Abstract
Objectives: Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision-making. Medical professionals and specifically resident physicians, who are involved in long-term nightshift schedules during their post-graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute-on-chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. Methods: Thirty-three medical and surgical residents were evaluated twice - at baseline and after a 26-hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high-sensitivity C-reactive protein (hs-CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk-taking questionnaire and the Pittsburgh Sleep Quality Index. Results: Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs-CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk-taking tendencies which were assessed in a separate cohort. Conclusions: In a real-life setting, resident physicians exhibit increased low-grade systemic inflammation (hs-CRP) and impaired HPA-axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short-term and potential long-term risks to physicians in training.
| Original language | American English |
|---|---|
| Pages (from-to) | 174-184 |
| Number of pages | 11 |
| Journal | Medical Education |
| Volume | 55 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2021 |
Bibliographical note
Funding Information:This work was partly supported by IB internal research grant. This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Funding: AGH is supported by The Israel Science Foundation grant 2779/19; DG is supported by the National Institutes of Health grants HL130984 and HL140548; IB is supported by the National Institute for Psychobiology in Israel grant (#1041819). SCH thanks the Recanati Fund of the School of Business Administration at the Hebrew University for funding. Parts of this work were performed as the requirement for MD degree (FM) and Board Certification in Pediatrics (AI) under the supervision of AGH, SCH & IB.
Funding Information:
This work was partly supported by IB internal research grant. This study did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors. Funding: AGH is supported by The Israel Science Foundation grant 2779/19; DG is supported by the National Institutes of Health grants HL130984 and HL140548; IB is supported by the National Institute for Psychobiology in Israel grant (#1041819). SCH thanks the Recanati Fund of the School of Business Administration at the Hebrew University for funding.
Publisher Copyright:
© 2020 Association for the Study of Medical Education and John Wiley & Sons Ltd