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Medisauskaite and Kamau conducted a randomized controlled trial to investigate the association between occupational distress and the risk of health problems among UK doctors (1). Occupational distress and job factors increased the odds of doctors using substances, having sleep problems, presenting with frequent symptoms of ill health and binge-eating. Especially, burnout increased the risk of all types of sleep problems, including difficulty falling/staying asleep, insomnia. I suppose that association might be caused from occupational distress to the risk of health problems in an intervention study. I have a general concern on the inter-relationship among health problems, and discussed the relationship between alcohol use and sleep problem as an example.
First, Hu et al. conducted a meta-analysis to examine the relationship of alcohol consumption with incidence of sleep disorder (2). Pooled odds ratios (ORs) (95% confidence intervals [CIs]) of mild/moderate and heavy alcohol consumptions for the incidence of sleep disorder were 1.37 (1.22, 1.54) and 1.22 (0.94, 1.60). They selected sleepiness and insomnia as sleep problems, and obstructive sleep apnea was not selected in spite of the frequent sleep disorders in drinkers (3). In addition, there is a space of evaluating dose-response relationship.
Second, Britton et al. evaluated the association between alcohol consumption and sleep disorders among older people (4). For men, OR (95% CI) of drinking more than 21...
Second, Britton et al. evaluated the association between alcohol consumption and sleep disorders among older people (4). For men, OR (95% CI) of drinking more than 21 units (approximately 168 grams) of alcohol per week for waking several times a night was 1.30 (1.02, 1.66). In contrast, there was no significant increase of OR for women. The criteria of increased amount of drinking were different from those by Hu et al. (2), and stratified analysis by sex was based on the same criteria of increased alcohol consumption. In addition, comorbidities including mental disorders might be affected by aging. As many contributing variables on the association might be existed in epidemiological studies, selecting prospective studies for a meta-analysis would be difficult to conduct.
Finally, Zheng et al. assessed the association between alcohol intake and sleep quality (5). The adjusted OR (95% CI) of heavy alcohol intake for short sleep duration and snoring were 1.31 (1.09, 1.57) and 1.38 (1.22, 1.57), respectively. Among several types of alcohol beverage, hard liquor was significantly associated with poor sleep quality. Comprehensive studies including lifestyle information might contribute to the risk of alcohol consumption on the incidence of sleep disorder.
Stress management is important to reduce health problems among doctors, especially in era of COVID-19 infection. Initiation of occupational distress would accelerate each health problem, and health problems make interactions each other. To solve the health problems, effective stress-lowering interventions should be conducted.
1. Medisauskaite A, Kamau C. Does occupational distress raise the risk of alcohol use, binge-eating, ill health and sleep problems among medical doctors? A UK cross-sectional study. BMJ Open 2019;9(5):e027362.
2. Hu N, Ma Y, He J, et al. Alcohol consumption and incidence of sleep disorder: A systematic review and meta-analysis of cohort studies. Drug Alcohol Depend 2020;217:108259.
3. Kolla BP, Foroughi M, Saeidifard F, et al. The impact of alcohol on breathing parameters during sleep: A systematic review and meta-analysis. Sleep Med Rev 2018;42:59-67.
4. Britton A, Fat LN, Neligan A. The association between alcohol consumption and sleep disorders among older people in the general population. Sci Rep 2020;10(1):5275.
5. Zheng D, Yuan X, Ma C, et al. Alcohol consumption and sleep quality: a community-based study. Public Health Nutr 2020 Nov 13. doi: 10.1017/S1368980020004553. [Online ahead of print]