Workplace Accidents, Absenteeism and Productivity in Patients With Sleep Apnea

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array:2 [ "paginaInicial" => "213" "paginaFinal" => "218" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Bernabé Jurado-Gámez, Ottavia Guglielmi, Francisco Gude, Gualberto Buela-Casal" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Bernabé" "apellidos" => "Jurado-Gámez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "nombre" => "Ottavia" "apellidos" => "Guglielmi" "email" => array:2 [ 0 => "ottavia@ugr.es" 1 => "ottavia.guglielmi@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Francisco" "apellidos" => "Gude" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Gualberto" "apellidos" => "Buela-Casal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad del Sueño, UGC Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Laboratorio de Psicofisiología, Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Facultad de Psicología, Universidad de Granada, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Unidad de Epidemiologia Clínica, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Accidentes laborales, absentismo y productividad en pacientes con apneas del sueño" ] ] "textoCompleto" => "IntroductionObstructive sleep apnea-hypopnea syndrome (OSAHS) is a very common respiratory disorder in industrialized societies, and occurs in 24% of men and 9% of women in middle age.<a class="elsevierStyleCrossRef" href="#bib0190">1</a> It consists of repeated episodes of limited airflow or airflow blockage during sleep causing micro-awakenings and intermittent hypoxemia. It has a serious impact on health,<a class="elsevierStyleCrossRef" href="#bib0195">2</a> causing hypertension<a class="elsevierStyleCrossRef" href="#bib0200">3</a> and cardiovascular disease.<a class="elsevierStyleCrossRefs" href="#bib0205">4,5</a>OSAHS patients often present significant cognitive limitations<a class="elsevierStyleCrossRef" href="#bib0215">6</a> and a generally poorer quality of life.<a class="elsevierStyleCrossRef" href="#bib0220">7</a> Obesity and poor quality of rest, which are often seen with this disorder, are associated with mood disorders such as anxiety and depression.<a class="elsevierStyleCrossRef" href="#bib0225">8</a> However, one of the most debilitating symptoms of this syndrome is excessive daytime sleepiness. Tiredness, together with loss of alertness and attention deficit, not only makes it difficult for OSAHS patients to function on a daily basis, but also contributes to a general increase in mortality, due to the increased risk of road traffic accidents.<a class="elsevierStyleCrossRef" href="#bib0230">9</a>Only 5%–9% of patients with OSAHS are diagnosed<a class="elsevierStyleCrossRef" href="#bib0235">10</a> and the burden on public health services in Western societies is considerable.<a class="elsevierStyleCrossRef" href="#bib0240">11</a> Moreover, OSAHS involves indirect costs that are very difficult to calculate, such as limited ability to work, accidents at work, and loss of productivity.<a class="elsevierStyleCrossRef" href="#bib0245">12</a>Some studies have evaluated work performance in patients with OSAHS, but results have been disputed. The syndrome has been shown to have a negative impact on patients’ ability to concentrate, to organize time, to learn new tasks and to carry out monotonous tasks.<a class="elsevierStyleCrossRefs" href="#bib0250">13,14</a> Another study found that OSAHS, when associated with excessive daytime sleepiness, was detrimental to work performance.<a class="elsevierStyleCrossRefs" href="#bib0260">15,16</a> Despite some methodological limitations, cohort studies have found a higher rate of absenteeism in patients with symptoms of OSAHS.<a class="elsevierStyleCrossRefs" href="#bib0270">17,18</a> However, no solid conclusions have been drawn regarding the relationship between OSAHS and absenteeism.<a class="elsevierStyleCrossRef" href="#bib0280">19</a>Some authors have reported a relationship between OSAHS symptoms and increased risk of work-related accidents. In a prospective study, Lindberg et al.<a class="elsevierStyleCrossRef" href="#bib0285">20</a> showed a 2-fold increase in the risk of workplace accidents in patients who snored and who had daytime sleepiness vs patients without those symptoms. Other large population studies,<a class="elsevierStyleCrossRef" href="#bib0290">21</a> including professional drivers<a class="elsevierStyleCrossRefs" href="#bib0295">22,23</a> or rural workers,<a class="elsevierStyleCrossRef" href="#bib0305">24</a> found that some OSAHS symptoms, such as snoring, sleep apneas or daytime sleepiness, evaluated by direct questioning or questionnaires, were associated with a greater risk of accidents in the workplace. However, very few studies have evaluated the rate of work-related accidents in patients with a definitive diagnosis of OSAHS.In view of the lack of consensus between studies investigating productivity and work accidents in patients with OSAHS, we designed a cross-sectional, descriptive ex postfacto study of productivity and work accidents in a sample of OSAHS patients vs a group of non-OSAHS individuals. A sleep study was performed in both the clinical group and the control group using the gold standard test, polysomnography. The study hypothesis was that participants in the clinical group would have a higher rate of work-related accidents and absenteeism than the control group, and that OSAHS patients would have poorer productivity than healthy subjects. This article was written following the Hartley guidelines.<a class="elsevierStyleCrossRef" href="#bib0310">25</a>MethodsData for this study were collected between 2010 and 2012 in 2 sleep units in hospitals in the north and in the south of Spain. The sample comprised 259 individuals who attended the sleep unit and underwent consecutive polysomnography studies. Participants were actively employed or had been unemployed for up to 6 months. All participants signed informed consent; only 6 individuals refused to take part in the study. Of the remaining 253 subjects, 204 were men and 49 were women, with ages ranging from 22 to 65 years, mean 46.85±9.5 years. The clinical group consisted of 182 patients with a diagnosis of OSAHS, and 71 non-OSAHS subjects were included in the control group. Patients with a diagnosis of other sleep disorders, serious debilitating diseases, alcohol or other drug addictions, or who were receiving treatment with neuroleptics, tranquilizers or other medications that could alter sleep or cause excessive daytime sleepiness, were excluded.InstrumentsSociodemographic data, general health and working conditions, such as work schedule, number of hours worked, shift work and type of employment contract, were collected by means of a questionnaire completed by all participants. Excessive daytime sleepiness was evaluated on the Epworth sleepiness scale (ESS)<a class="elsevierStyleCrossRef" href="#bib0315">26</a> and the subjective Pittsburgh Sleep Quality Index (PSQI).<a class="elsevierStyleCrossRef" href="#bib0320">27</a> Emotional disorders were evaluated using the Hospital Anxiety and Depression Scale (HADS).<a class="elsevierStyleCrossRef" href="#bib0325">28</a> The sum of the 2 subscales was considered, and a cut-off point of 14 was used to determine psychological distress. The survey included questions aimed at evaluating the number of days of sick leave and the number of work-related accidents in the last 18 months. Impact of disease on productivity was evaluated on the IMPALA scale,<a class="elsevierStyleCrossRef" href="#bib0330">29</a> consisting of 7 items addressing different aspects of the occupational impact of health problems, such as difficulty in following routine work schedules, in working without rest breaks, in avoiding mistakes, and in meeting deadlines. The response scale ranges from 1 (work affected constantly or for most of the time) to 4 (no impact at any time). The total transformed scale was scored from 0 (poorest productivity possible) to 100 (maximum productivity).ProcedureOSAHS was diagnosed from a complete sleep study with conventional polysomnography. The same methodology was used in both clinics: 3 electroencephalogram channels (F4-M1, C4-M1 and O2-M1), 2 electrooculogram channels, 2 electromyography channels placed under the chin, 1 placed on the anterior tibialis of each leg, and 1 electrocardiogram channel. SaO2, pulse and snoring rate were also analyzed. Airflow was measured using a pressure catheter and a thermistor, and chest and abdominal movements were recorded with elastic belts. Sleep studies were analyzed manually by specialists, according to the recommendations of the American Academy of Sleep Medicine.