Resource Toolkit

Shift Work and Sleep: Optimizing Health, Safety, and Performance

The American College of Occupational and Environmental Medicine (ACOEM) – in collaboration with the National Center on Sleep Disorders Research (part of the National Heart, Lung, and Blood Institute [NHLBI] of the NIH), the University of Cincinnati College of Medicine, and Rockpointe Corporation – is pleased to present this online toolkit on shift work, sleep, and patient health. The toolkit was designed to provide evidence-based tools to clinicians and patients, in order to improve patient/provider communication about, as well as the diagnosis and treatment of, shift work sleep disorder (SWSD). The toolkit features practical resources previously developed under the auspices of ACOEM, NHLBI, NIH and other disease-related societies/associations.

Note: This toolkit serves as a supplement to the curriculum developed at a scientific roundtable presented by the ACOEM and National Center on Sleep Disorders Research. The roundtable, "Shiftwork and Sleep: Optimizing Health, Safety and Performance," took place on September 27, 2010 in Crystal City, VA. Cooperating Organizations for this initiative included: the National Sleep Foundation, Sleep Research Soceity, American Academy of Sleep Medicine, American Association for Respiratory Care, American College of Osteopathic Family Physicians, American Lung Association, American Sleep Apnea Association, and National Organizations for Youth Safety.

Diagnosis Tools

This section contains online links to access and download diagnosis tools designed to help explore basic diagnosis and treatment recommendations and methods in patient care.

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American Sleep Association Sleep Disorder Screening Questionnaire
Click here to download

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American Sleep Association Sleep Log
Click here to download

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American Academy of Sleep Medicine Review: Circadian Rhythm Sleep Disorders: Part I, Basic Principles, Shift Work and Jet Lag Disorders (2007)    Click here to download

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American Academy of Sleep Medicine Report: Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders (2007)    Click here to download

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Berlin Questionnaire for OSA    Click here to download
Adapted from a publication from Netzer et al (1999), this questionnaire provides a means of identifying patients who are likely to have sleep apnea.

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The Insomnia Severity Index    Click here to download
This publication includes the Insomnia Severity Index, which is a reliable and valid questionnaire to quantify perceived insomnia severity, including next-day consequences.

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American Academy of Sleep Medicine Parameters for the Role of Actigraphy in the Study of Sleep and Circadian Rhythms
www.aasmnet.org/Resources/PracticeParameters/PP_Actigraphy_Circ.pdf

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Epworth Sleepiness Scale    www.epworthsleepinessscale.com
The ESS is a self-administered questionnaire with 8 questions. It provides a measure of a person's general level of daytime sleepiness, or their average sleep propensity in daily life. It has become a standard method for making an in-office assessment of sleepiness.

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PATIENT GROUPS AND ONLINE DISCUSSION FORUMS

This section contains links to patient educational resources and support websites.

American Sleep Association    www.sleepassociation.org/index.php?p=patients
The American Sleep Association (ASA) is a national organization focused on improving public awareness about sleep disorders and sleep health, promoting sleep medicine research, and providing a portal for communication between patients, physicians/healthcare professionals, corporations, and scientists. The ASA is a member-driven public service project that depends on volunteer efforts. The ASA provides basic information on sleep, symptoms of sleep disorders, insomnia treatments, information on good sleep health, treatments of sleep disorders, locations of sleep labs and/or doctors, message boards and live chat rooms, and support groups.

American Sleep Apnea Association    www.sleepapnea.org
The American Sleep Apnea Association (ASAA) is the only non-profit organization dedicated to educating the public about sleep apnea and to serving people with this common disorder. ASAA is dedicated to reducing injury, disability, and death from sleep apnea and enhancing the well-being of those affected by this common disorder. The ASAA promotes education and awareness, voluntary mutual support groups, research, and continuous improvement in care.

