Sleep problems are a strong predictor of stress-related metabolic changes in police officers. A prospective study

Objective: Sleep is an essential physiological function for well-being and health. Previous studies have shown that workers chronically exposed to occupational stress have an increased risk of metabolic syndrome (MetS). The purpose of this study was to verify whether sleep problems are MetS predictors, and to clarify the relationship between stress and sleep. Method: In a previously published longitudinal study we demonstrated that in the absence of other risk factors, continuous exposure to occupational stress was significantly associated with the risk of developing MetS at follow-up. In this study we also processed data concerning sleep quantity and quality and evaluated whether sleep problems alter the relationship between stress and MetS. Results: Sleep problems were significantly related to incident cases of MetS. The average number of hours of sleep had a protective effect. The adjusted OR (corrected for demographic variables, excessive daytime sleepiness and job stress) was 0.457 (CI95% = 0.255-0.818). However, MetS was more strongly related to quality of sleep than quantity of sleep: if insomnia symptoms (difficulty sleeping, sleep interruptions, and early awakenings) were added to the multivariate hierarchical logistic model, the hours of sleep were no longer significant, and insomnia symptoms showed a highly significant aOR (8.347; CI95%= 3.042-22.906) with MetS. We observed a bidirectional longitudinal relationship between job stress and sleep problems. Work-related stress was a significant predictor of insomnia symptoms, short sleep duration, sleep dissatisfaction, and sleepiness. Police officers with sleep problems at baseline had significantly higher odds of reporting job strain at follow-up compared to the reference group. Conclusion: Sleep problems play a mediating role in the relationship between occupational stress and MetS. Sleep symptoms are a powerful indicator of MetS. MetS prevention must include not only the control of stress factors and an increase in the resilience of workers, but above all correct sleep hygiene

Work Stress and Metabolic Syndrome in Police Officers. A Prospective Study.

Objective: The aim of this longitudinal study was to evaluate the association between occupational stress and metabolic syndrome (MetS) in a rapid response police unit. Method: Work-related stress was continuously monitored during the 5-year period with both the Demand-Control-Support (DCS) and the Effort-Reward Imbalance (ERI) models. Blood pressure, body mass index (BMI), waist circumference, triglycerides, HDL-cholesterol, and fasting blood glucose were measured at baseline in January 2009, and in January 2014. 234 out of 290 police officers (81%) completed the follow-up. Results: The majority of police officers had high stress levels. At follow-up, police officers in the highest quartile of stress had significantly higher mean levels of triglycerides, and lower levels of HDL-cholesterol than their colleagues in the lowest quartile. Police officers with high stress had an increased adjusted risk of developing MetS (aOR=2.68; CI95%=1.08-6.70), and hypertriglyceridemia (aOR=7.86; CI95=1.29-48.04). Demand and Effort were significant predictors of MetS. Conclusion: Our study supports the hypothesis that work-related stress induces MetS, particularly through its effects on blood lipids. Future longitudinal studies with continuous monitoring of stress levels will definitively confirm this hypothesis

Obstructive sleep apnea syndrome (OSAS), metabolic syndrome and mental health in small enterprise workers. Feasibility of an action for health.

Objective: To determine the frequency of obstructive sleep apnea syndrome (OSAS), metabolic syndrome and common mental disorders in the working population of 11 small enterprises and the feasibility of a program of action for health. Method: The clinical risk of OSAS, the prevalence of metabolic syndrome, and the level of psychological disorders were assessed during routine medical examination at the workplace in 2012. The response to medical advice was assessed in 2013 Results: 12.3% of the workers were suspected of being affected by OSAS. One or more components of metabolic syndrome were present in 24.5% of cases. OSAS in \u201chealthy\u201d workers was significantly associated with the presence of one or more components of metabolic syndrome (OR=3.83; 95%CI 1.45-10.13) and with a psychological disorders score in the highest quartile (OR= 4.67; 95%CI= 1.72-12.64). Workers with suspected OSAS were reluctant to follow advice about undergoing further tests under the NHS. However, in some cases, confirmation of the OSAS diagnosis and subsequent treatment led to an improvement in metabolic condition. Conclusion: Although participation in treatment was limited, anecdotal cases support the idea that prevention of obstructive sleep apnea in the workplace might be useful for workers\u2019 health