<a class="elsevierStyleCrossRef" href="#bib0335">30</a> SAHS diagnosis was determined using the apnea-hypopnea index (AHI). Any patient with a score ≥5 was considered to have OSAHS. Study participants completed the questionnaire just before beginning their sleep study.Educational levels were divided into 5 categories (no studies, primary, secondary, technical, and university studies). Types of occupation were classified according to the International Standard Classification of Occupations (ISCO-08)<a class="elsevierStyleCrossRef" href="#bib0340">31</a> and divided into 10 groups of professions. The presence of other diseases, such as hypertension, diabetes, hypercholesterolemia, and cardiovascular, pulmonary, endocrine and/or neurological diseases, was evaluated in some of the questionnaire items. Co-morbidity was defined as the presence of at least 1 of the above-mentioned diseases. Participants were also asked about their smoking and drinking habits and use of medications. Somatic symptoms of stress were defined as manifestation of at least 1 symptom, such as stomachache, headache, pain or chest tightness, breathlessness or muscle tension. Since the number of days missed from work due to illness did not show a normal distribution, this item was transformed into a qualitative variable. To do this, absenteeism was defined as the number of periods of leave due to illness lasting 30 days or longer in the previous year.Sample characteristics were expressed as mean and standard deviation. The Pearson chi-squared test was used to compare the clinical group vs the control group for work-related accidents and absenteeism rates, while the Student's t-test was used to measure the impact of the disease on productivity. All comparisons were two-tailed, with values of P<.05 being taken as significant. To analyze the influence of diagnostic variables and OSAHS symptoms on the incidence of work-related accidents and absenteeism, a logistic regression analysis was used and data were presented as odds ratios (OR) with 95% confidence intervals (CI). A linear regression model was used to analyze the influence of the study variables on productivity. All tests were performed using SPSS 20.0 statistical software.The project was approved by the Clinical Research Ethics Committee of the healthcare areas that participated in the study. Inclusion in the study was fully voluntary, and patients were duly informed about the objectives and signed informed consent.ResultsThe characteristics of the 253 study participants, classified according to diagnosis of OSAHS (n=182; AHI=42.6±28.4) or absence of OSAHS (n=71; AHI=2.1±1.7), are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The only differences between the OSAHS group and the control group lay in the distribution of sex, BMI and some of the job categories, such as scientific or intellectual professions. The type of working schedule was similar in both study groups. Patients with OSAHS were more frequently hypertensive and had a higher degree of psychological distress than the non-OSAHS control group.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of participants with OSAHS and their assessment of daytime sleepiness and perceived quality of sleep. Patients with OSAHS had more excessive daytime sleepiness than the control group (P=.021), but Pittsburgh scores for poor quality of sleep were similar in both groups (P=.238).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> compares repercussions in the workplace between the OSAHS group and the control group. Both groups had similar rates of work-related accidents, but it is interesting to observe that patients with OSAHS had a significantly higher rate of absenteeism and poorer productivity.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>A logistic regression model was constructed that included at least age, sex, excessive daytime sleepiness, subjective quality of sleep, and OSAHS or control subject. The only variables of interest when evaluating workplace accidents were use of medications, physically stressful work, and social level; the model produced an adjusted R2 of 0.126 (P=.001), and the only variable that showed an independent association with workplace accidents was physically stressful work (OR=0.347; CI: 0.167–0.718; P=.004). With respect to absenteeism, significant variables were: OSAHS or control group subject, and subjective quality of sleep (adjusted R2=0.045; P=.048). Notwithstanding, the only factor with an independent influence on work absenteeism was OSAHS subject (OR=2.718; CI: 1.004–7.356; P=.049). A linear regression model was used for productivity, and the variables accepted by the model were age, subjective quality of sleep, psychological distress, OSAHS or control subject and AHI. The model showed an adjusted R2 of 0.133, F=7.412 (P=.000), and there was an independent association between productivity and a diagnosis of OSAHS (β coefficient=0.251; P=.002) and psychological distress (β coefficient=−0.249; P=.001).DiscussionThis study found that patients with OSAHS did not have a significantly higher number of work-related accidents, although, compared to the non-OSAHS group, they did have a higher percentage of long-term absenteeism, lower productivity levels, and a high rate of psychological distress. These findings are significant, and confirm that OSAHS is a disease with considerable social and economic repercussions.The multivariate analysis corroborated the finding that patients with OSAHS had a lower level of productivity. This result was previously reported by Swanson et al.<a class="elsevierStyleCrossRef" href="#bib0345">32</a> who used an OSAHS symptom questionnaire to show that individuals with a high risk of suffering this disease had problems concentrating and organizing themselves at work, in addition to a loss of productivity. Similarly, Grunstein et al.<a class="elsevierStyleCrossRef" href="#bib0350">33</a> reported that sleepiness associated with the risk of sleep-disordered breathing was the main factor in loss of productivity and performance, although the sample was composed of obese individuals who were consequently more likely to present other sleep disorders associated with obesity. Nena et al.<a class="elsevierStyleCrossRef" href="#bib0355">34</a> using the Endicott productivity scale, did not find any relationship with severity of OSAHS or with sleep quality, although it should be borne in mind that their sample contained only patients with OSAHS. Thus, very few studies have investigated productivity in OSAHS patients compared to a control group using standardized questionnaires. Moreover, we found that psychological distress led to poorer productivity in patients with OSAHS. There is very little work on this aspect in the scientific literature.With regard to days off work due to illness, a greater rate of long-term absenteeism was found in OSAHS patients, in line with the findings of other authors. Sivertsen et al.<a class="elsevierStyleCrossRef" href="#bib0275">18</a> showed that subjects with OSAHS more often took periods of sick leave of longer than 8 weeks; other authors have also suggested that OSAHS is associated with a greater risk of taking sick leave and receiving a disability allowance.<a class="elsevierStyleCrossRef" href="#bib0270">17</a> Various studies have emphasized the importance of sleepiness as a determining factor for work absenteeism,<a class="elsevierStyleCrossRefs" href="#bib0275">18,32,35</a> although some of these have limitations. For example, Sivertsen et al.<a class="elsevierStyleCrossRefs" href="#bib0275">18,35</a> used the Karolinska sleep questionnaire, but did not perform an objective sleep study; Accattoli et al.<a class="elsevierStyleCrossRef" href="#bib0250">13</a> used only polygraph as their sleep study, and only evaluated work performance on the basis of some questions related to difficulties encountered at work.The number of work-related accidents in our patients was not significantly higher than in the control group. In line with this study, Karimi et al.<a class="elsevierStyleCrossRef" href="#bib0365">36</a> found similar work-related accident rates in OSAHS patients compared to healthy participants. In another setting, Accattoli et al.<a class="elsevierStyleCrossRef" href="#bib0250">13</a> compared the rate of work-related accidents in healthy workers to those with a diagnosis of OSAHS and found that administrative workers with severe OSAHS had a higher percentage of work-related accidents compared to controls in the same sector, but it must be emphasized that this group in general had a higher occupational accident rate than non-OSAHS workers in other areas. Workers with respiratory disorders were also found to have a greater risk of work-related accidents;<a class="elsevierStyleCrossRef" href="#bib0370">37</a> however subjects were classified on the basis of oximetry, a test that is not recommended for a clear diagnosis of OSAHS.To conclude, our study was conducted in a large cohort, using rigorous methodology with validated questionnaires for studying work productivity and perceived quality of sleep. Polysomnography was used as the reference test in sleep studies. The most relevant findings are the relationship of OSAHS with low work productivity, increased periods of sick leave lasting longer than 30 days, and a greater degree of psychological distress. These results have a clear application, which should be studied in clinical practices, and demonstrate the involvement of OSAHS in the working life of these patients.FundingThis study was possible thanks to funding from a Teaching and Research Personnel Training Grant from the Regional Government of Andalusia.Conflict of InterestsThe authors declare that they have no conflict of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres484701" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec506933" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres484700" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec506932" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Instruments" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Procedure" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of Interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-01-02" "fechaAceptado" => "2014-07-02" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec506933" "palabras" => array:4 [ 0 => "Obstructive sleep apnea-hypopnea syndrome" 1 => "Workplace accident" 2 => "Sick leave" 3 => "Productivity" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec506932" "palabras" => array:4 [ 0 => "Síndrome de apnea-hipopnea del sueño" 1 => "Accidentes laborales" 2 => "Días de baja" 3 => "Productividad laboral" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionObstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity. MethodOne hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results. ResultsPatients with OSAHS had more sick leave lasting longer than 30days (16.6% vs 7%, P=.049) and lower productivity (63.80% vs 83.20%, P=.000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P>.050). None of the OSAHS-related variables were associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity. ConclusionsOSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl síndrome de apneas-hipopneas del sueño (SAHS) provoca consecuencias sobre la salud, pero el impacto del SAHS sobre la salud laboral ha sido escasamente estudiado. El objetivo fue evaluar la influencia del SAHS en la presencia de accidentes laborales, absentismo y productividad laboral. MétodoUn total de 182 pacientes con SAHS y 71 personas sin SAHS contestaron a la escala de somnolencia de Epworth, el índice de calidad de sueño de Pittsburgh, el índice de impacto de la enfermedad en la productividad laboral y algunas preguntas sobre la frecuencia de accidentes laborales y el número de días de bajas laboral por enfermedad. Los participantes fueron clasificados mediante polisomnografía en un grupo con o sin SAHS. ResultadosLos pacientes con SAHS presentaron más bajas laborales > 30 días (16,6% vs 7%; p=0,049) y una menor productividad laboral (63,80% vs 83,20%; p=0,000) respecto a las personas sin SAHS, aunque la proporción de accidentes laborales fue similar (27,4% vs 25,4%; p>0,05). Ninguna de las variables asociadas al SAHS se relacionó con los accidentes laborales. Se evidenció una asociación entre el absentismo y el diagnóstico de SAHS, y entre este último, el distrés psicológico y la productividad laboral. ConclusionesEl SAHS provoca limitaciones en la vida laboral de los pacientes, con un número más elevado de bajas laborales y una menor productividad. El diagnóstico de SAHS fue la variable con mayor influencia en la vida laboral de los pacientes." