4.4 Article

Sleep and Alertness in Medical Interns and Residents: An Observational Study on the Role of Extended Shifts

期刊

SLEEP
卷 40, 期 4, 页码 -

出版社

OXFORD UNIV PRESS INC
DOI: 10.1093/sleep/zsx027

关键词

alertness; medical education; shiftwork; medical interns; psychomotor vigilance performance; fatigue; sleep deprivation; actigraphy; effects of sleep restriction on cognition and affect

资金

  1. Veterans Health Administration Health Services Research and Development [EDU 08-429]
  2. National Institutes of Health [NR004281]
  3. National Space Biomedical Research Institute (NSBRI) through NASA [NCC 9-58]

向作者/读者索取更多资源

Study Objectives: Fatigue from sleep loss is a risk to physician and patient safety, but objective data on physician sleep and alertness on different duty hour schedules is scarce. This study objectively quantified differences in sleep duration and alertness between medical interns working extended overnight shifts and residents not or rarely working extended overnight shifts. Methods: Sleep wake activity of 137 interns and 87 PGY-213 residents on 2-week Internal Medicine and Oncology rotations was assessed with wrist-actigraphy. Alertness was assessed daily with a brief Psychomotor Vigilance Test (PVT) and the Karolinska Sleepiness Scale. Results: Interns averaged 6.93 hours (95% confidence interval [CI] 6.84-7.03 hours) sleep per 24 hours across shifts, significantly less than residents not working overnight shifts (7.18 hours, 95% CI 7.06-7.30 hours, p =.007). Interns obtained on average 2.19 hours (95% CI 2.02-2.36 hours) sleep during on-call nights (17.5% obtained no sleep). Alertness was significantly lower on mornings after on-call nights compared to regular shifts (p <.001). Naps between 9 am and 6 pm on the first day post-call were frequent (90.8%) and averaged 2.84 hours (95% CI 2.69-3.00 hours), but interns still slept 1.66 hours less per 24 hours (95% CI 1.56-1.76 hours) compared to regular shift days (p <.001). Sleep inertia significantly affected alertness in the 60 minutes after waking on-call. Conclusions: Extended overnight shifts increase the likelihood of chronic sleep restriction in interns. Reduced levels of alertness after on-call nights need to be mitigated. A systematic comparison of sleep, alertness, and safety outcomes under current and past duty hour rules is encouraged.

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