The effects of on-duty napping on intern sleep time and fatigue
The effects of on-duty napping on intern sleep time and fatigue
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DOI：
10.7326/0003-4819-144-11-200606060-00005
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发表时间：
2006-06-06
影响因子：
39.2
通讯作者：
Meltzer, David
中科院分区：
文献类型：
--
作者：
Arora, Vineet;Dunphy, Carrie;Meltzer, David
背景资料：午睡在延长工作轮班是有效的，在其他行业中减少疲劳，但使用午睡作为一种对策，以防止居民疲劳是不确定的。目的：要评估的影响，一个电话夜间午睡居民的睡眠和fatigue.Design：1年内，参与者，交叉在月中配对试验。地点：教学医院。参与者：40名内科实习生中的38名。测量方法：使用腕动计测量睡眠。通过在个人数字助理上使用经验抽样方法，随机警报促使实习生在斯坦福大学的7分嗜睡量表上对疲劳进行评级（7分是最累的）。医院的寻呼日志和结构化访谈提供了使用coverage.Intervention的信息：每个月的2周，实习生被分配到午睡时间表，从午夜到早上7：00为值班实习生提供覆盖，以便他们可以完成工作并小睡一会儿。结果：实习生在随叫随到的情况下多睡了41分钟（185分钟比144分钟; P < 0.001）。当有午睡时间表的实习生使用覆盖时，他们多睡了68分钟（210分钟对142分钟; P < 0.001）。尽管睡眠时间略有增加，但实习生在午睡时间表上的总体疲劳程度低于标准时间表（1.74 vs. 2.26; P = 0.017）。午睡时间表的呼叫后疲劳降低了近1分（2.23 vs 3.16; P = 0.036），这几乎相当于标准时间表的呼叫和呼叫后疲劳之间的差异（2.06 vs 3.16）。然而，使用覆盖范围的实习生午睡时间表受损，他们的愿望，照顾他们的病人和关心不连续的care.Limitations：这是一个单一的机构研究，没有权力检查结果相关的实习生或病人wellbeing.Conclusions：覆盖范围，让午睡在延长值班时间的转变可以增加睡眠，减少居民疲劳。
Background: Naps during extended work shifts are effective in reducing fatigue in other industries, but the use of a nap as a countermeasure to prevent fatigue in residents is uncertain.Objective: To assess the effects of a call-night nap on resident sleep and fatigue.Design: 1-year, within-participant, paired trial with crossover at midmonth. Setting: Academic teaching hospital.Participants: 38 of 40 internal medicine interns.Measurements: Sleep was measured by using wristwatch actigraphy. By using the experience sampling method on a personal digital assistant, random alerts prompted interns to rate fatigue on the 7-point Stanford Sleepiness Scale (7 is most tired). Hospital paging logs and structured interviews provided information on use of coverage.Intervention: For 2 weeks of every month, interns were assigned to the nap schedule, which provided coverage to on-duty interns from midnight to 7:00 a.m. so that they could finish their work and take a nap. The other 2 weeks of the month constituted a standard schedule.Results: Interns received 41 more minutes of sleep while on call with the nap schedule (185 minutes vs. 144 minutes; P < 0.001). When interns with the nap schedule used coverage, they received 68 more minutes of sleep (210 minutes vs. 142 minutes; P < 0.001). Despite these small increases in sleep, interns reported less overall fatigue while on the nap schedule than while on the standard schedule (1.74 vs. 2.26; P = 0.017). Postcall fatigue with the nap schedule was lower by nearly 1 point (2.23 vs 3.16; P = 0.036), which is almost equivalent to the difference between oncall and postcall fatigue with the standard schedule (2.06 vs. 3.16). However, use of coverage by interns on the nap schedule was impaired by their desire to care for their patients and concerns about discontinuity of care.Limitations: This was a single-institution study that did not have the power to examine outcomes related to intern or patient wellbeing.Conclusions: Coverage to allow a nap during an extended duty-hour shift can increase sleep and decrease fatigue for residents.