Awake In America    www.awakeinamerica.org
Awake In America is a patient supportive website containing listings of local support groups, online blogs, and links to published articles on sleep. Local support groups focus on topics including obstructive sleep apnea, central sleep apnea, complex sleep apnea, narcolepsy, restless legs syndrome, insomnia, shift work sleep disorder, sleep eating, sleep walking, excessive sleepiness, sleep and emergency medical technicians, sleep and law enforcement officers, sleep and fire fighters, sleep and airline pilots, sleep and commercial drivers, or any other focus related to sleep.

Narcolepsy Network    www.narcolepsynetwork.org
Narcolepsy Network is a national patient support organization primarily focused on the improvement of the lives of those with the life-long neurological sleep disorder, narcolepsy. This website includes patient education, online supportive groups and message boards, as well as a listing of their regional support groups. The Narcolepsy Network educates and informs individuals with narcolepsy about this life-long neurological sleep disorder, available treatments, and symptom management, so patients can be empowered to achieve the highest quality of life possible.

National Institute for Occupational Safety and Health    www.cdc.gov/niosh
The National Institute for Occupational Safety and Health (NIOSH) is the federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness.

Plain Language About Shift Work    www.cdc.gov/niosh/pdfs/97-145.pdf
A publication of the National Institute for Occupational Safety and Health, US Department of Health and Human Services, and Centers for Disease Control and Prevention, this educational document provides basic facts about shift work and talks about ways to make shift work life easier. It is organized into 6 sections: basic background information, how to examine work schedules, health and safety effects of shiftwork, improving shiftwork through the organization, coping strategies for the individual, and recommended reading.

SleepEducation.com from the American Academy of Sleep Medicine    www.sleepeducation.com
This Web site is designed to be a valuable tool for patients and members of the public who are seeking dependable information related to sleep, sleep disorders, treatments, and patient discussion forums. The patient blog provides discussions on all topics related to sleep and sleep disorders.

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PROFESSIONAL RESOURCES AND SUPPORTIVE TOOLS

In this section, you will find a list of professional associations, cooperative groups, and online publications that house a wealth of information on shift work and sleep, such as clinical trial and research findings, classification systems, and best practices exchanges. This section also contains a list of recommended reading and links to other accredited education activities that are a part of the "Shift Work and Sleep" initiative.

Professional Associations and Organizations

American College of Occupational and Environmental Medicine    www.acoem.org
American College of Occupational and Environmental Medicine (ACOEM) is the nation's largest medical society dedicated to promoting the health of workers through preventive medicine, clinical care, research, and education. A dynamic group of physicians encompassing specialists in a variety of medical practices is united via the College to develop positions and policies on vital issues relevant to the practice of preventive medicine both within and outside of the workplace. Assisting employees and employers with the management of the effects of shift work, jet lag, and other chronobiological stressors is one of the ACOEM core competencies.

Harvard Work Hours Health and Safety Group    www.workhoursandsafety.org
The Harvard Work Hours Health and Safety Group is a multi-disciplinary collaborative group whose mission is to investigate sleep and work practices among physicians, police officers, and other occupational groups, and implement strategies to improve the safety of patients, workers, and the general public.

National Center on Sleep Disorders Research    www.nhlbi.nih.gov
The National Center on Sleep Disorders Research (NCSDR), located within the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), was established in 1993 to combat sleep problems. Each year, sleep disorders, sleep deprivation, and sleepiness add an estimated $15.9 billion to the national health care bill. The Center seeks to fulfill its goal of improving the health of Americans by serving 4 key functions: research, training, technology transfer, and coordination. The NIH has posted several patient education materials on sleep disorders at: www.nhlbi.nih.gov/about/ncsdr/patpub/patpub-a.htm

