Evaluating the impact of a sleep health education and a personalised smartphone application on sleep, productivity and healthcare utilisation among employees: results of a randomised clinical trial

Abstract

Objectives: We evaluated an online Sleep Health and Wellness (SHAW) programme paired with dayzz, a personalised sleep training programme deployed via smartphone application (dayzz app) that promotes healthy sleep and treatment for sleep disorders, among employees at a large healthcare organisation.

Design: Open-label, randomised, parallel-group controlled trial.

Setting: A healthcare employer in the USA.

Participants: 1355 daytime workers.

Intervention: Participants were randomised to intervention (n=794) or control (n=561) on consent. Intervention participants received the SHAW educational programme at baseline plus access to the personalised dayzz app for up to 9 months. The control condition received the intervention at month 10.

Primary and secondary outcome measures: Our primary outcome measures were sleep-related behavioural changes (eg, consistent sleep schedule); sleep behaviour tracked on an electronic sleep diary and sleep quality. Our secondary outcome measures included employee absenteeism, performance and productivity; stress, mood, alertness and energy; and adverse health and safety outcomes (eg, accidents).

Results: At follow-up, employees in the intervention condition were more likely to report increased sleep duration on work (7.20 vs 6.99, p=0.01) and on free (8.26 vs 8.04, p=0.03) nights. At follow-up, the prevalence of poor sleep quality was lower in the intervention (n=160 of 321, 50%) compared with control (n=184 of 327, 56%) (p=0.04). The mean total dollars lost per person per month due to reduced workplace performance (presenteeism) was less in the intervention condition (US$1090 vs US$1321, p=0.001). Employees in the intervention reported fewer mental health visits (RR 0.72, 95% CI 0.56 to 0.94, p=0.01) and lower healthcare utilisation over the study interval (RR 0.81, 95% CI 0.67 to 0.98, p=0.03). We did not observe differences in stress (4.7 (95% CI 4.6 to 4.8) vs 4.7 (95% CI 4.6 to 4.8)), mood (4.5 (95% CI 4.4 to 4.6) vs 4.6 (95% CI 4.5 to 4.7)), alertness (4.9 (95% CI 4.8 to 5.0) vs 5.0 (95% CI 4.9 to 5.1)) or adverse health and safety outcomes (motor vehicle crashes: OR 0.82 (95% CI 0.34 to 1.9); near-miss crashes: OR=0.89 (95% CI 0.5 to 1.5) and injuries: 0.9 (95% CI 0.6 to 1.3)); energy was higher at follow-up in the intervention group (4.3 vs 4.5; p=0.03).

Conclusions: Results from this trial demonstrate that a SHAW programme followed by access to the digital dayzz app can be beneficial to both the employee and employer.

Trial registration number: NCT04224285.

Keywords: Information technology; OCCUPATIONAL & INDUSTRIAL MEDICINE; Sleep medicine.

Conflict of interest statement

Competing interests: MC-Z and LG are employees at dayzz Live Well. MDW reports consulting fees from the National Sleep Foundation and the University of Pittsburgh. LKB reports consulting fees from the University of Helsinki, the AAA Foundation, Puget Sound Pilots, and Boston Children’s Hospital. RR reports consulting fees from SleepCycle AB; Rituals Cosmetics BV; Denihan Hospitality Group; AdventHealth; and With Deep. SFQ has served as a consultant for Best Doctors, the Bryte Foundation, Jazz Pharmaceuticals, and Whispersom. CAC reports grants and contracts to BWH from Dayzz Live Well, Delta Airlines, Jazz Pharma, Puget Sound Pilots, Regeneron Pharmaceuticals/Sanofi; is/was paid consultant/speaker for Inselspital Bern, Institute of Digital Media and Child Development, Klarman Family Foundation, M.D and Co, National Council for Mental Wellbeing, National Sleep Foundation, Physician's Seal, SRS Foundation, State of Washington Board of Pilotage Commissioners, Tencent, Teva Pharma Australia, With Deep, and Vanda Pharmaceuticals, in which CAC holds an equity interest; received travel support from Aspen Brain Institute, Bloomage International Investment Group, Dr. SH Medical Development Foundation, German National Academy of Sciences, Ludwig-Maximilians-Universität München, National Highway Transportation Safety Administration, National Safety Council, National Sleep Foundation, Salk Institute for Biological Studies/Foundation Ipsen, Society for Research on Biological Rhythms, Stanford Medical School Alumni Association, Tencent Holdings, and Vanda Pharmaceuticals; receives research/education gifts through BWH from Arbor Pharmaceuticals, Avadel Pharmaceuticals, Bryte, Alexandra Drane, Cephalon, DR Capital Ltd, Eisai, Harmony Biosciences, Jazz Pharmaceuticals, Johnson & Johnson, Mary Ann & Stanley Snider via Combined Jewish Philanthropies, NeuroCare, Optum, Philips Respironics, Regeneron, Regional Home Care, ResMed, Resnick Foundation (The Wonderful Company), San Francisco Bar Pilots, Sanofi SA, Schneider, Simmons, Sleep Cycle AB. Sleep Number, Sysco, Teva Pharmaceuticals, Vanda Pharmaceuticals; is/was an expert witness in legal cases, including those involving Advanced Power Technologies, Aegis Chemical Solutions, Amtrak; Casper Sleep Inc, C&J Energy Services, Catapult Energy Services Group, Covenant Testing Technologies, Dallas Police Association, Enterprise Rent-A-Car, Espinal Trucking/Eagle Transport Group/Steel Warehouse Inc, FedEx, Greyhound, Pomerado Hospital/Palomar Health District, PAR Electrical Contractors, Product and Logistics Services/Schlumberger Technology, Puckett EMS, Puget Sound Pilots, Union Pacific Railroad, UPS and Vanda Pharmaceuticals; serves as the incumbent of an endowed professorship given to Harvard by Cephalon; and receives royalties from McGraw Hill and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices. CAC’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of-interest policies.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Flow chart of study procedures.

Figure 2

Self-reported sleep behavioural changes during the study between intervention and control conditions.

Figure 3

Changes to self-reported sleep duration during the study between intervention and control conditions. A higher PSQI score indicates worse sleep quality. PSQI, Pittsburgh Sleep Quality Index. Note: *p

Figure 4

Changes in the Sleep Regularity Index during the study between intervention and control conditions.

Figure 5

Changes in absenteeism and presenteeism during the study between intervention and control conditions.

Figure 6

Changes in healthcare utilisation during the study between intervention and control conditions. Left indicates either fewer healthcare visits or total utilisation. PT/OT, Physical Therapy/Occupational Therapy. Notes: *p