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Implementing a Sleep Health Education and Sleep Disorders Screening Program in Fire Departments: A Comparison of Methodology

Barger, Laura K. PhD; O’Brien, Conor S. BA; Rajaratnam, Shantha M.W. PhD; Qadri, Salim BS; Sullivan, Jason P. BS; Wang, Wei PhD; Czeisler, Charles A. PhD, MD; Lockley, Steven W. PhD

Journal of Occupational and Environmental Medicine: June 2016 - Volume 58 - Issue 6 - p 601–609
doi: 10.1097/JOM.0000000000000709
Original Articles

Objective: The objective of this study is to compare three methods of administering a sleep health program (SHP) in fire departments.

Methods: An SHP, comprising sleep health education and screening for common sleep disorders, was implemented in eight fire departments using three approaches: expert-led, train-the-trainer, and online. Participation rates, knowledge assessments, surveys, and focus group interviews were analyzed to assess the reach and effectiveness of the methodologies.

Results: The Expert-led SHP had the highest participation rate, greatest improvement in knowledge scores, and prompted more firefighters to seek clinical sleep disorder evaluations (41%) than the other approaches (20 to 25%). Forty-two percent of focus group participants reported changing their sleep behaviors.

Conclusion: All approaches yielded reasonable participation rates, but expert-led programs had the greatest reach and effectiveness in educating and screening firefighters for sleep disorders.

Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital (Dr Barger, Mr O’Brien, Dr Rajaratnam, Mr Qadri, Mr Sullivan, Dr Wang, Dr Czeisler, Dr Lockley); Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts (Drs Barger, Rajaratnam, Wang, Czeisler, Lockley); and School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Australia (Drs Rajaratnam and Lockley).

Address correspondence to: Laura K. Barger, PhD, Harvard Medical School, Brigham and Women's Hospital, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, 221 Longwood Avenue, BLI 438, Boston, MA 02115-5817 (

Laura K. Barger and Conor S. O’Brien are co–first authors.

This project was supported by the Federal Emergency Management Agency, Assistance to Firefighters Grant Program, EMW-2007-FP-02917 and EMW-2008-FP-02566. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the Federal Emergency Management Agency or the Assistance to Firefighters Grant Program.

All authors report that they were supported in conducting this work by a research grant from the Assistance to Firefighters Grant Program through the Brigham and Women's Hospital and were supported in part by grant R01 OH 010300 from the National Institute of Occupational Safety and Health (LKB, CSO, SQ, JPS, WW, CAC, and SWL) and grant U01HL11478 from the National Heart Lung Blood Institute NHLBI (CAC and LKB).

Dr. Barger has previously received research support from Cephalon, NFL charities, Sysco, and San Francisco Bar Pilots. She has received consulting/lecture fees or served as a board member for Alertness Solution, Ceridian, Davis Joint Unified School Board, San Jose State University Foundation, Puget Sound Pilots, Sygma, and Torvec.

Mr. O’Brien reports no conflicts.

Dr Rajaratnam reports that he has served as a consultant through his institution to Vanda Pharmaceuticals, Philips Respironics, EdanSafe, National Transport Commission, Rail, Bus and Train Union, Australian Workers’ Union, Tontine Group, Transport Accident Commission, Media Consumer Healthcare, New South Wales Department of Education & Communities, and has through his institution received research grants and from Vanda Pharmaceuticals, Philips Respironics, and Rio Tinto, and reimbursements for conference travel expenses from Vanda Pharmaceuticals. He serves as a consultant to, and is a Program Leader for, the Cooperative Research Centre for Alertness, Safety and Productivity. His institution has received equipment donations or other support from Optalert, Compumedics, Philips Lighting, and Tyco Healthcare. He is a Director of the Sleep Health Foundation, and is a Past President of the Australasian Sleep Association. He has also served as an expert witness and/or consultant to shift work organizations and in legal cases involving sleep loss.

Mr Sullivan, Mr Qadri, Dr Wang report no conflicts.