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Jurado-Gámez B, Guglielmi O, Gude F, Buela-Casal G. Accidentes laborales, absentismo y productividad en pacientes con apneas del sueño. Arch Bronconeumol. 2015;51:213–218." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "BMI, body mass index; NA, not applicable; NS, not significant.Data are expressed as absolute numbers and percentages for qualitative variables and as mean±standard deviation for quantitative variables.Permission has been granted by the publisher, Elsevier B.V., for the reproduction of this table." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head " align="left" valign="top" scope="col">P \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAHS (No.=182) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls (No.=71) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47±9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46±10.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.263 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Sex, men, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">157 (86.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (66.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30.5±5.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.88±4.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Education, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.405 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Primary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (30.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (28.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Secondary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (23.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (21.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Technical training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (23.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (16.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">University studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (19.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (31.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Type of work, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Managers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Professionals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (20.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Technicians and associate professionals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (16.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (11.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Clerical support workers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Services and sales workers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (18.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (21.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Skilled agricultural, forestry and fishery workers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Craft and related trade workers \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Plant and machine operators \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (40.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (29) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Elementary occupations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (15.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Armed forces occupations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Working schedule, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.262 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Full time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 (54.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44 (62) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Part time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (31.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (25.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Shift work \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (13.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High alcohol consumption \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.595 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking habit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (12.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.120 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Comorbidities, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (27.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (14.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (6.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.474 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hyper-cholesterolemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (26.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.840 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.681 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Lung disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.136 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Endocrine disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.512 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neurological disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (4.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.551 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Habitual use of medications, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97 (53.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (45.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.208 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Psychological distress, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87 (48.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (32.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767370.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and Clinical Characteristics of Study Participants." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data are expressed as absolute numbers and percentages for qualitative variables and as mean±standard deviation for quantitative variables." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head " align="left" valign="top" scope="col">P \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAHS (No.=182) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control (No.=71) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Physically stressful work, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 (60.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (57.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.608 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Somatic symptom of stress, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (33.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (22.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.095 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Excessive daytime sleepiness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.3±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.55±4.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.021 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Subjective quality of sleep (Pittsburgh index) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.9±3.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.3±3.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.238 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767368.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Subjective and Objective Characteristics of Participants’ Sleepiness and Work." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Data are expressed as absolute numbers and percentages for qualitative variables and as mean±standard deviation for quantitative variables." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head " align="left" valign="top" scope="col">P \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAHS (No.=182) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control (No.=71) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Work-related accidents, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (27.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (25.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.745 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Absenteeism due to disease, number of sick leaves>30 days/year, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.049 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Impact of disease on work productivity (IMPALA scale) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63±33.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83±21.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab767369.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of Work-related Accidents, Absenteeism and Work Productivity of Subjects With and Without OSAHS." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0190" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. 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Original Article

