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Sleep and biological parameters in professional burnout: A psychophysiological characterization.

Arnaud Metlaine, Fabien Sauvet, Danielle Gomez-Merino, Thierry Boucher, Maxime Elbaz et al.
Other PloS one 2018 69 Zitierungen
PubMed DOI PDF
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Study Design

Studientyp
Observational Study
Stichprobengröße
140
Intervention
Sleep and biological parameters in professional burnout: A psychophysiological characterization.
Vergleichsgruppe
Placebo
Wirkungsrichtung
Positive
Verzerrungsrisiko
Moderate

Abstract

Professional burnout syndrome has been described in association with insomnia and metabolic, inflammatory and immune correlates. We investigated the interest of exploring biological parameters and sleep disturbances in relation to burnout symptoms among white-collar workers. Fifty-four participants with burnout were compared to 86 healthy control participants in terms of professional rank level, sleep, job strain (Karasek questionnaire), social support, anxiety and depression (HAD scale). Fasting concentrations of glycaemia, glycosylated hemoglobin (HbA1C), total-cholesterol, triglycerides, C-reactive protein (CRP), thyroid stimulating hormone (TSH), 25-hydroxyvitamin D (25[OH]D), and white blood cell (WBC) counts were assessed. Analysis of variance and a forward Stepwise Multiple Logistic Regression were made to identify predictive factors of burnout. Besides reporting more job strain (in particular job control p = 0.02), higher levels of anxiety (p<0.001), and sleep disorders related to insomnia (OR = 21.5, 95%CI = 8.8-52.3), participants with burnout presented higher levels of HbA1C, glycaemia, CRP, lower levels of 25(OH)D, higher number of leukocytes, neutrophils and monocytes (P<0.001 for all) and higher total-cholesterol (P = 0.01). In particular, when HbA1c is > 3.5%, the prevalence of burnout increases from 16.6% to 60.0% (OR = 4.3, 95%CI = 2.8-6.9). Strong significant positive correlation existed between HbA1C and the two dimensions (emotional exhaustion and depersonalization (r = 0.79 and r = 0.71, p<0.01)) of burnout. Models including job strain, job satisfaction, anxiety and insomnia did not predict burnout (p = 0.30 and p = 0.50). However, when HbA1C levels is included, the prediction of burnout became significant (P = 0.03). Our findings demonstrated the interest of sleep and biological parameters, in particular HbA1C levels, in the characterization of professional burnout.

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Tables

Table 1

ControlBurnoutAnova p-valueχ2, OR (95% CI)
Number, n8654
Women, n (%)45 (52.2%)24 (44.4%)NS
Age, yr30.8 ± 7.131.7 ± 7.40.51
Weight, Kg68.3 ± 13.467.0 ± 13.10.55
BMI, kg/m222.7 ± 3.222.4 ± 3.20.57
Rank /Level, n (%)
 Assistant6 (7.0%)4 (7.4%)NS
 Associate2 (2.3%)2 (3.7%)NS
 Director3 (3.4%)2 (3.7%)NS
 Senior59 (68.6%)33 (61.1%)NS
 Senior manager11 (12.8%)9 (16.6%)NS
Emotional exhaustion10.2 ± 3.537.9 ± 6.0<0.001
Depersonalization6.6 ± 2.717.8 ± 3.9<0.001
Accomplishment40.2 ± 2.029.6 ± 4.1<0.001
Job strain
 Job control64.2 ± 8.467.7 ± 9.30.02
 Job demand27.1 ± 3.627.2 ± 3.50.5
Social support22.2 ± 4.322.1 ± 3.80.8
Job satisfaction7.1 ± 1.55.7 ±1.90.01
Quality of life (VAS)7.38 ± 1.297.07 ± 1.850.25
HAD anxiety7.1 ± 2.010.1 ± 3.4<0.001
 Score HADa > 1030 (34.8%)7 (12.9%)35.9*, 13.1 (5.5–36.1)
HAD depression5.5 ± 2.46.7 ± 3.40.02
 Score HADd > 1005 (100%)

Table 2

ControlBurnoutANOVA p-valueχ2, OR (95% CI)
TST, h6.9 ± 0.76.7 ± 0.80.16
TST week, h6.7 ± 0.86.5 ± 0.90.23
TST week end, h8.9 ± 1.18.8 ± 1.10.37
Difference, h2.3 ± 1.22.3 ± 1.50.98
Epworth Sleepiness Scale (ESS) (/24)9.7 ± 4.09.4 ± 4.80.67
 ESS >10, n (%)46 (53.5%)28 (51.9%)NS
 ESS > 12, n (%)26 (30.2%)17 (31.5%)NS
 ESS > 14, n (%)16 (18.6%)11(20.4%)NS
 ESS > 16, n (%)10 (11.6%)6 (11.0%)NS
Insomnia n (%)
 Insomnia11 (12.8%)41 (75.9%)57*, 21.5 (8.8–52.3)
 Nb. troubles DSM 50.2 ± 0.71.6 ± 1.3<0.001
 Sleep latency disorder3 (3.5%)11 (29.6%)19*, 11.6 (3.2–42.4)
 Nocturnal awaking7 (8.1%)21 (38.9%)20*, 7.2 (2.8–18.5)
 Early awaking3 (3.5%)19 (35.2%)25*,15.1(4.2–54.0)
 Non-restorative sleep7 (8.1%)27 (50.0%)32*,11.3 (4.4–28.9)
Nap, n (%)11 (20.3%)18 (20.9%)NS
Snoring n (%)14 (25.9%)20 (28.3%)NS