Dr Czeisler has received consulting fees from or served as a paid member of scientific advisory boards for, Inc.; A2Z Development Center, Inc.; Bose Corporation; Boston Red Sox; Cleveland Browns; Institute of Digital Media and Child Development; Jazz Pharmaceuticals, Inc.; Merck Sharpe and Dohme; Purdue Pharma; Quest Diagnostics; Samsung Electronics; Teva Pharmaceutical Industries Ltd.; Koninklijke Philips Electronics, N.V.; Novartis; and Vanda Pharmaceuticals, Inc. He owns an equity interest in Somnus Therapeutics, Inc. and Vanda Pharmaceuticals, Inc., and has received research/education support from Mary Ann and Stanley Snider through Combined Jewish Philanthropies, National Football League Charities, Optum, ResMed, Philips Respironics, the San Francisco Bar Pilots, Simmons, Schneider, Inc., and Sysco. He has received royalties from McGraw Hill, Penguin Press/Houghton Mifflin Harcourt, and from Philips Respironics, Inc., for the Actiwatch 2 and Actiwatch Spectrum devices; his interests were reviewed and are managed by Brigham & Women's Hospital and Partners HealthCare in accordance with their conflict of interest policies. The Harvard Medical School Division of Sleep Medicine and the Brigham and Women's Hospital Division of Sleep and Circadian Disorders, which he directs, have received unrestricted research and educational gifts and endowment funds from Boehringer Ingelheim Pharmaceuticals, Inc.; Cephalon, Inc.; GlaxoSmithKline; Jazz Pharmaceuticals; Merck & Co., Inc.; Pfizer; ResMed; Philips Respironics, Inc.; Sanofi-Aventis, Inc.; Sealy, Inc.; Sepracor, Inc.; Simmons, Spring Aire; Takeda Pharmaceuticals; Tempur-Pedic; Walmart; Proctor and Gamble; Optum; Bose; Vanda Pharmaceuticals, Inc.; and has received Educational Grant funding from Apria Healthcare; Cephalon, Inc.; Jazz Pharmaceuticals; Philips Respironics; Takeda Pharmaceuticals; ResMed Foundation; Sanofi-Aventis, Inc.; Sepracor, Inc.; Teva Pharmaceutical Industries, Ltd.; and Wake Up Narcolepsy. He holds a number of process patent s in the field of sleep/circadian rhythms (eg, photic resetting of the human circadian pacemaker). Since 1985, he has also served as an expert witness on various legal cases related to sleep and circadian rhythms, including matters related to Bombardier, Citgo, HG Energy, Michael Jackson's mother and children, Purdue Pharma, StricLan LLC, Valero, and matters related to commercial drivers employed by Celadon, Crete Carrier Corporation, FedEx, United Parcel Service, and other commercial carriers.

In the past 3 years, Dr Lockley has received consulting fees from Blackrock; Carbon Limiting Technologies Ltd (on behalf of PhotonStar LED); Cowen & Co; Endurant Capital Management; Far West Capital Management; Fidelity; Frankel Group; Impax Laboratories; Kearney Venture Partners; Lazard Capital Markets; Naturebright; New Horizon Capital; Perceptive Advisors; Polar Capital; ResearchWorks Inc.; Serrado Capital; Wyvern Funds; and has current consulting contracts with Akili Interactive; Delos Living LLC; Environmental Light Sciences, LLC; Focal Point LLC; Headwaters Inc.; Hintsa Performance AG; OpTerra Energy Services Inc.; Pegasus Capital Advisors LP; PlanLED; Wyle Integrated Science and Engineering; has received unrestricted equipment gifts from Bioilluminations LLC; Bionetics Corporation; and Philips Lighting; advance author payment and royalties from Oxford University Press; payment for editing a textbook section from Elsevier; honoraria from the National Sleep Foundation; and for an article in the Wall Street Journal; honoraria plus travel, accommodation or meals for invited seminars, conference presentations or teaching from Brookline Adult Education; Brown University; Estee Lauder; Harvard University (CME); MediCom Worldwide, Inc.(CME); travel, accommodation and/or meals only (no honoraria) for invited seminars, conference presentations or teaching from 14th Annual Tennessee Perfusion Conference; American Society for Photobiology; Cantifix; Connecticut Business & Industry Association Health and Safety Conference; Emergency Services Steering Committee; FASEB; Harvard University; Hintsa Performance AG; Illuminating Engineering Society; Lightfair; Massachusetts General Hospital; Midwest Lighting Institute; New England College of Occupational and Environmental Medicine; Ontario Association of Fire Chiefs; Rio Tinto; UMass Memorial; University of Manchester; ongoing investigator-initiated research grants from Biological Illuminations LLC; and Respironics Inc.; completed service agreements with Rio Tinto Iron Ore and Vanda Pharmaceuticals Inc.; three completed sponsored initiated clinical research contracts with Vanda Pharmaceuticals Inc.; and one completed investigator-initiated research grant from Vanda Pharmaceuticals Inc. Dr Lockley also holds a process patent for the use of short-wavelength light for resetting the human circadian pacemaker and improving alertness and performance, which is assigned to the Brigham and Women's Hospital per Hospital policy. Dr Lockley has also served as a paid expert witness on behalf of four public bodies in cases related to sleep, circadian rhythms, and work hours. Dr Lockley also serves as a Program Leader in the Cooperative Research Centre for Alertness, Safety and Productivity.

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