title: Sleep disorders, health, and safety in police officers.
abstract: BACKGROUND
  Sleep disorders often remain undiagnosed. Untreated sleep disorders among police officers may adversely affect their health and safety and pose a risk to the public.
  
  
  OBJECTIVE
  To quantify associations between sleep disorder risk and self-reported health, safety, and performance outcomes in police officers.
  
  
  METHODS
  Cross-sectional and prospective cohort study of North American police officers participating in either an online or an on-site screening (n=4957) and monthly follow-up surveys (n=3545 officers representing 15,735 person-months) between July 2005 and December 2007. A total of 3693 officers in the United States and Canada participated in the online screening survey, and 1264 officers from a municipal police department and a state police department participated in the on-site survey.
  
  
  METHODS
  Comorbid health conditions (cross-sectional); performance and safety outcomes (prospective).
  
  
  RESULTS
  Of the 4957 participants, 40.4% screened positive for at least 1 sleep disorder, most of whom had not been diagnosed previously. Of the total cohort, 1666 (33.6%) screened positive for obstructive sleep apnea, 281 (6.5%) for moderate to severe insomnia, 269 (5.4%) for shift work disorder (14.5% of those who worked the night shift). Of the 4608 participants who completed the sleepiness scale, 1312 (28.5%) reported excessive sleepiness. Of the total cohort, 1294 (26.1%) reported falling asleep while driving at least 1 time a month. Respondents who screened positive for obstructive sleep apnea or any sleep disorder had an increased prevalence of reported physical and mental health conditions, including diabetes, depression, and cardiovascular disease. An analysis of up to 2 years of monthly follow-up surveys showed that those respondents who screened positive for a sleep disorder vs those who did not had a higher rate of reporting that they had made a serious administrative error (17.9% vs 12.7%; adjusted odds ratio [OR], 1.43 [95% CI, 1.23-1.67]); of falling asleep while driving (14.4% vs 9.2%; adjusted OR, 1.51 [95% CI, 1.20-1.90]); of making an error or safety violation attributed to fatigue (23.7% vs 15.5%; adjusted OR, 1.63 [95% CI, 1.43-1.85]); and of exhibiting other adverse work-related outcomes including uncontrolled anger toward suspects (34.1% vs 28.5%; adjusted OR, 1.25 [95% CI, 1.09-1.43]), absenteeism (26.0% vs 20.9%; adjusted OR, 1.23 [95% CI, 1.08-1.40]), and falling asleep during meetings (14.1% vs 7.0%; adjusted OR, 1.95 [95% CI, 1.52-2.52]).
  
  
  CONCLUSIONS
  Among a group of North American police officers, sleep disorders were common and were significantly associated with increased risk of self-reported adverse health, performance, and safety outcomes.
authors.affiliation: Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Shantha M W
authors.initials: SM
authors.lastname: Rajaratnam
authors.forename: Laura K
authors.initials: LK
authors.lastname: Barger
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lockley
authors.forename: Steven A
authors.initials: SA
authors.lastname: Shea
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Landrigan
authors.forename: Conor S
authors.initials: CS
authors.lastname: O'Brien
authors.forename: Salim
authors.initials: S
authors.lastname: Qadri
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sullivan
authors.forename: Brian E
authors.initials: BE
authors.lastname: Cade
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Epstein
authors.forename: David P
authors.initials: DP
authors.lastname: White
authors.forename: Charles A
authors.initials: CA
authors.lastname: Czeisler
mesh_terms: D000328:Adult; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D016272:Occupational Health; D016495:Police / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012306:Risk; D012449:Safety; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013647:Task Performance and Analysis