Table 3

ControlBurnoutpχ2, OR (95% CI)
Glycaemia, g/L0.82 ± 0.130.89 ± 0.140.001
Glycaemia > 0.8 g/L41 (47.7%)40 (70.1%)8.4 *, 1.8 (1.2–2.0)
HbA1C, (%3.0 ± 0.514.66 ± 0.57<0.001
HbA1C > 3.5%14 (16.6%)52 (60.0%)78.4*, 4.3 (2.8–6.9)
CRP, mg/L1.2 ± 0.92.07 ± 1.80.001
CRP ≥ 3 mg/L7 (8.3%)14 (25.1%)6.9*, 2 (1.1–3.9)
TSH, mUI/L1.95 ± 0.631.95 ± 0.800.999
25(OH)D, ng/mL28.9 ± 4.917.7 ± 6.9<0.001
25(OH)D<20 ng/mL4 (4.7%)33 (58.9%)51.3*, 4.4 (2.9–6.5)
Total-cholesterol, mmol/L1.66 ± 0.331.81 ± 0.380.01
Triglycerides, mmol/L0.68 ± 0.350.74 ± 0.360.37
HDL, mmol/L0.62 ± 0.160.63 ± 0.150.48
LDL, mmol/L0.98 ± 0.321.03 ± 0.340.35
LDL/HDF0.70 ± 0.280.68 ± 0.280.78
Leukocytes, / mm35110 ± 5356184 ± 1295<0.001
Neutrophils, / mm32460 ± 4203418 ± 1248<0.001
Eosinophils, / mm3155 ± 99174 ± 1260.32
Basophils, / mm339.5 ± 17.541.1± 19.80.61
Lymphocytes, / mm32002 ± 4882068 ± 4440.42
Monocytes, / mm3463 ± 115514 ± 133<0.001
Platelets, x 103 / mm3253 ± 49249 ± 440.68

Table 4

Emotional ExhaustionDepersonalizationPersonal accomplishment
Age0.010.02-0.1
Job demand0.080.040.02
Job control0.17*0.18-0.12
Job satisfaction-0.04-0.31*0.33*
Social support-0.05-0.120.09
Nb. sleep troubles (DSM 5)0.65*0.45*-0.51*
ESS0.01-0.02-0.02
TST-0.1-0.010.09
HADS Anxiety0.52*0.45*-0.50*
HADS Depression0.26*0.18-0.28*
Leucocytes0.46*0.44*-0.44*
PNN0.45*0.47*-0.39*
Glycaemia0.28*0.21-0.26*
HBA1C0.79*0.71*-0.70*
Total-cholesterol0.22*0.19*-0.17
25(OH)D-0.67*-0.59*0.60*
CRP0.28*0.15-0.20*

Table 5

PNNGlycemiaHbA1CCholesterol25(OH)DCRP
Leukocytes0.86*0.140.54*0.11-0.470.48
PNN0.140.56*0.17-0.430.56*
Glycaemia0.27*0.10-0.30*0.08
HbA1C0.36*-0.73*0.35*
Cholesterol-0.250.12
25(OH)D-0.13

Table 6

Ind. variableCoefficientStandard ErrorWald StatisticpOR95%CI
Job satisfaction-0.460.149.7450.0020.62(0.41–0.84)
HADS anxiety0.410.1113.506<0.0011.51(1.21–1.88)
Job control0.080.027.6570.0061.08(1.02–1.15)
Job demand-0.020.060.1430.700.98(0.86–1.11)

Table 7

Ind. variableCoefficientStandard ErrorWald StatisticpOR95%CI
Job satisfaction-0.410.175.930.020.67(0.48–0.92)
HADS anxiety0.380.137.280.0071.40(1.02–1.79)
Job control0.080.036.300.011.09(1.02–1.16)
Job demand-0.050.080.400.530.95(0.82–1.11)
Insomnia1.260.2919.02<0.0013.52(1.21–6.2)

Table 8

Ind. variableCoefficientStandard ErrorWald StatisticpOR95%CI
Job satisfaction-0.170.310.310.580.84(0.46–1.54)
HADS anxiety0.420.214.000.051.52(1.01–2.30)
Job control0.040.050.620.421.04(0.94–1.15)
Job demand-0.120.120.890.340.89(0.69–1.13)
HbA1C5.051.0822.0<0.001156(19.2–1293)

Table 9

Ind. variableCoefficientStandard ErrorWald StatisticpOR95%CI
Job satisfaction-0.020.340.030.950.98(0.50–1.91)
HADS anxiety0.340.232.220.131.41(0.89–2.20)
Job control0.0520.051.060.301.05(0.95–1.16)
Job demand-0.190.141.840.170.83(0.69–1.13)
Insomnia0.960.474.170.040.2.6(1.11–6.5)
HbA1C5.421.4014.9<0.001226(14.4–3325)

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