Sleeping tablet consumption, self reported quality of sleep, and working conditions. Group of Occupational Physicians of APSAT.

STUDY OBJECTIVE: The aim was to assess the frequency of sleep disorders in relation to working conditions. DESIGN: This was a cross sectional study. Data were collected prospectively, on a standardised form, by 13 occupational physicians. The quality of sleep was assessed by self perceived sleep disturbances and consumption of sleeping tablets. Working conditions were described by the worksite physician as well as by the participants. SETTING: 2769 small or medium sized firms in the Paris area. PARTICIPANTS: A random sample of 7629 wage earners was studied. Among the participants, 61% were men and 39% women; 44% were blue collar workers. MAIN RESULTS: The prevalence of sleeping tablet consumption was 6.1% and 11.3% respectively for men and women. Sixteen percent of men and 26% of women stated that they had sleep disturbances (p < 0.001). In both sexes, drug consumption and sleep disturbances increased with age and were highest among individuals aged 55 years and more. No association between working conditions (exposure to noise, assembly line working, or physical workload) and sleep disturbances or drug consumption was found. Sleeping tablet consumption was higher among subjects reporting a bad atmosphere at work; the same was true for men with little interest in their job and for women working under time pressure. For both sexes, subjects reporting any of these conditions were more likely to report sleep disturbances. CONCLUSIONS: A high prevalence of self reported sleep problems and related drug consumption was observed. Physical working conditions were not related to the quality of sleep in contrast to perceived job conditions. The results suggest that sleep quality might be a useful health indicator for the occupational physician.

Length of occupational noise exposure and blood pressure.

A cross-sectional study was performed in the Paris area, with a total of 7901 subjects; 432 of them were exposed to occupational noise greater than or equal to 85 dBA. Noise was measured by the worksite physicians, and length of exposure was collected through interview. The subjects exposed to noise were mainly workers, their body mass index was higher and their job characteristics different from the other subjects, assembly line, shift-work and job under time pressure being more frequent. Blood pressure (BP) was higher among the exposed subjects; this was no longer the case after adjustment for age, body mass index and alcohol intake. Taking length of exposure into account, BP and the prevalence of hypertension increased for durations greater than or equal to 25 years. This relationship was still significant after adjustment for age, body mass index and alcohol intake. These results suggest that a long occupational noise exposure is a risk factor for high blood pressure.

[Sleep and hypertension. An epidemiologic study in 7,901 workers]. / Sommeil et hypertension artérielle. Une étude épidémiologique chez 7,901 salariés.

In order to evaluate possible correlations between blood pressure levels and sleep quality, 7,901 workers of both sexes living in Paris area have been the subject of a survey during their annual examination performed by workside physicians. The enquiry included questions related to sleep quantity and quality, sleeping pills consumption, awakenings, nightmares, snoring, way of life and working conditions. The information concerning these parameters was available for 7,542 people. Among them, 6,551 (86.9%) did not suffer from high blood pressure (HBP) (blood pressure less than 160/95 mmHg), 618 (8.2%) presented a high blood pressure but were not treated, 371 (4.9%) received a treatment against HBP. The average sleep duration is about 7.4 h (S.D. = 1.0) for men and about 7.6 h (S.D. = 1.0) for women (less than 0.001). It is significatively and negatively correlated with the systolic blood pressure level (SBP) (less than 0.001) and the diastolic blood pressure level (DBP) (less than 0.001). The frequency of patients complaining of nightly awakening and of snoring significatively increase with SBP (p less than 0.05) and DBP (p less than 0.001). The observed association between DBP (but not SBP) and sleep duration and nightly awakening remains significant in multivariate analysis including age, sex, tobacco smoking, alcohol and coffee consumption, use of sleeping pills and hypotensive treatment, as well as the negative correlation between SBP and nightmare frequency. The correlation between SBP or SBP and snoring was no more significant. In conclusion, a significant correlation has been found between the blood pressure levels and the sleep quality whose clinical consequences remain to be explored.(ABSTRACT TRUNCATED AT 250 WORDS)

[Methods and results of arterial hypertension control in a working population]. / Modalités et résultats de la prise en charge de l'hypertension artérielle dans une population de salariés.

