Sleep Disorders Among Health Care Providers Increase Risk of Occupational Burnout

A recent study identified a link between undiagnosed and untreated sleep disorders with occupational burnout among health care providers (HCPs).

“Physicians’ mental health concerns affect the quality of life of caregivers, patient safety, health care expenditures, and occupational turnover,” wrote study author Matthew Weaver, PhD, and colleagues. “More than half of US physicians report burnout.”

According to the researchers, sleep deficiency is a common occurrence among HCPs. Many HCPs experience rotating or extended-duration shifts, night call, and competing demands, which ultimately leads to sleep deficiencies.

For their study, the authors “sought to identify the prevalence of sleep disorders and estimate the cross-sectional association between sleep disorders and burnout symptoms among faculty and staff in a large teaching hospital system.”

To better understand the study design, findings, and future implications of this research, we spoke with Dr Weaver.

What existing data led you and your coinvestigators to conduct this research?

We had conducted sleep health education and sleep disorder screening studies in a variety of other occupational groups and consistently found that approximately 1 in 3 participants screens positive for at least one sleep disorder, with about 90% previously undiagnosed and untreated. Sleep deficiency is common among health care providers for a variety of reasons, one of which is likely undiagnosed sleep disorders. This led us to suspect that there could be a benefit to providing sleep health education and removing barriers to evaluation for sleep disorders in this population.

In addition, sleep is closely tied to mental health. There is evidence of a bidirectional relationship between insomnia and mood, for example. Preliminary evidence suggested that sleep-related impairment was one of the most prominent drivers of burnout at our institution. However, sleep has not been a focus of prior burnout interventions. Collectively, this was our rationale for pursuing this work as a quality improvement project.

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

We developed a Sleep Health and Wellness (SHAW) program, including sleep health education and sleep disorder screening, that was deployed in-person through presentations to hospital groups. We also administered validated surveys to assess burnout and professional fulfillment within the sessions. We found that undiagnosed sleep disorders were common (29% prevalence). Those that screened positive for a sleep disorder were nearly four-times more likely to report burnout (OR 3.67; 95% CI 2.75-4.89) and were half as likely to feel fulfilled professionally (OR 0.53; 95% CI 0.40-0.70).

We were surprised by the magnitude of the association. To find a modifiable risk factor that has this strong of an association with burnout risk was unexpected and presents an opportunity for intervention.

What are the possible real-world applications of these findings in clinical practice?

This or a similar program could easily be incorporated into grand rounds presentations or other meetings that are routinely held by health care providers. Identifying and treating undiagnosed sleep disorders may be an effective intervention against burnout, which has been resistant to other treatment approaches. These programs may also provide broad benefits in other areas of health, wellness, and safety.

Do you and your coinvestigators intend to expand upon this research?

Yes, we believe the next step is to test if those who receive treatment through a program like this one have durable improvements in a variety of outcomes, including occupational burnout.

Is there anything else pertaining to your research and findings that you would like to add?

Undiagnosed and untreated sleep disorders are pervasive in our population. They appear to be an important, independent risk factor for occupational burnout. Further study is needed to determine whether identifying and treating them alleviates burnout, but sufficient data already exist to conclude that treatment for sleep disorders improves health, safety, and well-being. Improvement of sleep health deserves to be a public health priority.

About Dr Weaver

Matthew Weaver, PhD is an associate epidemiologist at Brigham and Women’s Hospital and an instructor in medicine at Harvard Medical School. His research group focuses on how sleep impacts population health, safety, and well-being. 

Reference:
Weaver MD, Robbins R, Quan SF, et al. Association of Sleep Disorders With Physician Burnout. JAMA Netw Open. 2020;3(10):e2023256. Published 2020 Oct 1. doi:10.1001/jamanetworkopen.2020.23256