Can shift work increase the risk of developing Obstructive Sleep Apnea (OSA)?

Shift Work and Obstructive Sleep Apnea Risk

Shift work can contribute to the development of obstructive sleep apnea (OSA) through multiple mechanisms including disruption of circadian rhythms, promotion of obesity, and exacerbation of sleep disorders. 1

Relationship Between Shift Work and OSA

• Shift work has been associated with an increased risk of obesity, insulin resistance, and other cardiometabolic issues that are known risk factors for OSA 1
• Studies suggest the prevalence of OSA in shift workers ranges from 14.3% to 38.1%, which is higher than estimates for the general population 2
• Shift work disorder is characterized by clinically significant disturbances in sleep, fatigue, and/or circadian alignment that cannot be attributed to other causes 1
• Shift workers with OSA demonstrate significantly higher Apnea-Hypopnea Index (AHI) during daytime sleep after night shifts compared to their nighttime sleep (50±27 vs. 32±22) 3

Mechanisms Linking Shift Work to OSA

• Disruption of normal sleep-wake cycles leads to circadian misalignment, which may affect upper airway muscle tone during sleep 1
• Shift work promotes weight gain and metabolic disturbances that increase OSA risk 1
• Sleep deprivation from shift work can reduce arousal responses to respiratory events 4
• Daytime sleep after night shifts is associated with more severe oxygen desaturation in shift workers compared to non-shift workers with similar OSA severity 3

Clinical Implications

• The combination of shift work and OSA creates a dangerous synergy for workplace accidents and driving safety 4
• Excessive daytime sleepiness is more frequent in shift workers than day workers (16.3% vs. 5.9%) and is further increased in those with high risk for OSA (28.6% vs. 8.4%) 4
• Path analysis shows that car accidents or falling asleep at work are directly associated with excessive daytime sleepiness and shift work, and indirectly with OSA 4
• Inadequately treated OSA has been identified as a contributor to major transportation accidents 1

Screening and Management Considerations

• The American Thoracic Society recommends better education regarding the impact of shift work on sleep quality and the association with workplace injuries 1
• Healthcare providers should screen shift workers for OSA symptoms, particularly those with excessive daytime sleepiness 1
• Regular cardiovascular monitoring is necessary for shift workers with OSA due to their potentially increased cardiovascular risk 5
• Shift workers with OSA should avoid night shifts if not effectively treated, as daytime sleep after night shifts significantly worsens OSA severity 3

Common Pitfalls and Considerations

• Inconsistent sleep-wake schedules on days off prevent circadian adaptation and may worsen OSA symptoms 5
• Inadequate light exposure during night shifts and excessive light exposure before daytime sleep can further disrupt sleep quality 5
• Self-medication with alcohol or sedatives by shift workers attempting to improve sleep can worsen OSA 6
• The association between shift work and OSA may be underrecognized, as one meta-analysis showed a small, non-significant increase in possible OSA cases (pooled prevalence relative risk = 1.05; 95% CI 0.85-1.30) 7