The health benefits of hypertension treatment at the community level depend both of the quality of the blood pressure control obtained for each patient treated individually and of the percentage of the hypertensive patients actually aware, treated and controlled for hypertension in the entire population. The data collected in 1987 in a group of 7,901 subjects working in medium-sized companies of the Paris region were analysed, and compared with those obtained in a very comparable population in 1979-80. Among patients aware of their disease, the percentage of treated patients was higher in 1987 than in 1979, 55 p. 100 and 46 p. 100 respectively in men (p less than 0.001); 70 p. 100 in 87, 59 p. 100 in 79 for women (p less than 0.01). Hypertension was treated and controlled in 27 p. 100 of the men (16 p. 100 in 1979), and 42 p. 100 of women (27 p. 100 in 1979). Awareness was significantly lower among migrant workers than among european personnel (p less than 0.001). The lower the educational level, the lower the compliance with antihypertensive treatment, ranging from 99 p. 100 for the highest educational level, to 82 p. 100 among low educated subjects (p less than 0.001). The hospitalization rate did not differ according to sociocultural factors. Hypertension was detected by the worksite physician in 51 p. 100 of the male hypertensive patients. He was the sole physician who examined 17 p. 100 of the patients in the previous year. These results suggest a moderate improvement in hypertension detection and control. However, development of intervention strategies and their evaluation are clearly needed.

Alcohol consumption and impaired glycoregulation results in a population of 6665 salaried employees.

Alcohol consumption and glycosuria were found to be associated (p less than 0.001) in a population of 6571 salaried employees who underwent a systematic examination. The prevalence of glycosuria was found to range from 1.3% among 2609 non-drinkers to 5% among 816 heavy drinkers (six glasses or more of alcoholic beverage daily). This association was still significant after adjustment for age, sex and body mass index. Similarly, a positive association was observed between fasting glycemia and alcoholic intake in a subgroup of 998 subjects when such a result was available (p less than 0.05).

Relationship between alcohol consumption and hypertension prevalence and control in a French population.

Six thousand six hundred thirty two subjects, employed in 420 small and medium-sized companies in the Paris region were examined in a cross-sectional study. Their alcohol consumption, as obtained by interview was found to be higher among males than among females, among workers than among managers, executives, and clerks. Alcohol consumption was positively associated with age, body mass index, coffee and cigarette consumption, occupational exposure to noise and working nights or alternating shifts. A positive, continuous, relationship was observed, for men and women, between alcohol intake and both systolic and diastolic blood pressure. This association was highly significant in the multivariate analysis (multiple linear regression) where alcohol intake, following age and body mass index, was the third predictive factor of blood pressure level in the stepwise regression. The positive association between alcohol consumption and prevalence of arterial hypertension was aggravated by the poor control of hypertension which was found among drinkers. Awareness of hypertension, compliance with an antihypertensive treatment and its efficacy, were negatively associated with alcohol intake. The findings stress the importance of alcohol consumption which was found to be a major risk factor for arterial hypertension and noncompliance with antihypertensive treatment in this population.

[Alcohol consumption and treatment of hypertension. Results of an occupational medicine survey]. / Consommation d'alcool et traitement de l'hypertension artérielle. Résultats d'une enquête en médecine du travail.

The results of a cross-sectional study were analysed in order to assess the therapeutic control of hypertension in relation to alcohol consumption. 6,665 subjects, employed in small and medium-sized companies of the Paris region were examined in a cross sectionnal study. Among the 1,008 hypertensive subjects, awareness of hypertension decreased with increasing alcohol consumption, from 72% among the 304 non-drinkers to 59% among the 201 heavy drinkers (six glasses/day and more) (p less than 0.05). Similarly, the percentage of subjects under current antihypertensive medication on the day of examination was lower in heavy drinkers, 19%, than among tetotalers, 42% (p less than 0.001). An antihypertensive treatment had been prescribed to 510 subjects. Among them, compliance, as stated by the interview, decreased with increasing alcohol consumption, from 70% to 34% (p less than 0.001). Using a logistic regression, the adjusted relative risk of non-compliance among heavy drinkers (6 glasses/day or more) was found to be 1.9. Among the 344 subjects under antihypertensive treatment on the day of examination, systolic and diastolic blood pressure were higher among heavy drinkers, 167/102 mmHg, than among teetotallers, 154/95 mmHg (p less than 0.01 both). The relative hypertension awareness, treatment and control status was thus poorer among, moderate and heavy drinkers than among the light and non-drinkers (table I). (Table: see text). The importance of the problem of alcoholism is thus emphasized, in both the fields of hypertension prevalence and control.

[Occupational exposure to noise, hearing loss and arterial hypertension]. / Exposition professionnelle au bruit, déficit auditif et hypertension artérielle.