Workplace Accidents, Absenteeism and Productivity in Patients With Sleep Apnea

Accidentes laborales, absentismo y productividad en pacientes con apneas del sueño

Bernabé Jurado-Gámeza,b, Ottavia Guglielmic,

Corresponding author

ottavia@ugr.es
ottavia.guglielmi@gmail.com

Corresponding author.

, Francisco Guded, Gualberto Buela-Casalc

a Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain

b Unidad del Sueño, UGC Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain

c Laboratorio de Psicofisiología, Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Facultad de Psicología, Universidad de Granada, Granada, Spain

d Unidad de Epidemiologia Clínica, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain

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        "titulo" => "Accidentes laborales&#44; absentismo y productividad en pacientes con apneas del sue&#241;o"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obstructive sleep apnea-hypopnea syndrome &#40;OSAHS&#41; is a very common respiratory disorder in industrialized societies&#44; and occurs in 24&#37; of men and 9&#37; of women in middle age&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a> It consists of repeated episodes of limited airflow or airflow blockage during sleep causing micro-awakenings and intermittent hypoxemia&#46; It has a serious impact on health&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">2</span></a> causing hypertension<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a> and cardiovascular disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">OSAHS patients often present significant cognitive limitations<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">6</span></a> and a generally poorer quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a> Obesity and poor quality of rest&#44; which are often seen with this disorder&#44; are associated with mood disorders such as anxiety and depression&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a> However&#44; one of the most debilitating symptoms of this syndrome is excessive daytime sleepiness&#46; Tiredness&#44; together with loss of alertness and attention deficit&#44; not only makes it difficult for OSAHS patients to function on a daily basis&#44; but also contributes to a general increase in mortality&#44; due to the increased risk of road traffic accidents&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Only 5&#37;&#8211;9&#37; of patients with OSAHS are diagnosed<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a> and the burden on public health services in Western societies is considerable&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a> Moreover&#44; OSAHS involves indirect costs that are very difficult to calculate&#44; such as limited ability to work&#44; accidents at work&#44; and loss of productivity&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Some studies have evaluated work performance in patients with OSAHS&#44; but results have been disputed&#46; The syndrome has been shown to have a negative impact on patients&#8217; ability to concentrate&#44; to organize time&#44; to learn new tasks and to carry out monotonous tasks&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">13&#44;14</span></a> Another study found that OSAHS&#44; when associated with excessive daytime sleepiness&#44; was detrimental to work performance&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">15&#44;16</span></a> Despite some methodological limitations&#44; cohort studies have found a higher rate of absenteeism in patients with symptoms of OSAHS&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">17&#44;18</span></a> However&#44; no solid conclusions have been drawn regarding the relationship between OSAHS and absenteeism&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Some authors have reported a relationship between OSAHS symptoms and increased risk of work-related accidents&#46; In a prospective study&#44; Lindberg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">20</span></a> showed a 2-fold increase in the risk of workplace accidents in patients who snored and who had daytime sleepiness vs patients without those symptoms&#46; Other large population studies&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a> including professional drivers<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">22&#44;23</span></a> or rural workers&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a> found that some OSAHS symptoms&#44; such as snoring&#44; sleep apneas or daytime sleepiness&#44; evaluated by direct questioning or questionnaires&#44; were associated with a greater risk of accidents in the workplace&#46; However&#44; very few studies have evaluated the rate of work-related accidents in patients with a definitive diagnosis of OSAHS&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In view of the lack of consensus between studies investigating productivity and work accidents in patients with OSAHS&#44; we designed a cross-sectional&#44; descriptive <span class="elsevierStyleItalic">ex postfacto</span> study of productivity and work accidents in a sample of OSAHS patients vs a group of non-OSAHS individuals&#46; A sleep study was performed in both the clinical group and the control group using the gold standard test&#44; polysomnography&#46; The study hypothesis was that participants in the clinical group would have a higher rate of work-related accidents and absenteeism than the control group&#44; and that OSAHS patients would have poorer productivity than healthy subjects&#46; This article was written following the Hartley guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">Data for this study were collected between 2010 and 2012 in 2 sleep units in hospitals in the north and in the south of Spain&#46; The sample comprised 259 individuals who attended the sleep unit and underwent consecutive polysomnography studies&#46; Participants were actively employed or had been unemployed for up to 6 months&#46; All participants signed informed consent&#59; only 6 individuals refused to take part in the study&#46; Of the remaining 253 subjects&#44; 204 were men and 49 were women&#44; with ages ranging from 22 to 65 years&#44; mean 46&#46;85&#177;9&#46;5 years&#46; The clinical group consisted of 182 patients with a diagnosis of OSAHS&#44; and 71 non-OSAHS subjects were included in the control group&#46; Patients with a diagnosis of other sleep disorders&#44; serious debilitating diseases&#44; alcohol or other drug addictions&#44; or who were receiving treatment with neuroleptics&#44; tranquilizers or other medications that could alter sleep or cause excessive daytime sleepiness&#44; were excluded&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Instruments</span><p id="par0040" class="elsevierStylePara elsevierViewall">Sociodemographic data&#44; general health and working conditions&#44; such as work schedule&#44; number of hours worked&#44; shift work and type of employment contract&#44; were collected by means of a questionnaire completed by all participants&#46; Excessive daytime sleepiness was evaluated on the Epworth sleepiness scale &#40;ESS&#41;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a> and the subjective Pittsburgh Sleep Quality Index &#40;PSQI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">27</span></a> Emotional disorders were evaluated using the Hospital Anxiety and Depression Scale &#40;HADS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">28</span></a> The sum of the 2 subscales was considered&#44; and a cut-off point of 14 was used to determine psychological distress&#46; The survey included questions aimed at evaluating the number of days of sick leave and the number of work-related accidents in the last 18 months&#46; Impact of disease on productivity was evaluated on the IMPALA scale&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">29</span></a> consisting of 7 items addressing different aspects of the