Elsevier

Sleep Medicine

Volume 8, Issue 1, January 2007, Pages 90-93
Sleep Medicine

Fast-track article
Sleepiness in medical residents: Impact of mandated reduction in work hours

https://doi.org/10.1016/j.sleep.2006.08.018Get rights and content

Abstract

Objectives:

To assess the sleepiness among Family Practice residents using subjective data, the Epworth sleepiness scale (ESS), as well as objective assessment, the multiple sleep latency test (MSLT).

Method:

We conducted the study on Family Practice residents at Texas A&M University, Corpus Christi. Sixteen residents, aged 21–40 yrs, were recruited and divided into two groups. The study group was comprised of residents who were on night-float rotation for at least three days and underwent MSLT post-call, and the control group was comprised of residents who were not on night-float and were not post-call. Daytime sleepiness was evaluated using both the ESS and MSLT. Respondents also completed a questionnaire assessing their beliefs regarding effects of sleep loss.

Results:

Sleep latencies <10 min were observed in 6 out of the 8 day shift-work interns, while only 1 out of 8 night-float residents had an average sleep latency <10 min (p = 0.0195). Following night-float, despite less sleep, residents had sleep latencies which were higher [14.2 (±5.0) min] than those in the control group [8.4 (±5.4) min, (p = 0.043)]. Despite the difference in objective sleepiness, subjective sleepiness (Epworth scores) did not differ. Over 80% of interns reported having driven while sleepy.

Conclusion:

Sleepiness continues to be a significant issue among medical residents despite recently mandated reductions in resident work hours. MSLT values in the pathologic range are seen in the majority of residents studied, but in those who were post-night call there seemed to be a paradoxical improvement.

Introduction

Sleep deprivation among resident physicians has been an issue of much focus and debate. Numerous studies within the past decade have analyzed the deleterious effect of sleep deprivation on medical house staff in various medical as well as surgical specialties[1], [2], [3], [4]. Residents who suffer from sleep deprivation run a greater risk of creating serious medical errors than those who have had an adequate amount of rest. The Accreditation Council for Graduate Medical Education (ACGME) has attempted to address the problem of fatigue in residents by issuing work limitation standards in 2003 [5]. The standards are as follows: (a) maximum hours a resident physician can work is limited to 80 h per week averaged over four weeks and (b) continuous duty time is limited to 24 h. The standards also require rest periods between duty shifts and one day in seven to be free of program responsibilities Fig. 1.

The effect of this mandatory reduction in resident work hours on reduction in performance errors is not conclusive. Landrigan et al. [6] were able to show a 35.9% reduction in errors by interns by introducing an intervention schedule that eliminated extended work shifts and reduced the number of hours worked per week. A recent national multi-specialty survey of 1653 surgical residents found that 87% reported more than 80 duty hours per week, whereas 45% reported working more than 100 h per week.[7] There is a paucity of studies that have used objective measures to assess sleepiness in residents. The objective of the current study was to assess the impact of the recent mandatory reductions in work hours on daytime sleepiness in post-night-call medical residents both subjectively as well as objectively by means of a multiple sleep latency test (MSLT), using day shift-work residents as a control group for comparison.

Section snippets

Methods

We recruited residents (postgraduate year (PGY)1, PGY2 and PGY3) from the department of Family Practice program at Texas A&M University Corpus Christi. The residency program has 36 total residents.

Results

Groups were well-matched for age, sex, and BMI (see Table 1). In all, 75% of residents from both groups were married and 43% had one or more children.

There was no difference in quantity of sleep per day based on the prior weeks’ sleep diaries (see Table 1).

Mean sleep latencies <10 min were observed in 6 of the 8 day shift-work residents, while only 1 of 8 night-float residents had an average sleep latency <10 min. Despite less sleep, mean MSLT values for night-float residents was higher (14.2).

Discussion

Over the past several decades, concern has grown that sleep loss and fatigue in medical trainees has significant potential to compromise both the quality of patient care and their own quality of life [2]. While several articles [2], [9], [10] have summarized evidence regarding the association between sleep deprivation and outcome measures such as neurocognitive testing and work performance, there have been very few studies [11] which have objectively tested the daytime sleepiness of medical

References (16)

  • E.E. Whang et al.

    Work hours reform: perceptions and desires of contemporary surgical residents

    J Am Coll Surg

    (2003)
  • J.A. Owens et al.

    Physician, heal thyself: sleep, fatigue and medical education

    Sleep

    (2001)
  • L. Leung et al.

    Sleep deprivation and house staff performance; update. 1984–1991

    J Occup med

    (1992)
  • S.K. Howard et al.

    The risks and implication of excessive daytime sleepiness in resident physicians

    Acad Med

    (2002)
  • S. Veasey et al.

    Sleep loss and fatigue in residency training: a reappraisal

    JAMA

    (2002)
  • Accreditation Council for Graduate Medical Education. Common program requirements. Available at...
  • C. Landigran et al.

    Effects of reducing interns work hours on serious medical errors in intensive care units

    NEJM

    (2004)
  • Mark J. Niederee et al.

    A survey of residents and faculty regarding work hour limitations in surgical training programs

    Arch Surg

    (2003)
There are more references available in the full text version of this article.

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