National Institutes of Health    www.nih.gov
The NIH's mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce the burdens of illness and disability. The goals of the agency are: to foster fundamental creative discoveries, innovative research strategies, and their applications as a basis for ultimately protecting and improving health; to develop, maintain, and renew scientific human and physical resources that will ensure the Nation's capability to prevent disease; to expand the knowledge base in medical and associated sciences in order to enhance the nation's economic well-being and ensure a continued high return on the public investment in research; and to exemplify and promote the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science. The NIH has posted several patient education materials on sleep disorders located at: www.nhlbi.nih.gov/health/public/sleep

American Academy of Sleep Medicine    www.aasmnet.org
The American Academy of Sleep Medicine is the leader in setting standards and promoting excellence in sleep medicine health care, education, and research. AASM serves its members and advances the field of sleep health care by setting the clinical standards for the field of sleep medicine; advocating for recognition, diagnosis and treatment of sleep disorders; educating professionals dedicated to providing optimal sleep health care; and fostering the development and application of scientific knowledge.

American Academy of Dental Sleep Medicine    www.aadsm.org
The American Academy of Dental Sleep Medicine (AADSM) is a professional medical society for dentists who research, assess and manage the treatment of sleep-related breathing disorders through the use of oral appliances and surgery. The AADSM provides training and resources for dental sleep specialists and works closely with the medical community to provide safe and effective treatments for sleep disorders patients.

American Association of Sleep Technologists    www.aastweb.org
The AAST is a professional society for sleep technology specialists who perform the technical evaluation of patients with sleep disorders and ensure the proper use of therapeutic intervention. The AAST advances the sleep technology profession by establishing standards of care, developing training programs and materials, and promoting technical and clinical excellence.

American Sleep Association    www.sleepassociation.org/index.php?p=patients
The American Sleep Association (ASA) is a national organization focused on improving public awareness about sleep disorders and sleep health, promoting sleep medicine research, and providing a portal for communication between patients, physicians/healthcare professionals, corporations, and scientists. The ASA is a member-driven public service project that depends on volunteer efforts. The ASA provides basic information on sleep, symptoms of sleep disorders, insomnia treatments, information on good sleep health, treatments of sleep disorders, locations of sleep labs and/or doctors, message boards and live chat rooms, and support groups.

National Sleep Awareness Roundtable    www.nsart.org
The National Sleep Awareness Roundtable (NSART) is a national coalition of governmental, professional, voluntary, and other organizations. Its mission is: 1) to raise awareness about; 2) to increase the understanding of; and 3) to reduce the public health and safety impact of sleep deprivation and sleep disorders by improving communication and collaboration among local, state, and federal agencies; professional organizations; and the public.

National Sleep Foundation    www.sleepfoundation.org
NSF is dedicated to improving public health and safety by achieving understanding of sleep and sleep disorders, and by supporting sleep-related education, research, and advocacy.

Sleep Research Society Foundation    www.sleepresearchsociety.org/Foundation
The Sleep Research Society Foundation (SRSF) was established in 2005 by the Sleep Research Society Board of Directors to support growth and development in the field of sleep research. The SRSF exists to provide support for investigators to conduct pilot studies that will form the basis of more comprehensive applications to federal agencies and private foundations.

Sleep Research Society    http://www.sleepresearchsociety.org/
The Sleep Research Society is a member organization fostering scientific investigation on all aspects of sleep and its disorders, promoting training and education in sleep research, and providing forums for the exchange of knowledge pertaining to sleep.

Society for Light Treatment and Biological Rhythms    www.websciences.org/sltbr
The Society for Light Treatment and Biological Rhythms is a not-for-profit international organization founded in 1988, dedicated to fostering research, professional development, and clinical applications in the fields of light therapy and biological rhythms.

Additional Resource Links

Healthy people 2020    www.healthypeople.gov/hp2020
Healthy People provides science-based, 10-year national objectives for promoting health and preventing disease. Since 1979, Healthy People has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Currently, Healthy People 2010 is leading the way to achieve increased quality and years of healthy life and the elimination of health disparities.

