Trends in Strategic Napping in Surgical Residents by Gender, Postgraduate Year, Work Schedule, and Clinical Rotation

OBJECTIVE: To identify surgical resident and clinical rotation attributes which predict on-shift napping through objectively measured sleep patterns and work schedules over a 2-month period. DESIGN: In a cross-sectional study, participants provided schedules, completed the Epworth Sleepiness Scale (ESS), and wore sleep-tracking devices (Zulu watch) continuously for 8 weeks. Multiple linear regression predicted percent days with on-shift napping from resident and rotation characteristics. SETTING: Greater Washington, DC area hospitals. PARTICIPANTS: Twenty-two (n = 22) surgical residents rotating in at least 1 of 5 different clinical rotation categories. RESULTS: Residents slept 6 hours within a 24-hour period (370 +/- 129 minutes) with normal sleep efficiency (sleep efficiency (SE): 87.13% +/- 7.55%). Resident ESS scores indicated excessive daytime sleepiness (11.64 +/- 4.03). Ninety-five percent (n = 21) of residents napped on-shift. Residents napped on-shift approximately 32% of their working days and were most likely to nap when working between 23:00 and 05:00 hours. Earlier shift start times predicted less on-shift napping (B = -0.08, SE = 0.04, beta = -2.40, t = -2.09, p = 0.05) while working more night shifts (B = 1.55, SE = 0.44, beta = 4.12, t = 3.52, p = 0.003) and shifts over 24 hours (B = 1.45, SE = 0.55, beta = 1.96, t = 2.63, p = 0.01) predicted more frequent on-shift napping. CONCLUSIONS: Residents are taking advantage of opportunities to nap on-shift. Working at night seems to drive on-shift napping. However, residents still exhibit insufficient sleep and daytime sleepiness which could reduce competency and represent a safety risk to themselves and/or patients. These findings will help inform intervention strategies which are tailored to surgical residents using a biomathematical model of fatigue. (C) 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

The study found that surgical residents frequently take on-shift naps, especially during night shifts. Earlier shift start times were associated with less on-shift napping, while working more night shifts and shifts over 24 hours predicted more frequent on-shift napping.