Social psychiatry in the waiting room. What a physician can learn about occupational stress from workers waiting to be examined

BACKGROUND: Work-related stress is a major problem for mental health. The occupational physician has the opportunity to gather information on the perception of stress from workers in the course of regular medical examinations. METHOD: 1,231 subjects, engaged in 6 different occupations, were invited to compile the demand/control/support and the effort/reward/imbalance questionnaire. RESULTS: A specific profile of work-related stress emerged for each group of workers. Radiology physicians were found to have the highest levels of self-perceived stress and the highest percentage of subjects at risk of distress; they reported high control over work, but also exceedingly high demand and effort, high over- commitment, low social support and low rewards from work. Health care workers were often overcommitted but had high levels of reward and social support; in general hospital workers, effort was higher and control lower than in workers in a hospital specializing in infectious diseases, so that stress levels and percentage of subjects at risk of distress were higher. Low levels of social support and reward were recorded for mature workers , while special force policemen engaged in law enforcement during the G8 meeting had high levels of social support and regards, so that their resulting stress levels were closer to the reference group of employees in an insurance company with no front-office. CONCLUSION: The practice of administering questionnaires to groups of workers who are subject to medical surveillance is useful for monitoring mental health and well-being

Sleepiness, Safety and Transport

The economic development of modern society requires continuous improvement of transport and their efficiency throughout the span of 24 hours. Drowsiness may be a serious risk to the safety of employees, passengers and third parties. Sleepiness at the wheel is responsible for 5% to 30% of road accidents. Several pathophysiological factors governing the driving skills were studied: lifestyles, work schedules, prolonged wakefulness, stress, and sleep disorders. Screening of sleep disorders and education of workers at a proper sleep hygiene are fundamental keys to the safe transport. The individual initiatives to reduce the risk of drowsiness should be framed in a more general safety effort of the institutions

Measuring psychological trauma in the workplace: psychometric properties of the Italian version of the Psychological Injury Risk Indicator (PIRI). A Cross-Sectional Study

Background: The aim of this study was to cross-culturally adapt the Psychological Injury Risk Indicator (PIRI) and to validate its psychometric properties. Methods: Workers from 24 small companies were invited to self-complete the PIRI before undergoing their routine medical examination at the workplace. All participants (841 out of 845, 99.6%) were also asked to report occupational injuries and episodes of violence that had occurred at the workplace in the previous 12 months and were given the General Health Questionnaire (GHQ12) to complete. Results: Exploratory factor analysis (EFA) revealed a 4-factor structure: \u201csleep problems\u201d, \u201crecovery failure\u201d, \u201cpost-traumatic stress symptoms\u201d, \u201cchronic fatigue\u201d, which were the same subscales observed in the original version. The internal consistency was excellent (alpha= 0.932). Correlation between the PIRI scores and GHQ12 showed good criterion validity. Receiver Operating Characteristic (ROC) curve analysis revealed that the PIRI was much more efficient than GHQ12 in diagnosing workers who had suffered trauma (workplace violence or injury) in the previous year, as it revealed an area under the curve (AUC) of 0.679 (95% CI: 0.625-0.734) for the PIRI, while for the GHQ12, the area under the curve was 0.551 (not significant). Conclusions: This study, performed on a large population of workers, provides evidence of the validity of the Italian version of the PIRI

MYC Expression and Metabolic Redox Changes in Cancer Cells: A Synergy Able to Induce Chemoresistance

Chemoresistance is due to multiple factors including the induction of a metabolic adaptation of tumor cells. In fact, in these cells, stress conditions induced by therapies stimulate a metabolic reprogramming which involves the strengthening of various pathways such as glycolysis, glutaminolysis and the pentose phosphate pathway. This metabolic reprogramming is the result of a complex network of mechanisms that, through the activation of oncogenes (i.e., MYC, HIF1, and PI3K) or the downregulation of tumor suppressors (i.e., TP53), induces an increased expression of glucose and/or glutamine transporters and of glycolytic enzymes. Therefore, in order to overcome chemoresistance, it is necessary to develop combined therapies which are able to selectively and simultaneously act on the multiple molecular targets responsible for this adaptation. This review is focused on highlighting the role of MYC in modulating the epigenetic redox changes which are crucial in the acquisition of therapy resistance