occupational impact of health problems&#44; such as difficulty in following routine work schedules&#44; in working without rest breaks&#44; in avoiding mistakes&#44; and in meeting deadlines&#46; The response scale ranges from 1 &#40;work affected constantly or for most of the time&#41; to 4 &#40;no impact at any time&#41;&#46; The total transformed scale was scored from 0 &#40;poorest productivity possible&#41; to 100 &#40;maximum productivity&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Procedure</span><p id="par0045" class="elsevierStylePara elsevierViewall">OSAHS was diagnosed from a complete sleep study with conventional polysomnography&#46; The same methodology was used in both clinics&#58; 3 electroencephalogram channels &#40;F4-M1&#44; C4-M1 and O2-M1&#41;&#44; 2 electrooculogram channels&#44; 2 electromyography channels placed under the chin&#44; 1 placed on the anterior tibialis of each leg&#44; and 1 electrocardiogram channel&#46; SaO<span class="elsevierStyleInf">2</span>&#44; pulse and snoring rate were also analyzed&#46; Airflow was measured using a pressure catheter and a thermistor&#44; and chest and abdominal movements were recorded with elastic belts&#46; Sleep studies were analyzed manually by specialists&#44; according to the recommendations of the <span class="elsevierStyleItalic">American Academy of Sleep Medicine</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">30</span></a> SAHS diagnosis was determined using the apnea-hypopnea index &#40;AHI&#41;&#46; Any patient with a score &#8805;5 was considered to have OSAHS&#46; Study participants completed the questionnaire just before beginning their sleep study&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Educational levels were divided into 5 categories &#40;no studies&#44; primary&#44; secondary&#44; technical&#44; and university studies&#41;&#46; Types of occupation were classified according to the International Standard Classification of Occupations &#40;ISCO-08&#41;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">31</span></a> and divided into 10 groups of professions&#46; The presence of other diseases&#44; such as hypertension&#44; diabetes&#44; hypercholesterolemia&#44; and cardiovascular&#44; pulmonary&#44; endocrine and&#47;or neurological diseases&#44; was evaluated in some of the questionnaire items&#46; Co-morbidity was defined as the presence of at least 1 of the above-mentioned diseases&#46; Participants were also asked about their smoking and drinking habits and use of medications&#46; Somatic symptoms of stress were defined as manifestation of at least 1 symptom&#44; such as stomachache&#44; headache&#44; pain or chest tightness&#44; breathlessness or muscle tension&#46; Since the number of days missed from work due to illness did not show a normal distribution&#44; this item was transformed into a qualitative variable&#46; To do this&#44; absenteeism was defined as the number of periods of leave due to illness lasting 30 days or longer in the previous year&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Sample characteristics were expressed as mean and standard deviation&#46; The Pearson chi-squared test was used to compare the clinical group vs the control group for work-related accidents and absenteeism rates&#44; while the Student&#39;s <span class="elsevierStyleItalic">t</span>-test was used to measure the impact of the disease on productivity&#46; All comparisons were two-tailed&#44; with values of <span class="elsevierStyleItalic">P</span>&#60;&#46;05 being taken as significant&#46; To analyze the influence of diagnostic variables and OSAHS symptoms on the incidence of work-related accidents and absenteeism&#44; a logistic regression analysis was used and data were presented as odds ratios &#40;OR&#41; with 95&#37; confidence intervals &#40;CI&#41;&#46; A linear regression model was used to analyze the influence of the study variables on productivity&#46; All tests were performed using SPSS 20&#46;0 statistical software&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The project was approved by the Clinical Research Ethics Committee of the healthcare areas that participated in the study&#46; Inclusion in the study was fully voluntary&#44; and patients were duly informed about the objectives and signed informed consent&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The characteristics of the 253 study participants&#44; classified according to diagnosis of OSAHS &#40;n&#61;182&#59; AHI&#61;42&#46;6&#177;28&#46;4&#41; or absence of OSAHS &#40;n&#61;71&#59; AHI&#61;2&#46;1&#177;1&#46;7&#41;&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The only differences between the OSAHS group and the control group lay in the distribution of sex&#44; BMI and some of the job categories&#44; such as scientific or intellectual professions&#46; The type of working schedule was similar in both study groups&#46; Patients with OSAHS were more frequently hypertensive and had a higher degree of psychological distress than the non-OSAHS control group&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of participants with OSAHS and their assessment of daytime sleepiness and perceived quality of sleep&#46; Patients with OSAHS had more excessive daytime sleepiness than the control group &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;021&#41;&#44; but Pittsburgh scores for poor quality of sleep were similar in both groups &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;238&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> compares repercussions in the workplace between the OSAHS group and the control group&#46; Both groups had similar rates of work-related accidents&#44; but it is interesting to observe that patients with OSAHS had a significantly higher rate of absenteeism and poorer productivity&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">A logistic regression model was constructed that included at least age&#44; sex&#44; excessive daytime sleepiness&#44; subjective quality of sleep&#44; and OSAHS or control subject&#46; The only variables of interest when evaluating workplace accidents were use of medications&#44; physically stressful work&#44; and social level&#59; the model produced an adjusted <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> of 0&#46;126 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#44; and the only variable that showed an independent association with workplace accidents was physically stressful work &#40;OR&#61;0&#46;347&#59; CI&#58; 0&#46;167&#8211;0&#46;718&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;004&#41;&#46; With respect to absenteeism&#44; significant variables were&#58; OSAHS or control group subject&#44; and subjective quality of sleep &#40;adjusted <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#61;0&#46;045&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;048&#41;&#46; Notwithstanding&#44; the only factor with an independent influence on work absenteeism was OSAHS subject &#40;OR&#61;2&#46;718&#59; CI&#58; 1&#46;004&#8211;7&#46;356&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;049&#41;&#46; A linear regression model was used for productivity&#44; and the variables accepted by the model were age&#44; subjective quality of sleep&#44; psychological distress&#44; OSAHS or control subject and AHI&#46; The model showed an adjusted <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> of 0&#46;133&#44; <span class="elsevierStyleItalic">F</span>&#61;7&#46;412 &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;000&#41;&#44; and there was an independent association between productivity and a diagnosis of OSAHS &#40;<span class="elsevierStyleItalic">&#946;</span> coefficient&#61;0&#46;251&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41; and psychological distress &#40;<span class="elsevierStyleItalic">&#946;</span> coefficient&#61;&#8722;0&#46;249&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">This study found that patients with OSAHS did not