Brief (<4 Hr) Sleep Episodes Are Insufficient for Restoring Performance in First-Year Resident Physicians Working Overnight Extended-Duration Work Shifts

Details

• Personal Author:
  Anderson C ; Anwar J ; Cade BE ; Czeisler, Charles A. ; Flynn-Evans EE ; Lockley SW ; St Hilaire MA ; Sullivan JP ; Anderson C ; Anwar J ; Cade BE ; Czeisler, Charles A. ; Flynn-Evans EE ; Lockley SW ; St Hilaire MA ; Sullivan JP
• Corporate Authors:
  Harvard Medical School. Harvard Work Hours Health and Safety Group ; Harvard Medical School. Harvard Work Hours Health and Safety Group
• Description:
  Study Objectives: The Accreditation Council for Graduate Medical Education (ACGME) recently reinstated extended-duration (24-28 hr) work shifts (EDWS) for postgraduate year 1 (PGY-1) resident physicians. This study examined the relationship between overnight sleep duration during EDWS and subsequent "post-call" performance in PGY-1 resident physicians. Methods: Thirty-four PGY-1 resident physicians (23 males; 24-32 years) were studied between 2002 and 2004 during 3-week Q3 "on-call" rotation schedules in the Medical and Cardiac Intensive Care Units at Brigham and Women's Hospital in Boston. Daily sleep logs (validated by ambulatory polysomnography) were collected and the 10 min psychomotor vigilance task (PVT) was administered every approx. 6 hr during each EDWS. Generalized estimating equations were used to examine the relationship between overnight sleep duration and PVT performance "post-call" (0500-1900 hr). Postcall performance during EDWS was compared with sessions matched for time-of-day and weeks-into-schedule in the same resident physician during an intervention schedule that eliminated EDWS. Results: Resident physicians obtained an average of 1.6 +/- 1.5 hr cumulative sleep overnight during EDWS (<4 hr on 92% of nights). PVT attentional failures were significantly reduced only after >4 hr sleep (p = 0.027 versus no sleep). Despite this apparent improvement, the odds of incurring >1 attentional failure were 2.72 times higher during postcall following >4 hr sleep compared with matched sessions during non-EDWS. Conclusions: Even with >4 hr sleep overnight (8% of EDWS), performance remained significantly impaired. These findings suggest that even "strategic napping," a recommendation recently removed from ACGME guidelines, is insufficient to mitigate severe performance impairment introduced by extending duty beyond 16 hr. [Description provided by NIOSH]
• Subjects:
  Health Personnel Occupational Health Safety Sleep Sleep Initiation And Maintenance Disorders Staff Development
• Keywords:
  Author Keywords: Medical Errors Long Work Hours Medical Personnel Medical Training Patient Care Physicians Resident Physicians Sleep Deprivation Training Work Intervals Work Schedules

  More +
• ISSN:
  0161-8105
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Volume:
  42
• Issue:
  5
• NIOSHTIC Number:
  nn:20068559
• Citation:
  Sleep 2019 May; 42(5):zsz041
• Contact Point Address:
  Melissa A. St Hilaire, Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, BLI-438, Boston, MA 02115
• Email:
  msthilaire@bwh.harvard.edu
• Federal Fiscal Year:
  2019
• Performing Organization:
  Brigham and Women's Hospital
• Peer Reviewed:
  True
• Start Date:
  20010930
• Source Full Name:
  Sleep
• End Date:
  20060929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fb9480891bbe23966b5a6d94edbb4f95c011ed06ef6e0b7ea576a8ebbd4d35611b0e532a95e926b836057afb3a4ab6641b029974ba23ff82e18f43e99db54322
• Download URL:
  https://stacks.cdc.gov/view/cdc/207169/cdc_207169_DS1.pdf
• File Type:
  [PDF - 436.04 KB ]