Healthy people Consortium    www.healthypeople.gov/hp2020/Consortium/Default.aspx
The Consortium is a diverse, motivated, and dedicated group of agencies and organizations committed to working together to help achieve Healthy People 2020's health goals and objectives for the nation.

Plain Language About Shift Work    www.cdc.gov/niosh/pdfs/97-145.pdf
A publication of the National Institute for Occupational Safety and Health, US Department of Health and Human Services, and Centers for Disease Control and Prevention, this educational document provides basic facts about shift work and talks about ways to make shift work life easier. It is organized into 6 sections: basic background information, how to examine work schedules, health and safety effects of shiftwork, improving shiftwork through the organization, coping strategies for the individual, and recommended reading.

Shift Work Disorder News    www.shiftworkdisorder.com
Shift Work Disorder News keeps professionals (doctors, nurses, researchers) up to date regarding the world of sleep disorders, new treatment methods (with special emphasis on shift work sleep disorder), and the dangers of "drowsy driving".

Sleep Center Locations    www.sleepcenters.org
A listing of accredited sleep disorders centers and/or sleep-related breathing laboratories from the American Academy of Sleep Medicine.

Accredited Shift Work and Sleep Education Links

Journal Supplements

Sleep Review Journal Supplement    Click here to download
Enduring CME-certified Supplement (4-page Supplement)
In this interview, two national experts- Natalie Hartenbaum, MD, MPH (President of the American College of Occupational and Environmental Medicine, and President and Chief Medical Officer of OccuMedix, Dresher, PA) and Phyllis Zee, MD, PhD (Professor of Neurology and Neurobiology and Physiology and Director of the Sleep and Wake Disorders Center at Northwestern University, Chicago, IL) - discuss the effects of shift work on sleep, circadian alignment, workplace safety and performance, and mental and physical health. Dr. Hartenbaum and Dr. Zee also address the roles of employers, employees, and healthcare professionals in identifying and managing the risks of workplace fatigue.

Journal of Occupational and Environmental Medicine Supplement        journals.lww.com/joem/toc/2011/05001
Enduring CME-certified Supplement (16-Page Supplement)
This supplement has been published by the Journal of Occupational and Environmental Medicine,the official journal of the American College of Occupational and Environmental Medicine (ACOEM). It provides a summary of the curriculum developed at a scientific roundtable presented by the American College of Occupational and Environmental Medicine and the National Center on Sleep Disorders Research. The roundtable "Shiftwork and Sleep: Optimizing Health, Safety and Performanc" took place on September 27, 2010 in Crystal City, VA.

Online Activities

MedscapeCME Online Test and Teach Activity        www.medscape.org/viewarticle/737497
Enduring CME-certified On-demand Activity (1 hour)
This online activity is an interactive case-based educational program. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and will then read evidence-based information that supports the most appropriate answer choice. This activity will explore topics such as prevalence of shift work disorder in physician practice; risk factors associated with shift work disorder; comorbidities associated with shift work disorder; making a diagnosis of shift work disorder (including differential diagnoses); consequences of shift work disorder (physical, emotional, workplace safety, productivity); and the management of shift work disorder (guidelines, treatment options).

MedscapeCME Online Webcourse    www.medscape.org/viewarticle/733587
Enduring CME-certified On-demand Activity (1 hour)
This audio-guided slide activity provides a summary of the curriculum developed at a scientific roundtable presented by the American College of Occupational and Environmental Medicine and the National Center on Sleep Disorders Research. The roundtable "Shiftwork and Sleep: Optimizing Health, Safety and Performance" took place on September 27, 2010 in Crystal City, VA.

