Elevated blood pressure is a major risk factor for cardiovascular morbidity and mortality. Increased risk begins in the prehypertensive range and increases further with higher pressures. The strenuous duties of emergency responders (firefighters, police officers, and emergency medical services (EMS) personnel) can interact with their personal risk profiles, including elevated blood pressure, to precipitate acute cardiovascular events. Approximately three-quarters of emergency responders have prehypertension or hypertension, a proportion which is expected to increase, based on the obesity epidemic. Elevated blood pressure is also inadequately controlled in these professionals and strongly linked to cardiovascular disease morbidity and mortality. Notably, the majority of incident cardiovascular disease events occur in responders who are initially prehypertensive or only mildly hypertensive and whose average premorbid blood pressures are in the range in which many physicians would hesitate to prescribe medications (140-146/88-92). Laws mandating public benefits for emergency responders with cardiovascular disease provide an additional rationale for aggressively controlling their blood pressure. This review provides a background on emergency responders, summarizes occupational risk factors for hypertension and the metabolic syndrome, their prevalence of elevated blood pressure, and evidence linking hypertension with adverse outcomes in these professions. Next, discrepancies between relatively outdated medical standards for emergency responders and current, evidence-based guidelines for blood pressure management in the general public are highlighted. Finally, a workplace-oriented approach for blood pressure control among emergency responders is proposed, based on the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.

Obstructive sleep apnea (OSA), a syndrome defined by breathing abnormalities during sleep, can lead to fatigue and excessive daytime sleepiness (EDS) with an increased risk of motor vehicle crashes. Identifying commercial motor vehicle operators with unrecognized OSA is a major public health priority. Portable monitors (PMs) are being actively marketed to trucking firms as potentially lower-cost and more accessible alternatives to the reference standard of in-laboratory polysomnography (PSG) in the diagnosis of OSA among commercial motor vehicle operators. Several factors regarding PMs remain uncertain in this unique patient population: their sensitivity and specificity; the cost-benefit ratio of the PMs versus PSG; potential barriers from human factors; and evolving technologic advancement. Human factors that alter test accuracy are a major concern among commercial drivers motivated to gain/maintain employment. Current available data using PMs as a diagnostic tool among CMV operators indicate relatively high data loss and high loss to follow-up. Loss to follow-up has also been an issue using PSG in commercial motor vehicle operators. Furthermore, PM testing and PM results interpretation protocols may have no sleep specialist oversight, and sometimes minimal physician oversight and involvement. Additional studies comparing unattended and unmonitored PMs directly against full in-laboratory PSG are needed to provide evidence for their efficacy among commercial motor vehicle operators.

Objective Psychomotor vigilance testing (PVT) rapidly assesses attention, reaction time (RT) and abnormal vigilance. Thus, PVT may be an adjunct to screening drivers for high risk obstructive sleep apnea (OSA)/excess daytime sleepiness (EDS). Methods Commercial drivers and emergency responders undergoing occupational examinations took a 10-minute PVT and were instructed to achieve their fastest possible RTs. Participants with maximum RT >5 seconds or ≥2 “super lapses” (RT ≥1000ms) were categorized as “microsleepers”. Results Among 193 male participants, the 15 microsleepers (8%) were significantly more obese, but not different on age or Epworth Sleepiness Score. Time of day had no effect on RT. Conclusion PVT is suitable to occupational clinics and can identify otherwise unrecognized, impaired vigilance. Further studies must validate the PVT abnormalities most predictive of OSA/EDS and vehicular crashes, compared to adiposity measures alone.

Objective: To examine the potential long-term impact of restless legs syndrome (RLS) and other common sleep complaints on subsequent physical function (PF), we conducted a longitudinal analysis of 12,556 men in the Health Professionals Follow-up Study. Results: The participants with RLS at baseline had significantly lower PF-10 score 6 years later than those without RLS (mean difference 5 22.32, p 5 0.01), after adjusting for potential confounders. The magnitude of difference in PF-10 score for RLS symptoms $15 times/month vs no RLS was more than that of a 5-year increase of age or moderate amount of smoking. Having daily daytime sleepiness and sleep duration $9 hours/day were associated with lower mean PF value than not having these symptoms (p , 0.05 for both). MethodsConclusions: RLS and other sleep complaints are associated with lower PF. Our findings need to be replicated by more longitudinal studies including women and populations of other social and cultural backgrounds. It is important to understand whether RLS is an independent risk factor or a marker for other unknown risk factors for disability. Restless legs syndrome (RLS), also known as Ekbom syndrome, is characterized by a strong, nearly irresistible, urge to move the legs, resulting in marked sleep disturbances. RLS can present with a wide range of severity. Severe RLS is known to be associated with sleep fragmentation, depression, anxiety, obesity, obstructive sleep apnea (OSA), cardiovascular diseases, diabetes, erectile dysfunction, and end-stage renal disease (ESRD).1-3 Individuals with RLS may also have difficulties in job performance and participating in social activities. 2,4The association of RLS and health-related quality of life (HRQOL) has been shown previously.5-9 However, there has been a lack of longitudinal data showing the long-term association of RLS with the individual's physical function (PF) in activities of daily living (ADLs). Our objective was to characterize the longitudinal association of RLS on PF and juxtapose its impact with those of other common diseases, such as hypertension, myocardial infarction (MI), anxiety, and depression. This is a large population-based long-term observational study on individuals' PF, which reflects an individual's ability to live independently and is a validated marker for