So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents

Insomnia-A Systematic Review and Comparison of Medical Resident's Average Off-Call Sleep Times

Sleep deprivation is known to have serious consequences, including a decrease in performance, attention and neurocognitive function. It seems common knowledge that medical residents are routinely sleep deprived, yet there is little objective research recording their average sleep times. To discern whether residents may be suffering from the abovementioned side effects, this review aimed to analyze their average sleep times. Thirty papers recording the average sleep time of medical residents were found via a literature search using the key words "resident" and "sleep". An analysis of the mean sleep times cited therein revealed a range of sleep from 4.2 to 8.6 h per night, the median being 6.2 h. A sub-analysis of papers from the USA showed barely any significant differences in sleep time between the specialties, but the mean sleep times were below 7 h. The only significant difference (p = 0.039) was between the mean sleep times of pediatric and urology residents, with the former achieving less sleep. The comparison of methods for data collection showed no significant difference in the sleep times collected. The results of this analysis imply that residents are regularly sleep deprived and may therefore suffer from the abovementioned consequences.

Quality of sleep in a sample of Egyptian medical residency

Background

Sleep disturbances among medical staff are common serious entities with devastating consequences. Numerous studies have analyzed the effects of residency on the quality of sleep of the medical trainees in various specialties, but only few studies were conducted in Egypt.

Results

One hundred fifty medical residents from various medical and surgical specialties who work in the hospitals of Ain Shams University, Egypt, agreed to participate in our study. Sociodemographic and work-related data were collected by a semi-structured sheet. Sleep quality was assessed by self-administered questionnaire—Pittsburgh Sleep Quality Index (PSQI). According to the PSQI, 96.7% of the residents had poor sleep quality with mean PSQI score of 10.4 ± 2.5. No statistically significant difference was detected among the different specialties. Poorer sleep quality was more frequent among senior residents who spent longer duration in residency. The number of hours of sleep before residency and the number of days off during residency were the main predictors of total PSQI score and determinants of sleep quality

Conclusions

Poor sleep quality is highly prevalent among medical residents and is associated with work-related factors. It is necessary to consider residents’ sleep estate and conduct more analyses to diagnose, treat, and improve their sleep quality.

The effect of prior night sleep on simulated driving performance in medical residents

OBJECTIVE

Indications of driving performance negatively affected by poor sleep often occur early in simulated driving experiments and are measured to progress over relatively large epochs of time. How driving performance changes over smaller increments of time as a function of not only sleep quantity but also sleep quality is largely unknown. The overall objective of this work in progress is to examine the trajectory of driving performance in medical residents as a function of the prior night's sleep quality using a high-fidelity driving simulator.

METHOD

Thirty-two medical residents were enrolled and wore sleep tracking devices for up to 2 weeks. The residents drove a 16-min scenario in a high-fidelity driving simulator. A mixed effects model was used to estimate baseline intercept and slope of simulated driving performance over the course of the drive. The slope of driving performance over the drive and actigraphy-estimated sleep variables from the prior 24 h served as predictors.

RESULTS

Preliminary descriptive findings indicate a wide range of sleep quality metrics in the sample.

CONCLUSIONS

This study is among the first to focus on the trajectory of driving performance over small continuous epochs of time when simulated driving performance may first begin to degrade. Further, objective estimates of sleep using actigraphy as predictors of the next day's driving will enhance our understanding of the potential "dose-response" between low sleep quality and crash risk in the following 24 hours.

Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations: A Secondary Analysis of the iCOMPARE Trial

BACKGROUND

Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear.

OBJECTIVE

To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations.

METHODS

This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed.

RESULTS

Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all P > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, P < .001) and 6am-12pm (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001).

CONCLUSIONS

Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.

