Estimating the Attributable Cost of Physician Burnout in the United States.

Background: Although physician burnout is associated with negative clinical and organizational outcomes, its economic costs are poorly understood. As a result, leaders in health care cannot properly assess the financial benefits of initiatives to remediate physician burnout. Objective: To estimate burnout-associated costs related to physician turnover and physicians reducing their clinical hours at national (U.S.) and organizational levels. Design: Cost-consequence analysis using a mathematical model. Setting: United States. Participants: Simulated population of U.S. physicians. Measurements: Model inputs were estimated by using the results of contemporary published research findings and industry reports. Results: On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States. This estimate ranged from $2.6 billion to $6.3 billion in multivariate probabilistic sensitivity analyses. At an organizational level, the annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year. Limitations: Possibility of nonresponse bias and incomplete control of confounders in source data. Some parameters were unavailable from data and had to be extrapolated. Conclusion: Together with previous evidence that burnout can effectively be reduced with moderate levels of investment, these findings suggest substantial economic value for policy and organizational expenditures for burnout reduction programs for physicians.

Obstructive sleep apnea is associated with impaired exercise capacity: a cross-sectional study.

OBJECTIVE: Obstructive sleep apnea (OSA) is associated with increased risk of adverse cardiovascular events. Because cardiopulmonary exercise testing (CPET) aids in prognostic assessment of heart disease, there is rising interest in its utility for cardiovascular risk stratification of patients with OSA. However, the relationship between OSA and exercise capacity is unclear. This study was conducted to test the hypothesis that OSA is associated with impaired exercise capacity. METHODS: Fifteen subjects with moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥15 events/h) and 19 controls with mild or no OSA (AHI <15 events/h) were enrolled. Subjects underwent standard polysomnography to determine AHI and exclude other sleep disorders. Resting metabolic rate was measured via indirect calorimetry, followed by maximum, symptom-limited CPET. Subjects completed a sleep diary and physical activity questionnaire characterizing behaviors in the week prior to testing. RESULTS: Percent predicted peak oxygen uptake (V˙O2) was significantly lower in OSA subjects than controls (70.1%±17.5% vs 83.8%±13.9%; p = 0.02). Each 1-unit increase in log-transformed AHI was associated with a decrease in percent predicted peak V˙O2 of 3.20 (95% CI 0.53-5.88; p = 0.02). After adjusting for baseline differences, this association remained significant (p < 0.01). AHI alone explained 16.1% of the variability observed in percent predicted peak V˙O2 (p = 0.02). CONCLUSIONS: OSA is associated with impaired exercise capacity. Further study is needed to evaluate the utility of CPET for prognostic assessment of patients with OSA.

Effects of exercise and nutritional intake on sleep architecture in adolescents.

PURPOSE: Few studies have evaluated the relationship between sleep architecture and body mass index (BMI), nutrition, and physical activity in children. This study determined the relationship between sleep architecture and diet and exercise. METHODS: Three hundred nineteen Caucasian and Hispanic children aged 10 to 17 years participated in the follow-up assessment of the Tucson Children's Assessment of Sleep Apnea study. The children and parents completed several questionnaires on dietary habits, amount of physical activity, and sleep habits. Subjects also underwent a home polysomnogram to characterize their sleep. RESULTS: Significant bivariate correlations were noted between stage II sleep percentage and the following: BMI (r = 0.246, p < 0.01), estimated total recreational energy expenditure (r = 0.205, p < 0.01), vigorous activity (r = 0.130, p = 0.009), and total estimated activity (r = 0.148, p = 0.009). In girls, significant correlations were noted between stage II percentage sleep and BMI score (r = 0.279, p < 0.01). Also in girls, significant negative correlation was noted between rapid eye movement (REM) sleep percentage and total fat intake (r = -0.168, p = 0.039). In boys, significant correlations were again seen between stage II percentage sleep and the following: BMI score (r = 0.218, p = 0.005), estimated total recreational energy expenditure (r = 0.265, p = 0.001), vigorous activity (r = 0.209, p = 0.008), and total estimated activity (r = 0.206, p = 0.010). When controlling for BMI percentile and age, significant bivariate correlation was also noted between REM sleep percentage and total fat intake (r = 0.176, p = 0.034) in boys. CONCLUSIONS: BMI and exercise were associated with increases in stage II sleep. In girls, total fat intake was associated with a reduction in REM sleep, while in boys (after controlling for BMI percentile and age), total fat intake correlated with REM sleep.

Exercise is associated with a reduced incidence of sleep-disordered breathing.

BACKGROUND: The effect of exercise on sleep-disordered breathing is unknown. While diet and weight loss have been shown to reduce the severity of sleep-disordered breathing, it is unclear whether exercise has an independent effect. METHODS: A population-based longitudinal epidemiologic study of adults measured the association between exercise and incidence and severity of sleep-disordered breathing. Hours of weekly exercise were assessed by 2 mailed surveys (1988 and 2000). Sleep-disordered breathing was assessed by 18-channel in-laboratory polysomnography at baseline and at follow-up. RESULTS: Associations were modeled using linear and logistic regression, adjusting for body mass index, age, sex, and other covariates. Hours of exercise were associated with reduced incidence of mild (odds ratio 0.76, P=.011) and moderate (odds ratio 0.67, P=.002) sleep-disordered breathing. A decrease in exercise duration also was associated with worsening sleep-disordered breathing, as measured by the apnea-hypopnea index (ß=2.368, P=.048). Adjustment for body mass index attenuated these effects. CONCLUSIONS: Exercise is associated with a reduced incidence of mild and moderate sleep-disordered breathing, and decreasing exercise is associated with worsening of sleep-disordered breathing. The effect of exercise on sleep-disordered breathing appears to be largely, but perhaps not entirely, mediated by changes in body habitus.