Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
Brief (<4 hr) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
复制标题
短暂（<4 小时）的睡眠不足以恢复通宵加班的第一年住院医生的表现。
DOI：
10.1093/sleep/zsz041
复制
发表时间：
2019
期刊：
影响因子：
5.6
通讯作者：
HarvardWorkHoursHealthandSafetyGroup
中科院分区：
文献类型：
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作者：
StHilaire,MelissaA;Anderson,Clare;Anwar,Junnat;Sullivan,JasonP;Cade,BrianE;Flynn-Evans,ErinE;Czeisler,CharlesA;Lockley,StevenW;HarvardWorkHoursHealthandSafetyGroup
研究目标研究生医学教育认证委员会（ACGME）最近恢复了研究生一年级（PGY-1）住院医生的延长工作时间（24-28小时）轮班（EDWS）。本研究调查了PGY-1住院医师在EDWS期间的夜间睡眠时间与随后的“事后”表现之间的关系。方法研究了34名PGY-1住院医师（23名男性，24-32岁）在2002年至2004年期间在波士顿布里格姆妇女医院内科和心脏重症监护室进行的为期3周的Q3“随叫随到”轮转计划。收集每日睡眠记录（通过动态多导睡眠图验证），并在每次EDWS期间每6小时进行10分钟精神运动警戒任务（PVT）。使用广义估计方程来检验夜间睡眠时间与“呼叫后”（0500-1900小时）PVT表现之间的关系。在消除EDWS的干预计划中，将EDWS期间的术后表现与同一住院医师在一天中的时间和周内的安排相匹配的会话进行比较。结果住院医师在EDWS期间平均每晚累计睡眠时间为1.6±1.5小时（92%的夜晚<4小时）。PVT注意失败只有在睡眠40小时后才显著减少（p= 0.027与不睡眠相比）。尽管有这种明显的改善，但与非edws期间的匹配时段相比，在睡眠>4小时后的呼叫中发生>注意失败的几率高出2.72倍。结论夜间睡眠时间为4小时的患者（占EDWS的8%），其表现仍明显受损。这些发现表明，即使是最近从ACGME指南中删除的“战略性午睡”建议，也不足以减轻因延长工作时间超过16小时而导致的严重绩效损害。
Study ObjectivesThe 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.MethodsThirty-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.ResultsResident 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.ConclusionsEven 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.