title: Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters.
abstract: OBJECTIVE
  Heart attacks and motor vehicle crashes are the leading causes of death in US firefighters. Given that sleep disorders are an independent risk factor for both of these, we examined the prevalence of common sleep disorders in a national sample of firefighters and their association with adverse health and safety outcomes.
  
  
  METHODS
  Firefighters (n = 6,933) from 66 US fire departments were assessed for common sleep disorders using validated screening tools, as available. Firefighters were also surveyed about health and safety, and documentation was collected for reported motor vehicle crashes.
  
  
  RESULTS
  A total of 37.2% of firefighters screened positive for any sleep disorder including obstructive sleep apnea (OSA), 28.4%; insomnia, 6.0%; shift work disorder, 9.1%; and restless legs syndrome, 3.4%. Compared with those who did not screen positive, firefighters who screened positive for a sleep disorder were more likely to report a motor vehicle crash (adjusted odds ratio 2.00, 95% CI 1.29-3.12, p = 0.0021) and were more likely to self-report falling asleep while driving (2.41, 2.06-2.82, p < 0.0001). Firefighters who screened positive for a sleep disorder were more likely to report having cardiovascular disease (2.37, 1.54-3.66, p < 0.0001), diabetes (1.91, 1.31-2.81, p = 0.0009), depression (3.10, 2.49-3.85, p < 0.0001), and anxiety (3.81, 2.87-5.05, p < 0.0001), and to report poorer health status (p < 0.0001) than those who did not screen positive. Adverse health and safety associations persisted when OSA and non-OSA sleep disorders were examined separately.
  
  
  CONCLUSIONS
  Sleep disorders are prevalent in firefighters and are associated with increased risk of adverse health and safety outcomes. Future research is needed to assess the efficacy of occupational sleep disorders prevention, screening, and treatment programs in fire departments to reduce these safety and health risks.
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.|Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Barger
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.|Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.|School of Psychology and Psychiatry, Monash University, Clayton VIC, Australia.
authors.forename: Shantha M W
authors.initials: SM
authors.lastname: Rajaratnam
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.|Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.|Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Conor S
authors.initials: CS
authors.lastname: O'Brien
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sullivan
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Salim
authors.initials: S
authors.lastname: Qadri
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.|Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Lockley
authors.affiliation: Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.|Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Czeisler
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D061388:Firefighters / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D012148:Restless Legs Syndrome / Q000150:complications; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications; D020178:Sleep Disorders, Circadian Rhythm / Q000150:complications; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications; D012893:Sleep Wake Disorders / Q000150:complications*; D055815:Young Adult
keywords: Occupational health; driving; obstructive sleep apnea; safety