Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts. Issue 5 (22nd February 2019)

• Record Type: Journal Article
• Authors: St Hilaire, Melissa A; Anderson, Clare; Anwar, Junnat; Sullivan, Jason P; Cade, Brian E; Flynn-Evans, Erin E; Czeisler, Charles A; Lockley, Steven W
• Is Part Of: Sleep. Volume 42:Issue 5(2019)
• Publication Date: 2019-02-22
• Subjects: sleep deprivation -- resident physicians -- patient care -- medical errors -- medical training; Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsz041
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: 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 &quot;post-call&quot; 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 &quot;on-call&quot; rotation schedules in the Medical and Cardiac Intensive Care Units at Brigham and Women&#39;s Hospital in Boston. Daily sleep logs (validated by ambulatory polysomnography) were collected and the 10 min psychomotor vigilance task (PVT) was administered every ~6 hr during each EDWS. Generalized estimating equations were used to examine the relationship between overnight sleep duration and PVT performance &quot;post-call&quot; (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 (&lt;4 hr on 92% of nights). PVT attentional failures were significantly reduced only after &gt;4 hr sleep ( p = 0.027 versus no sleep). Despite this apparent improvement, the odds of incurring &gt;1 attentional failure were 2.72 times higher during postcall following &gt;4 hr sleep compared with matched sessions during non-EDWS. Conclusions: Even with &gt;4 hr sleep overnight (8% of EDWS), performance remained significantly impaired. These findings suggest that even &quot;strategic napping, &quot; a recommendation recently removed from ACGME guidelines, is insufficient to mitigate severe performance impairment introduced by extending duty beyond 16 hr.