High rate of burnout among residents under standardized residency training in a tertiary teaching hospital of middle China: Results from a cross-sectional survey

Burnout has been commonly observed in health care workers. Though research has been conducted involving burnout among doctors in China, few studies have focused on residents during standardized residency training (SRT). The professional status of the residents during SRT remains largely unclear. The present study was conducted in order to clarify the prevalence and potential risk factors of burnout in residents during SRT.An electronic questionnaire comprised 2 parts. The first part was designed to collect some basic characteristic information. Maslach Burnout Inventory-Human Services Survey was included in the second part.As many as 71.05% residents had at least 1 scale of burnout. Emotional exhaustion (EE) was found in 55.6% residents, depersonalization (DP) in 29.7% and reduced personal accomplishment (RPA) in 41.6%. Being older than 27, senior SRT year, working time more than 60 hours per week and poor sleeping quality was independently associated with at least on scale of burnout. Being unable to receive timely supervisor support significantly increased the probability of DP and EE. Not having friends at work or feeling cared for by the hospital were independently related to all 3 symptoms of burnout as well as overall burnout.Burnout rate is high in residents under SRT from middle part of China. Organizational, professional, and social support was demonstrated critical by the potential roles in protecting against burnout. Residents with burnout were prone to considering turnover. Strategies for managing burnout related factors among residents should be focused in future studies.

Sleep and stress before and after duty across residency years under 2017 ACGME hours

INTRODUCTION

Residents may differentially experience high stress and poor sleep across multiple post-graduate years (PGYs), negatively affecting safety. This study characterized sleep and stress among medical and surgical residents across multiple PGYs and at specific times surrounding duty.

METHOD

Thirty-two medical and surgical residents (M_age = 28.6 years; 56% male) across PGYs 1-5 participated in 3 appointments (immediately before duty, after duty, and on an off day) providing 96 data points. Sleep, stress, and occupational fatigue were measured by both self-report and objectively (actigraphy, salivary coritsol).

RESULTS

Residents averaged 7 h of actigraphy-estimated sleep per night but varied ±3 h day-to-day. Residents reported clinically poor sleep quality. Life stress decreased by PGY-2. All residents averaged elevated life stress values. Poor sleep quality did not differ among PGY cohorts.

DISCUSSION

Poor sleep quality is similar between early residency cohorts (PGY-1) and later residency cohorts (PGY-3+). Persistent fatigue is highest in later residency cohorts. Even the most experienced residents may struggle with persisting fatigue. Current hour policies may have shortcomings in addressing this risk.

The effect of poor sleep and occupational demands on driving safety in medical residents

OBJECTIVE

The Accreditation Council for Graduate Medical Examination recently revised and implemented duty hour standards that increased maximum duty hours for first-year medical residents and reduced the minimal amount of time off between duty periods for all medical residents. Little work has examined driving performance of medical residents at multiple periods surrounding duty, including in reference to off-duty driving performance as a baseline. Certain work-related factors that may be negatively impacted in medical residents, such as sleep quality, fatigue, and stress, are known to affect mental and physical performance and may further exacerbate driving risks. The overall objective of this study was to examine driving performance of medical residents off duty, preduty, and postduty using a high-fidelity driving simulator.

METHOD

Thirty-two medical residents were enrolled and wore sleep tracking devices over several days. Both self-reported and objective estimates of sleep quality, fatigue, and stress were collected at off-duty, preduty, and postduty points of time. The medical residents drove in a high-fidelity driving simulator at each time point to provide objective driving performance metrics.

RESULTS

Findings indicated that medical residents experienced the highest levels of stress and sleep propensity preduty and displayed riskier driving behaviors postduty. Those further into their residency were less affected by the negative effect of stress on driving performance, and those with better sleep quality metrics were also less affected by the negative effects of increased stress on driving outcomes.

CONCLUSIONS

The impact of occupational demands on psychophysiological outcomes requires further investigation to better understand the mechanisms of how work demands affect these psychophysiological outcomes. Understanding how to mitigate high job strain may have several implications in improving psychophysiological functions impacted by occupational demands, namely, sleep quality and stress, and subsequently improving driving safety outcomes that may also be negatively affected by the duty demands.