Recommended Reading

1. Aeschbach D, Lockyer BJ, Dijk DJ et al. Use of transdermal melatonin delivery to improve sleep maintenance during daytime. Clin Pharmacol Ther. 2009;86(4):378-382.
2. Akerstedt T, Kecklund G, Selen J. Early morning work--prevalence and relation to sleep/wake problems: a national representative survey. Chronobiol Intl. 2010;27(5):975-986.
3. Akerstedt T, Nordin M, Alfredsson L et al. Sleep and sleepiness: impact of entering or leaving shiftwork--a prospective study. Chronobiol Intl. 2010;27(5):987-996.
4. Akerstedt T, Wright KP. Sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin. 2009;4(2):257-271.
5. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic & Coding Manual. 2nd ed. Westchester: American Academy of Sleep Medicine; 2005.
6. Campbell SS, Dijk DJ, Boulos Z et al. Light treatment for sleep disorders: consensus report. III. Alerting and activating effects. J Biol Rhythms. 1995;10(2):129-132.
7. Caruso CC, Hitchcock EM. Strategies for nurses to prevent sleep-related injuries and errors. Rehabil Nurs. 2010;35(5):192-197.
8. Cohen DA, Wang W, Wyatt JK et al. Uncovering residual effects of chronic sleep loss on human performance. Sci Transl Med. 2010;2(14):14ra3.
9. Costa G. Shift work and occupational medicine: an overview. Occup Med (Lond). 2003;53(2):83-88.
10. Costa G, Akerstedt T, Nachreiner F et al. Flexible working hours, health, and well-being in Europe: some considerations from a SALTSA project. Chronobiol Int. 2004; 21:831-844.
11. Costa G, Di Milia L. Introductory Overview--19th International Symposium on Shiftwork and Working Time: Health and Well-being in the 24-h Society. Chronobiol Intl. 2010;27(5):889-897.
12. Crowley SJ, Lee C, Tseng CY et al. Combinations of bright light, scheduled dark, sunglasses, and melatonin to facilitate circadian entrainment to night shift work. J Biol Rhythms. 2003;18(6):513- 523.
13. Czeisler CA, Walsh JK, Roth T et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder. N Engl J Med. 2005;353:476-486.
14. Czeisler CA, Walsh JK, Wesnes KA et al. Armodafinil for treatment of excessive sleepiness associated with shift work disorder: a randomized controlled study. Mayo Clin Proc. 2009;84(11):958-972.
15. Dawson D, McCulloch K. Managing fatigue: it's about sleep. Sleep Med Rev. 2005;9(5):365-380.
16. Derk-Jan D, Simon NA. PERIOD3, circadian phenotypes, and sleep homeostasis. Sleep Med Rev. 2010;14:151-160.
17. Fatigue Risk Management Systems for Personnel in the Refining and Petrochemical Industries, ANSI/API Recommended Practice 755. 2010. Available at: http://www.api.org/Standards/psstandards/upload/755_e1.pdf
18. Gabarino S, Mascialino B, Penco MA et al. Professional shift-work drivers who adopt prophylactic naps can reduce the risk of car accidents during night work. Sleep. 2004;27:1295-1302.
19. Gertler, J, Popkin, S, Nelson D, O'Neil K. Toolbox for Transit Operator Fatigue. TCRP Report 81. Transportation Research Board for the Federal Transit Administration. 2002. Available at: http://onlinepubs.trb.org/onlinepubs/tcrp/tcrp_rpt_81.pdf
20. Gold DR, Rogacz S, Bock N et al. Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. Am J Public Health. 1992;82(7):1011-1014.
21. Hart CL, Haney M, Nasser J, Foltin RW. Combined effects of methamphetamine and zolpidem on performance and mood during simulated nightshift work. Pharmacol Biochem Behav. 2005;81:559-568.
22. Hart CL, Ward AS, Haney M, Foltin RW. Zolpidemrelated effects on performance and mood during simulated night-shift work. Exp Clin Psychopharmacol. 2003;11(4):259-268.
23. Hursh SR, Raslear TG, Kaye AS, Fanzone JF. Validation and calibration of a fatigue assessment tool for railroad work schedules. Summary Report DOT/FRA/ORD-06/21 . US Department of Transportation, Federal Railroad Administration. October 31, 2006.
24. International Petroleum Industry Environmental Conservation Association (IPIECA) and International Association of Oil and Gas Producers (OGIP). Managing fatigue in the workplace. 2007. Available at: http://www.ogp.org.uk/pubs/392.pdf.
25. Ker K, Edwards PJ, Felix LM et al. Caffeine for the prevention of injuries and errors in shift workers. Cochrane Database Syst Rev. 2010 May 12;CD008508.
26. Literature Review on Health and Fatigue Issues Associated with Commercial Motor Vehicle Driver Hours of Work. Transportation Research Board 2005. Available at: http://onlinepubs.trb.org/onlinepubs/ctbssp/ctbssp_syn_9.pdf.
27. Lockley SW, Barger LK, Ayas NT et al. Harvard Work Hours, Health and Safety Group. Effects of health care provider workhours and sleep deprivation on safety and performance. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl):7-18.
