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

Mar 23, 2017Sleep

Sleep and Alertness in Medical Trainees During Long Work Shifts

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

Interns averaged 6.93 hours of sleep per 24 hours, significantly less than the 7.18 hours averaged by residents not working overnight shifts.

Interns obtained an average of 2.19 hours of sleep during on-call nights, with 17.5% reporting no sleep at all.
Alertness levels were significantly lower on mornings after on-call nights compared to regular shifts.
Naps taken by interns on the first day post-call were common (90.8%) and averaged 2.84 hours.
Despite napping, interns still slept 1.66 hours less per 24 hours on post-call days compared to regular shift days.
Sleep inertia significantly impacted alertness during the first 60 minutes after waking on-call.

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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-2/3 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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Sleep and Alertness in Medical Interns and Residents: An Observational Study on the Role of Extended Shifts

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