have a significantly higher number of work-related accidents&#44; although&#44; compared to the non-OSAHS group&#44; they did have a higher percentage of long-term absenteeism&#44; lower productivity levels&#44; and a high rate of psychological distress&#46; These findings are significant&#44; and confirm that OSAHS is a disease with considerable social and economic repercussions&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The multivariate analysis corroborated the finding that patients with OSAHS had a lower level of productivity&#46; This result was previously reported by Swanson et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">32</span></a> who used an OSAHS symptom questionnaire to show that individuals with a high risk of suffering this disease had problems concentrating and organizing themselves at work&#44; in addition to a loss of productivity&#46; Similarly&#44; Grunstein et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> reported that sleepiness associated with the risk of sleep-disordered breathing was the main factor in loss of productivity and performance&#44; although the sample was composed of obese individuals who were consequently more likely to present other sleep disorders associated with obesity&#46; Nena et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a> using the Endicott productivity scale&#44; did not find any relationship with severity of OSAHS or with sleep quality&#44; although it should be borne in mind that their sample contained only patients with OSAHS&#46; Thus&#44; very few studies have investigated productivity in OSAHS patients compared to a control group using standardized questionnaires&#46; Moreover&#44; we found that psychological distress led to poorer productivity in patients with OSAHS&#46; There is very little work on this aspect in the scientific literature&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">With regard to days off work due to illness&#44; a greater rate of long-term absenteeism was found in OSAHS patients&#44; in line with the findings of other authors&#46; Sivertsen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a> showed that subjects with OSAHS more often took periods of sick leave of longer than 8 weeks&#59; other authors have also suggested that OSAHS is associated with a greater risk of taking sick leave and receiving a disability allowance&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a> Various studies have emphasized the importance of sleepiness as a determining factor for work absenteeism&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">18&#44;32&#44;35</span></a> although some of these have limitations&#46; For example&#44; Sivertsen et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">18&#44;35</span></a> used the Karolinska sleep questionnaire&#44; but did not perform an objective sleep study&#59; Accattoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> used only polygraph as their sleep study&#44; and only evaluated work performance on the basis of some questions related to difficulties encountered at work&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The number of work-related accidents in our patients was not significantly higher than in the control group&#46; In line with this study&#44; Karimi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">36</span></a> found similar work-related accident rates in OSAHS patients compared to healthy participants&#46; In another setting&#44; Accattoli et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a> compared the rate of work-related accidents in healthy workers to those with a diagnosis of OSAHS and found that administrative workers with severe OSAHS had a higher percentage of work-related accidents compared to controls in the same sector&#44; but it must be emphasized that this group in general had a higher occupational accident rate than non-OSAHS workers in other areas&#46; Workers with respiratory disorders were also found to have a greater risk of work-related accidents&#59;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">37</span></a> however subjects were classified on the basis of oximetry&#44; a test that is not recommended for a clear diagnosis of OSAHS&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">To conclude&#44; our study was conducted in a large cohort&#44; using rigorous methodology with validated questionnaires for studying work productivity and perceived quality of sleep&#46; Polysomnography was used as the reference test in sleep studies&#46; The most relevant findings are the relationship of OSAHS with low work productivity&#44; increased periods of sick leave lasting longer than 30 days&#44; and a greater degree of psychological distress&#46; These results have a clear application&#44; which should be studied in clinical practices&#44; and demonstrate the involvement of OSAHS in the working life of these patients&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study was possible thanks to funding from a Teaching and Research Personnel Training Grant from the <span class="elsevierStyleGrantSponsor" id="gs1">Regional Government of Andalusia</span>&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of Interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Obstructive sleep apnea-hypopnea syndrome &#40;OSAHS&#41; has health-related outcomes&#44; but the impact of OSAHS on occupational health has been scarcely studied&#46; The aim of this study was to evaluate the effect of OSAHS on workplace accidents&#44; absenteeism and productivity&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale&#44; the Pittsburgh Sleep Quality Index and the Spanish IMPALA <span class="elsevierStyleItalic">&#40;Impact of Disease on Work Productivity&#41;</span> index and answered various questions on workplace accidents and sick leave&#46; Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Patients with OSAHS had more sick leave lasting longer than 30<span class="elsevierStyleHsp" style=""></span>days &#40;16&#46;6&#37; vs 7&#37;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;049&#41; and lower productivity &#40;63&#46;80&#37; vs 83&#46;20&#37;&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;000&#41; than subjects without OSAHS&#44; although the rate of workplace accidents was similar in both groups &#40;27&#46;4&#37; vs 25&#46;4&#37;&#59; <span class="elsevierStyleItalic">P</span>&#62;&#46;050&#41;&#46; None of the OSAHS-related variables were associated with workplace accidents&#46; A diagnosis of OSAHS was related with absenteeism&#46; Psychological distress and OSAHS were related with productivity&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity&#46; A diagnosis of OSAHS was the variable with most influence on the working lives of patients&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de apneas-hipopneas del sue&#241;o &#40;SAHS&#41; provoca consecuencias sobre la salud&#44; pero el impacto del SAHS sobre la salud laboral ha sido escasamente estudiado&#46; El objetivo fue evaluar la influencia del SAHS en la presencia de accidentes laborales&#44; absentismo y productividad laboral&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 182 pacientes con SAHS y 71 personas sin SAHS contestaron a la escala de somnolencia de Epworth&#44; el &#237;ndice de calidad de sue&#241;o de Pittsburgh&#44; el &#237;ndice de impacto de la enfermedad en la productividad laboral y algunas preguntas sobre la frecuencia de accidentes laborales y el n&#250;mero de d&#237;as de bajas laboral por enfermedad&#46; Los participantes fueron clasificados mediante polisomnograf&#237;a en un grupo con o sin SAHS&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con SAHS presentaron m&#225;s bajas laborales &#62; 30 d&#237;as &#40;16&#44;6&#37; vs 7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;049&#41; y una menor productividad laboral &#40;63&#44;80&#37; vs 83&#44;20&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; respecto a las personas