咖啡因的药物可能对一些 SWD 患者有临床益处。然而，莫达非尼和阿莫达非尼已被美国食品和药物管理局批准用于改善与 SWD 相关的过度嗜睡患者的清醒度，最近的数据表明它们具有临床益处。这些治疗方法的使用可以显著改善 SWD 患者的睡眠、表现和生活质量。
