Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts

Melissa A St Hilaire, Clare Anderson, Junnat Anwar, Jason P Sullivan, Brian E Cade, Erin E Flynn-Evans, Charles A Czeisler, Steven W Lockley, for the Harvard Work Hours Health and Safety Group

Research output: Contribution to journalArticleResearchpeer-review

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 “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 ~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.

Original languageEnglish
Article numberzsz041
Number of pages6
JournalSleep
Volume42
Issue number5
DOIs
Publication statusPublished - 1 May 2019
Externally publishedYes

Keywords

  • Medical errors
  • Medical training
  • Patient care
  • Resident physicians
  • Sleep deprivation

Cite this

St Hilaire, M. A., Anderson, C., Anwar, J., Sullivan, J. P., Cade, B. E., Flynn-Evans, E. E., ... for the Harvard Work Hours Health and Safety Group (2019). Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts. Sleep, 42(5), [zsz041]. https://doi.org/10.1093/sleep/zsz041
St Hilaire, Melissa A ; Anderson, Clare ; Anwar, Junnat ; Sullivan, Jason P ; Cade, Brian E ; Flynn-Evans, Erin E ; Czeisler, Charles A ; Lockley, Steven W ; for the Harvard Work Hours Health and Safety Group. / Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts. In: Sleep. 2019 ; Vol. 42, No. 5.
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title = "Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts",
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 “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 ~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.",
keywords = "Medical errors, Medical training, Patient care, Resident physicians, Sleep deprivation",
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St Hilaire, MA, Anderson, C, Anwar, J, Sullivan, JP, Cade, BE, Flynn-Evans, EE, Czeisler, CA, Lockley, SW & for the Harvard Work Hours Health and Safety Group 2019, 'Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts' Sleep, vol. 42, no. 5, zsz041. https://doi.org/10.1093/sleep/zsz041

Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts. / St Hilaire, Melissa A; Anderson, Clare; Anwar, Junnat; Sullivan, Jason P; Cade, Brian E; Flynn-Evans, Erin E; Czeisler, Charles A; Lockley, Steven W; for the Harvard Work Hours Health and Safety Group.

In: Sleep, Vol. 42, No. 5, zsz041, 01.05.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts

AU - St Hilaire, Melissa A

AU - Anderson, Clare

AU - Anwar, Junnat

AU - Sullivan, Jason P

AU - Cade, Brian E

AU - Flynn-Evans, Erin E

AU - Czeisler, Charles A

AU - Lockley, Steven W

AU - for the Harvard Work Hours Health and Safety Group

PY - 2019/5/1

Y1 - 2019/5/1

N2 - 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 ~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.

AB - 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 ~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.

KW - Medical errors

KW - Medical training

KW - Patient care

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KW - Sleep deprivation

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