Clinical examinations and audiograms were conducted in a group of 249 men working in a foundry of the Paris area. Before and after adjustment for age, systolic blood pressure levels were positively associated with the duration of the occupational exposure to a noise greater than 85 dBA: 127.8 mmHg in the non-exposed group, 128.6 mmHg when the exposure lasted less than 10 years, 130.1 mmHg from 10 to 19 years, and 140.1 mmHg over 20 years (p less than 0.001). The odds-ratio of arterial hypertension associated with an occupational exposure over 20 years was 1.6 (p less than 0.05). There was no relationship between noise-induced hearing loss and blood pressure levels. These results suggest that there may be a population at increased risk of high blood pressure. However, the causal relationship between noise exposure and high blood pressure should be confirmed.

Influence of educational and sociocultural factors on hypertension care.

The influence of occupational category (OC) on the prevalence of hypertension (HT) and cardiovascular risk factors and on their management was studied in Paris in a general population and in a series of patients followed up in two university hospital hypertension clinics. Three OCs were defined as follows: high executives and members of liberal professions middle executives and clerks and manual workers. In the general population, the prevalence of HT was positively associated with OC, and ranged from 12.8% (1) to 19.3% (3). Body Mass Index (BMI) and tobacco and alcohol consumption were higher in category 3. Exposure to noise and assembly-line work raised blood pressure. Of the hypertensive subjects, 60% were aware of their illness, independently of OC, but the percentage of treated hypertensive subjects at examination and their compliance with treatment were significantly and negatively correlated with OC. In the hypertension departments, more category 1 and 2 patients were examined than expected for a theoretical French population of similar sex, age and geographical distribution. By contrast, clerks and manual workers were under-represented. BMI was higher in OC 3 than in OC 1, in both sexes. Cigarette consumption was higher in OC 1 than in OC 3 in males only. Permanent teaching staff members examined more people from OC 1 than the other physicians did. Drop-out rates at 1, 2 and 3 years were higher in OC 3 than OC 1. The problems of compliance with antihypertensive treatment were more frequent in OC 3 patients than in those in the other categories.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of socioprofessional conditions on blood pressure levels and hypertension control. Epidemiologic study of 6,665 subjects in the Paris district.

A total of 6,665 subjects (3,896 men and 2,769 women) employed by small and medium-sized companies in the Paris region were examined. Mean systolic blood pressure (SBP) was significantly higher in the lowest than in the highest occupational categories (p less than 0.001), even when results were adjusted for age (p less than 0.001) and body mass index (p less than 0.001). Diastolic blood pressure (DBP) differed among the occupational categories (p less than 0.001); the differences were still significant after adjustment for age but not for body mass index, suggesting that the latter might be partly responsible for the differences in DBP. Prevalence of hypertension was 14.7% and was negatively associated with a high occupational category (p less than 0.001). Multivariate analysis confirmed the influence of occupational category on SBP (p less than 0.001). Exposure to noise at work and assembly line work were associated with high SBP (p less than 0.01 for both). Of the subjects with detected hypertension, 65.6% were aware of their illness, and 35.3% were undergoing treatment. Both the percentage of treated patients and compliance with treatment were positively associated with occupational category (p less than 0.01 in both cases). Among women, SBP of treated hypertensives was higher in the lowest than in the highest occupational categories (p less than 0.05). It is suggested that the differences in blood pressure levels observed among occupational categories are partly due to working conditions, and that poor compliance with treatment among the low occupational categories enhances these differences.

Relation between coffee drinking and blood pressure: analysis of 6,321 subjects in the Paris region.

The possible link between coffee drinking and blood pressure (BP) was studied in a cross-sectional epidemiologic survey of 6,321 adults in the Paris region. Systolic and diastolic BP levels were higher among the 5,430 coffee drinkers than among the 891 nondrinkers (p less than 0.001 and p less than 0.01). BP levels adjusted for age by covariance analysis increased gradually from the non-coffee consumption category (125.6/79.8 +/- 15.0/10.5 mm Hg [mean +/- standard deviation]) to the highest consumption category (greater than or equal to 5 cups/day) (128.1/80.6 +/- 15.6/10.2 mm Hg) (p less than 0.001 for systolic BP and p less than 0.002 for diastolic BP). The positive association between coffee consumption and systolic, but not diastolic, BP remained significant in a multivariate analysis after controlling for age, sex, body mass index, alcohol consumption, tobacco consumption and socioeconomic category (p less than 0.02 for systolic BP and p = 0.16 for diastolic BP). It is concluded that coffee consumption is a significant but not strong contributor to the variation in BP levels.