sin SAHS&#44; aunque la proporci&#243;n de accidentes laborales fue similar &#40;27&#44;4&#37; vs 25&#44;4&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Ninguna de las variables asociadas al SAHS se relacion&#243; con los accidentes laborales&#46; Se evidenci&#243; una asociaci&#243;n entre el absentismo y el diagn&#243;stico de SAHS&#44; y entre este &#250;ltimo&#44; el distr&#233;s psicol&#243;gico y la productividad laboral&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El SAHS provoca limitaciones en la vida laboral de los pacientes&#44; con un n&#250;mero m&#225;s elevado de bajas laborales y una menor productividad&#46; El diagn&#243;stico de SAHS fue la variable con mayor influencia en la vida laboral de los pacientes&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Jurado-G&#225;mez B&#44; Guglielmi O&#44; Gude F&#44; Buela-Casal G&#46; Accidentes laborales&#44; absentismo y productividad en pacientes con apneas del sue&#241;o&#46; Arch Bronconeumol&#46; 2015&#59;51&#58;213&#8211;218&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; NA&#44; not applicable&#59; NS&#44; not significant&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as absolute numbers and percentages for qualitative variables and as mean&#177;standard deviation for quantitative variables&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Permission has been granted by the publisher&#44; Elsevier B&#46;V&#46;&#44; for the reproduction of this table&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAHS &#40;No&#46;&#61;182&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Controls &#40;No&#46;&#61;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#177;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#177;10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;263&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; men&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">157 &#40;86&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">BMI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#46;5&#177;5&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&#46;88&#177;4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Education&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;405&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55 &#40;30&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;23&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Technical training&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;23&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>University studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;19&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Type of work&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Managers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Professionals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;5&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;20&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Technicians and associate professionals&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;16&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;11&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clerical support workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Services and sales workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;18&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skilled agricultural&#44; forestry and fishery workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Craft and related trade workers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plant and machine operators&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;40&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Elementary occupations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;15&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Armed forces occupations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Working schedule&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Full time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98 &#40;54&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Part time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;31&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Shift work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High alcohol consumption&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;595&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking habit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;12&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;474&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyper-cholesterolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;840&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lung disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Endocrine disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;512&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurological disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;551&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Habitual use of medications&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;53&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;45&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;208&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Psychological distress&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">87 &#40;48&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;32&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#46;015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and Clinical Characteristics of Study Participants&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Data are expressed as absolute numbers and percentages for qualitative variables and as mean&#177;standard deviation for quantitative variables&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Group</th><th class="td" title="table-head  " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OSAHS &#40;No&#46;&#61;182&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control &#40;No&#46;&#61;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Physically stressful work&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99 &#40;60&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;608&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Somatic symptom of stress&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;33&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;22&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Excessive daytime sleepiness&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;3&#177;5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;55&#177;4&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Subjective quality of sleep &#40;Pittsburgh index&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;3&#177;3&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Work-related accidents&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;27&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;745&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Absenteeism due to disease&#44; number of sick leaves&#62;30 days&#47;year&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Impact of disease on work productivity &#40;IMPALA scale&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#177;33&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#177;21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison of Work-related Accidents&#44; Absenteeism and Work Productivity of Subjects With and Without OSAHS&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Dur&#225;n"
                            1 => "S&#46; Esnaola"
                            2 => "R&#46; Rubio"
                            3 => "A&#46; Iztueta"
                          ]
                        ]
                      ]
                    ]
                  ]
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  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914003760?idApp=UINPBA00003Z"
]

Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2014.12.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	1	3
2024 October	44	23	67
2024 September	52	16	68
2024 August	71	36	107
2024 July	48	22	70
2024 June	56	35	91
2024 May	56	34	90
2024 April	52	27	79
2024 March	48	17	65
2024 February	36	20	56
2023 March	12	5	17
2023 February	61	22	83
2023 January	31	26	57
2022 December	52	36	88
2022 November	68	21	89
2022 October	57	40	97
2022 September	22	31	53
2022 August	76	37	113
2022 July	50	29	79
2022 June	50	25	75
2022 May	67	31	98
2022 April	42	26	68
2022 March	62	45	107
2022 February	58	42	100
2022 January	44	23	67
2021 December	41	36	77
2021 November	37	34	71
2021 October	54	47	101
2021 September	36	45	81
2021 August	28	31	59
2021 July	26	33	59
2021 June	36	27	63
2021 May	51	32	83
2021 April	223	88	311
2021 March	90	29	119
2021 February	266	20	286
2021 January	56	14	70
2020 December	41	20	61
2020 November	39	18	57
2020 October	34	12	46
2020 September	26	14	40
2020 August	32	15	47
2020 July	37	20	57
2020 June	28	14	42
2020 May	36	15	51
2020 April	38	21	59
2020 March	29	15	44
2020 February	29	18	47
2020 January	52	17	69
2019 December	35	20	55
2019 November	41	26	67
2019 October	47	36	83
2019 September	54	17	71
2019 August	55	15	70
2019 July	44	21	65
2019 June	38	39	77
2019 May	49	17	66
2019 April	40	34	74
2019 March	61	26	87
2019 February	48	20	68
2019 January	58	21	79
2018 December	43	25	68
2018 November	102	25	127
2018 October	199	29	228
2018 September	61	8	69
2018 May	59	1	60
2018 April	28	7	35
2018 March	17	6	23
2018 February	31	5	36
2018 January	12	8	20
2017 December	20	9	29
2017 November	27	7	34
2017 October	27	7	34
2017 September	18	18	36
2017 August	25	13	38
2017 July	23	15	38
2017 June	39	13	52
2017 May	44	16	60
2017 April	27	13	40
2017 March	34	25	59
2017 February	16	7	23
2017 January	14	9	23
2016 December	38	6	44
2016 November	51	16	67
2016 October	35	18	53
2016 September	47	16	63
2016 August	56	10	66
2016 July	25	10	35
2016 March	3	0	3
2016 February	1	0	1
2016 January	1	0	1
2015 December	1	0	1
2015 October	56	4	60
2015 September	42	13	55
2015 August	50	27	77
2015 July	1	1	2
2015 June	0	1	1
2015 May	1	2	3
2015 April	3	0	3

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