28. Lombardi DA, Folkard S, Willetts JL, Smith GS. Daily sleep, weekly working hours, and risk of work-related injury. US National Health Interview Survey (2004-2008). Chronobiol Int. 2010; 27(5) :1013-1030.
29. Lowden A, Akerstedt T, Wibom R. Suppression of sleepiness and melatonin by bright light exposure during breaks in night work. J Sleep Res. 2004;13:37-43.
30. McCallum M, Sanquist T, Mitler, M, Krueger G. Commercial Transportation Operator Fatigue Management Reference. July 2003. Available at: http://hfcc.dot.gov/ofm/docs/fmr07-03.doc.
31. Moalem J, Salzman P, Ruan DT et al. Should all duty hours be the same? Results of a national survey of surgical trainees. J Am Coll Surg. 2009;209:47-54.
32. Morgenthaler TI, Lee-Chiong T, Alessi C et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders: an American Academy of Sleep Medicine report. Sleep. 2007;30(11):1445-1458.
33. National Sleep Foundation. 2010 Sleep in America Poll: Summary of Findings. Available at: http://www.sleepfoundation.org/sites/default/files/nsaw/NSF Sleep in America Poll - Summary of Findings .pdf
34. National Transportation Safety Board. Factors that affect fatigue in heavy truck accidents. Washington, DC; 1995. NTSB/SS-95/01.
35. NCSDR/NHTSA Expert Panel on Driver Fatigue and Sleepiness (1998). Drowsy Driving and Automobile Crashes. Report No. DOT HS 808 707. National Center on Sleep Disorders Research; National Heart, Lung, and Blood Institute; and National Highway Traffic Safety Administration. Washington, DC. April 1998.
36. Porcù S, Bellatreccia A, Ferrara M, Casagrande M. Performance, ability to stay awake, and tendency to fall asleep during the night after a diurnal sleep with temazepam or placebo. Sleep. 1997;20(7):535- 541.
37. Puca FM, Perrucci S, Prudenzano MP et al. Quality of life in shift work syndrome. Funct Neurol. 1996;11(5):261-268.
38. Rajaratnam SM, Polymeropoulos MH, Fisher DM et al. Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. Lancet. 2009;373(9662):482-491.
39. Reid KJ, Zee PC. Circadian rhythm disorders. Semin Neurol. 2009;29(4):393-405.
40. Rosekind MR. Underestimating the societal costs of impaired alertness: safety, health and productivity risks. Sleep Med. 2005;6:S21-S25.
41. Rosekind MR, Gregory KB, Mallis MM et al. The Cost of poor sleep: workplace productivity loss and associated costs. J Occup Environ Med. 2010;52(1):91-98.
42. Sack RL, Auckley D, Auge RR et al. Circadian rhythm sleep disorders: Part I, Basic principles, shift work and jet lag disorders. Sleep. 2007;30(11):1460-1483.
43. Sack RL, Auckley D, Auge RR et al. Circadian rhythm sleep disorders: Part II, Advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. Sleep. 2007;30(11):1484-1501.
44. Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A. 2009;106(11):4453-4458.
45. Schulz P. Biological clocks and the practice of psychiatry. Dialogues Clin Neurosci. 2007;9:257-272.
46. Schweitzer PK, Randazzo AC, Stone K et al. Laboratory and field studies of naps and caffeine as practical countermeasures for sleep-wake problems associated with night work. Sleep. 2006;29:39-50.
47. Scott A. Sleepiness and fatigue: Risks for the transportation industry. Clinics in Occup and Environ Med. 2003 February;81-108.
48. Sharkey KM, Eastman CI: Melatonin phase shifts human circadian rhythms in a placebo-controlled simulated night-work study. Am J Physiol Regul Integr Comp Physiol. 2002;282:R454-R463.
49. Smith MR, Fogg LF, Eastman CI. A compromise circadian phase position for permanent night work improves mood, fatigue, and performance. Sleep. 2009;32(11):1481-1489.
50. Swanson L, Arnedt J, Rosa R et al. Sleep, health, and work outcomes for shift workers: results from the 2008 sleep in America poll. Sleep. 2009;32(1):A58-A59.
51. Tucker P, Folkard S, Ansiau D, Marquie JC. The effects of age and shiftwork on perceived sleep problems: results from the VISAT-combined longitudinal and cross-sectional study. J Occup Environ Med. 2010;52(4):392-398.
52. US Department of Health and Human Services, Centers for Disease Control and Prevention, and National Institute for Occupational Safety and Health. Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries, and Health Behaviors. Cincinnati, OH. April 2004.
53. Valent F, Di Bartolomeo S, Marchetti R et al. A case-crossover study of sleep and work hours and the risk of road traffic accidents. Sleep. 2010;33(3):349-354.
54. Walsh JK. Clinical and socioeconomic correlates of insomnia. J Clin Psychiatry. 2004;65(Suppl 8):13-19.
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ACKNOWLEDGEMENTS

