Sleepy cops abound; you won't like them when they're angry (JAMA, NYT) - PulmCCM
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Jan 072012
 

Did you ever wonder what that police officer is really doing while you wait forever in your car for him to write you your ticket? According to new research, it’s possible he’s taking a quick nap. And you’d best save your snarky comment when he brings you the citation: sleepy cops, it turns out, tend to be in foul moods.

Shantha Rajaratnam et al screened 4,957 young police officers (97% U.S.; mean age 38) for sleep disorders using survey tools in-person and online. (For example, the Berlin questionnaire was used for obstructive sleep apnea; its sensitivity is 86% and specificity is 77%). They also performed polysomnography on 126 officers (63 of whom were Berlin-positive).

RESULTS:

  • 79% were overweight or obese, and one third were obese — about the same or higher proportions than in the general population.
  • 34% screened positive for obstructive sleep apnea by Berlin questionnaire.
  • 40% screened positive for at least one sleep disorder, the main others being insomnia (7%) and shift work disorder (54% of those working night shifts were positive for this).
  • 28% reported excessive sleepiness (Epworth Sleepiness Scale > 11).
  • 26% reported they fell asleep while driving 1-2 times a month; 6% reported falling asleep while driving 1-2 times a week.

Those screening positive for OSA were about twice as likely to report diabetes or cardiovascular disease as health conditions.

During 2-year monthly survey follow-up, those with screen-positive sleep disorders were also more likely to have “uncontrolled anger toward a citizen or suspect” (34% vs. 29%), and to commit unsafe errors due to fatigue (24% vs. 16%). Those who had reported falling asleep while driving had an odds ratio of 1.5 for a self-reported motor vehicle crash, compared to the well-rested cops.

(Um, just curious, is anyone looking into the fact that 29% of the well-rested officers are reporting “uncontrolled anger toward citizens or suspects”?)

Of course, these findings are all vulnerable to the pitfalls of survey-based research: responder bias (impossible to avoid; they had about a 60% participation rate) and recall bias. Did the non-responders opt out because they knew they had sleep disorders and were paranoid about losing their jobs? Or knew were they healthy and didn’t want to waste their time?

Polysomnography on 262 patients corroborated the findings: although positive predictive value of a positive Berlin was only 82%, fully 18% of those with a negative Berlin had moderate or severe OSA on PSG. Sounds like a wash.

Of course, the lay press (New York Times) picked this one up too.

sleep review policy ethics education review jama cardiovascular disease review  Sleepy cops abound; you wont like them when theyre angry (JAMA, NYT)Clinical Takeaway: Cops do a hard job for low pay, and we all owe them a debt of gratitude … as well as some more paid exercise time, adequate time off between shifts, and better health insurance for sleep studies, apparently. Sleep disorders should be considered anytime you see a police officer in your clinic. (That goes for truck drivers, too, by the way. I think I’ll fly this holiday season.)

Rajaratnam SMW et al. Sleep Disorders, Health, and Safety in Police Officers. JAMA 2011;306(23):2567-2578.

Anahad O’Connor, “Sleep Problems in Police Officers Take Heavy Toll,” New York Times, December 20, 2011.

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