A survey of police officers in the US and Canada finds that about 40% have a sleep disorder, and this is significantly linked to a raised risk of adverse health, performance, and safety issues. The researchers report their findings online this week in JAMA, Journal of the American Medical Association. Experts reviewing the paper suggest more studies should be done to assess health and economic impact not only on individuals but also on society as a whole. Such research could set an example for other occupational groups, they add.

For the study, Dr Shantha M. W. Rajaratnam of Brigham and Women’s Hospital, Boston, and colleagues analyzed data from surveys completed by 4,957 police officers serving in Canada and the US.

Their average age was 38.5 years, and their average length of service in the police force was 12.7 years.

Most of the respondents completed an online survey (3,693 officers), whilst a smaller contingent of 1,264 officers, from a municipal police department and a state police department, were approached in person.

These initial surveys collected health and medical information, and because they included questions used in sleep disorder screening, they allowed the researchers to establish which of the respondents screened positive for particular sleep disorders, such as insomnia or obstructive sleep apnea (OSA).

A total of 3,545 of the participants also completed monthly follow up surveys between July 2005 and December 2007, and these follow ups collected information about job performance and safety issues.

Note that all data collected was based on self reports: that is information provided by the respondents themselves, and not, for example, by accessing their health and personnel files or talking to their doctors or supervisors.

The results showed that:

  • 40.4% of the respondents screened positive for at least one sleep disorder, and in most cases this had not been diagnosed previously.
  • 33.6% screened positive for obstructive sleep apnea (OSA), the most common disorder.
  • 6.5% screened positive for moderate to severe insomnia and 5.4% with shift work disorder (representing 14.5% of those officers working night shifts).
  • Positive screening for any sleep disorder was linked to an increased risk of self-reported health and safety-related issues.
  • 10.7% of those who screened positive for a sleep disorder also reported having depression, compared with only 4.4% of those who did not screen positive for a sleep disorder.
  • 34.1% of the positive-screen for a sleep disorder group reported burnout or emotional exhaustion, compared with 17.9% in the negative-screen group.
  • 20% of the positive-screen for a sleep disorder group reported falling asleep while driving, compared with 7.9% in the negative-screen group.
  • As well as being more likely to fall asleep while driving, compared to those who screened negative, participants who screened positive for any sleep disorder were also more likely to report making important administrative errors, making mistakes or committing safety violations due to fatigue, incurring complaints from citizens, having uncontrolled anger towards citizens or suspects, a higher level of absenteeism, or falling asleep during meetings.
  • A positive screen for OSA was also linked to a diagnosis of diabetes, cardiovascular disease, and high intake of caffeine.

In their conclusion the authors write:

“… a large proportion of police officers in our sample showed a positive sleep disorder screening result, which was associated with adverse health, safety, and performance outcomes. Further research is needed to determine whether sleep disorder prevention, screening, and treatment programs in occupational settings will reduce these risks.”

In an accompanying editorial, Drs Michael A. Grandner and Allan I. Pack, of the University of Pennsylvania in Philadelphia say more studies should be done to evaluate the impact of sleep problems on people’s jobs. These should screen workers for sleep disorders and evaluate the effect of interventions in those diagnosed with sleep disorders:

“Such studies need to be large enough to allow evaluation of the health effects for the individual as well as the economic implications for the employee and employer and the larger effect on society as a whole. Because police forces are focused on public safety, the study by Rajaratnam et al may represent an impetus for further studies of police forces that could set an example for other occupational groups,” they note.

Some 50 to 70 million people in the US are affected by sleep disorders, including obstructive sleep apnea, insomnia, and shift work disorder (where constant or recurrent sleep interruption leads to insomnia or excessive sleepiness). Most of these cases are undiagnosed and untreated.

In their paper, Rajaratnam and colleagues note that:

“Police officers frequently work extended shifts and long work weeks, which in other occupations are associated with increased risk of errors, unintended injuries, and motor vehicle crashes. According to data through the year 2003, more officers are killed by unintended adverse events than during the commission of felonies.”

“It has been hypothesized that fatigue – likely due to reduced duration and quality of sleep and untreated sleep disorders – may play an important role in police officer unintentional injuries and fatalities,” they add.

It appears that their study is the first systematically to investigate the effect of sleep disorders on police officers’ health, safety and performance.

Written by Catharine Paddock PhD