Arora Vineet M, Georgitis Emily, Woodruff James N, Humphrey Holly J, Meltzer David
Department of Medicine, University of Chicago, 5841 S Maryland Ave, Mail Code 2007, Ste AMB W216, Chicago, IL 60637, USA.
Arch Intern Med. 2007 Sep 10;167(16):1738-44. doi: 10.1001/archinte.167.16.1738.
Because of concerns regarding sleep deprivation, the Accreditation Council for Graduate Medical Education limits duty hours and endorses education regarding sleep loss for residents. We assessed the effectiveness of a 60- to 90-minute lecture, the Sleep, Alertness, and Fatigue Education in Residency (SAFER) program, on sleep loss and recovery sleep in residents adhering to Accreditation Council for Graduate Medical Education duty hours.
From July 1, 2003, through June 24, 2005, interns from the inpatient medicine service at the University of Chicago were asked to wear wristwatch activity monitors. In March 2005, interns received the SAFER program intervention. We used fixed-effects linear regression to estimate within-subject mean sleep per call day (on-call, precall, postcall, and second-day postcall sleep). These estimates were compared with recommended minimum levels of preventive (7 hours of precall) and recovery (16 hours during the 2 days after call) sleep in healthy populations using 2-tailed t tests. These analyses were repeated to test the effect of the SAFER program.
Fifty-eight of 81 interns (72%) participated for 147 intern-months (63%). Interns on call slept an average of 2.84 hours (95% confidence interval, 2.75-2.93 hours). Interns obtained less than recommended amounts of recovery sleep (14.06 hours [95% confidence interval, 13.84-14.28 hours]; P < .001). Intern preventive sleep was also less than recommended (6.47 hours [95% confidence interval, 6.39-6.56 hours]; P < .001). Interns attempted to compensate for their acute sleep loss; for each hour of on-call sleep loss, they received 18 minutes (95% confidence interval, 7-30 minutes) more recovery sleep (P = .003). The SAFER program had no significant beneficial effect on intern sleep.
Under the current duty-hour regulations of the Accreditation Council for Graduate Medical Education, residents continue to be sleep deprived. The SAFER program has no impact on resident precall or postcall sleep.
由于对睡眠剥夺的担忧，毕业后医学教育认证委员会限制了值班时长，并支持对住院医师进行关于睡眠不足的教育。我们评估了一场时长60至90分钟的讲座——住院医师睡眠、警觉性与疲劳教育（SAFER）项目——对遵守毕业后医学教育认证委员会值班时长的住院医师的睡眠不足及恢复性睡眠的效果。
从2003年7月1日至2005年6月24日，芝加哥大学内科住院部的实习医生被要求佩戴腕部活动监测器。2005年3月，实习医生接受了SAFER项目干预。我们使用固定效应线性回归来估计每个值班日的受试者内平均睡眠时间（值班时、值班前、值班后以及值班后第二天的睡眠）。使用双侧t检验将这些估计值与健康人群中推荐的预防性睡眠（值班前7小时）和恢复性睡眠（值班后两天内16小时）的最低水平进行比较。重复这些分析以测试SAFER项目的效果。
81名实习医生中的58名（72%）参与了147个实习医生月（63%）。值班的实习医生平均睡眠2.84小时（95%置信区间，2.75 - 2.93小时）。实习医生获得的恢复性睡眠少于推荐量（14.06小时[95%置信区间，13.84 - 14.28小时]；P <.001）。实习医生的预防性睡眠也少于推荐量（6.47小时[95%置信区间，6.39 - 6.56小时]；P <.001）。实习医生试图弥补他们的急性睡眠不足；每值班时少睡一小时，他们的恢复性睡眠就会多18分钟（95%置信区间，7 - 30分钟）（P = 0.003）。SAFER项目对实习医生的睡眠没有显著的有益影响。
在毕业后医学教育认证委员会目前的值班时长规定下，住院医师仍然存在睡眠剥夺的情况。SAFER项目对实习医生值班前或值班后的睡眠没有影响。