Presenting Organizations

www.acoem.org	www.nhlbi.nih.gov	www.nih.gov

Joint Sponsors

The University of Cincinnati (UC)    www.cme.uc.edu
UC is the accredited sponsor for this initiative. UC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) as a provider of continuing medical education. UC provides educational initiatives that are responsive to the needs of clinicians and offer opportunities for ongoing intellectual stimulation and professional renewal. The topics selected for CME development are based on an expressed need from the community, the expert opinion of leaders in the field, and national or regional guidelines developed by recognized authorities.

The Division of Pulmonary, Critical Care, & Sleep Medicine at the University of Cincinnati is recognized as a national leader in education, research, and clinical medicine. The UC Comprehensive Sleep Medicine Center provides specialized care for people in need of sleep evaluation. UC's board-certified faculty is comprised of renowned physicians, scientists, and technologists. The Sleep Medicine Center combines academic-based expertise with cutting-edge technology to provide superior care. The sleep medicine faculty at UC currently participates in NetWellness, an Ohio-sponsored, multi-institutional consortium designed to provide health information to the public.

Rockpointe Corporation
Rockpointe Corporation is the joint sponsor for this initiative. Rockpointe is a science-based medical communications company whose clinical specialists, educators, and producers collaborate with national thought leaders to create integrated educational initiatives that are innovative, engaging, and clinically relevant. Under the direction of and in conjunction with the CME sponsor, Rockpointe creates scientifically sound, innovative, and engaging programs that meet the needs of the audiences served.

Cooperating Organizations

www.aarc.org	www.aasmnet.org	www.acofp.org/default.aspx	www.lungusa.org
www.sleepapnea.org	www.noys.org	www.sleepresearchsociety.org/

 

Supported by an educational grant from

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