Sleep, health and wellness at work: A scoping review

Many occupational factors may interfere with sleep. Sleep disturbances can, in turn, endanger the health and safety of workers. This rapid review of the literature identifies the main factors that alter the quantity and quality of sleep, indicates the effects these alterations have on the wellbeing of workers and suggests some health promotion measures

Obstructive Sleep Apnea With or Without Excessive Daytime Sleepiness: Clinical and Experimental Data-Driven Phenotyping

Introduction: Obstructive sleep apnea (OSA) is a serious and prevalent medical condition with major consequences for health and safety. Excessive daytime sleepiness (EDS) is a common\u2014but not universal\u2014accompanying symptom. The purpose of this literature analysis is to understand whether the presence/absence of EDS is associated with different physiopathologic, prognostic, and therapeutic outcomes in OSA patients. Methods: Articles in English published in PubMed, Medline, and EMBASE between January 2000 and June 2017, focusing on no-EDS OSA patients, were critically reviewed. Results: A relevant percentage of OSA patients do not complain of EDS. EDS is a significant and independent predictor of incident cardiovascular disease (CVD) and is associated with all-cause mortality and an increased risk of metabolic syndrome and diabetes. Male gender, younger age, high body mass index, are predictors of EDS. The positive effects of nasal continuous positive airway pressure (CPAP) therapy on blood pressure, insulin resistance, fatal and non-fatal CVD, and endothelial dysfunction risk factors have been demonstrated in EDS-OSA patients, but results are inconsistent in no-EDS patients. The most sustainable cause of EDS is nocturnal hypoxemia and alterations of sleep architecture, including sleep fragmentation. These changes are less evident in no-EDS patients that seem less susceptible to the cortical effects of apneas. Conclusions: There is no consensus if we should consider OSA as a single disease with different phenotypes with or without EDS, or if there are different diseases with different genetic/epigenetic determinants, pathogenic mechanisms, prognosis, and treatment.The small number of studies focused on this issue indicates the need for further research in this area. Clinicians must carefully assess the presence or absence of EDS and decide accordingly the treatment. This approach could improve combination therapy targeted to a patient\u2019s specific pathology to enhance both efficacy and long-term adherence to OSA treatment and significantly reduce the social, economic, and health negative impact of OSA

Planetary sleep medicine: Studying sleep at the individual, population, and planetary level

Circadian rhythms are a series of endogenous autonomous oscillators that are generated by the molecular circadian clock which coordinates and synchronizes internal time with the external environment in a 24-h daily cycle (that can also be shorter or longer than 24 h). Besides daily rhythms, there exist as well other biological rhythms that have different time scales, including seasonal and annual rhythms. Circadian and other biological rhythms deeply permeate human life, at any level, spanning from the molecular, subcellular, cellular, tissue, and organismal level to environmental exposures, and behavioral lifestyles. Humans are immersed in what has been called the “circadian landscape,“ with circadian rhythms being highly pervasive and ubiquitous, and affecting every ecosystem on the planet, from plants to insects, fishes, birds, mammals, and other animals. Anthropogenic behaviors have been producing a cascading and compounding series of effects, including detrimental impacts on human health. However, the effects of climate change on sleep have been relatively overlooked. In the present narrative review paper, we wanted to offer a way to re-read/re-think sleep medicine from a planetary health perspective. Climate change, through a complex series of either direct or indirect mechanisms, including (i) pollution- and poor air quality-induced oxygen saturation variability/hypoxia, (ii) changes in light conditions and increases in the nighttime, (iii) fluctuating temperatures, warmer values, and heat due to extreme weather, and (iv) psychological distress imposed by disasters (like floods, wildfires, droughts, hurricanes, and infectious outbreaks by emerging and reemerging pathogens) may contribute to inducing mismatches between internal time and external environment, and disrupting sleep, causing poor sleep quantity and quality and sleep disorders, such as insomnia, and sleep-related breathing issues, among others. Climate change will generate relevant costs and impact more vulnerable populations in underserved areas, thus widening already existing global geographic, age-, sex-, and gender-related inequalities