Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Sleep. 2012 Aug 1;35(8):1137-46. doi: 10.5665/sleep.2004.
Although acute sleep loss during 24- to 30-h extended duration work shifts (EDWS) has been shown to impair the performance of resident physicians, little is known about the effects of cumulative sleep deficiency on performance during residency training. Chronic sleep restriction induces a gradual degradation of neurobehavioral performance and exacerbates the effects of acute sleep loss in the laboratory, yet the extent to which this occurs under real-world conditions is unknown. In this study, the authors quantify the time course of neurobehavioral deterioration due to repeated exposure to EDWS during a 3-week residency rotation.
A prospective, repeated-measures, within-subject design.
Medical and cardiac intensive care units, Brigham and Women's Hospital, Boston, MA.
Thirty-four postgraduate year one resident physicians (23 males; age 28.0 ± 1.83 (standard deviation) years)
Residents working a 3-week Q3 schedule (24- to 30-h work shift starts every 3(rd) day), consisting of alternating 24- to 30-h (EDWS) and approximately 8-h shifts, underwent psychomotor vigilance testing before, during, and after each work shift. Mean response time, number of lapses, and slowest 10% of responses were calculated for each test. Residents also maintained daily sleep/wake/work logs. EDWS resulted in cumulative sleep deficiency over the 21-day rotation (6.3 h sleep obtained per day; average 2.3 h sleep obtained per extended shift). Response times deteriorated over a single 24- to 30-h shift (P < 0.0005), and also cumulatively with each successive EDWS: Performance on the fifth and sixth shift was significantly worse than on the first shift (P < 0.01). Controlling for time of day, there was a significant acute (time on shift) and chronic (successive EDWS) interaction on psychomotor vigilance testing response times (P < 0.05).
Chronic sleep deficiency caused progressive degradation in residents' neurobehavioral performance and exacerbated the effects of acute sleep loss inherent in the 24- to 30-h EDWS that are commonly used in resident schedules.
尽管已有研究表明，24 小时至 30 小时延长工作时间（EDWS）期间的急性睡眠缺失会损害住院医师的表现，但对于住院医师培训期间累积性睡眠不足对表现的影响知之甚少。慢性睡眠限制会导致神经行为表现逐渐恶化，并在实验室中加剧急性睡眠缺失的影响，但在现实条件下，这种情况发生的程度尚不清楚。在这项研究中，作者量化了在住院医师轮转期间反复暴露于 EDWS 导致的神经行为恶化的时间过程。
前瞻性、重复测量、个体内设计。
波士顿布莱根妇女医院的医疗和心脏重症监护病房。
34 名住院医师一年级医生（23 名男性；年龄 28.0 ± 1.83 岁）。
轮班 3 周的 Q3 时间表（每隔 3 天开始 24 小时至 30 小时的工作时间），包括交替的 24 小时至 30 小时（EDWS）和大约 8 小时的轮班，在每次轮班前后接受精神运动警觉性测试。为每个测试计算平均反应时间、失误次数和最慢的 10%反应。住院医师还每天记录睡眠/觉醒/工作日志。EDWS 在 21 天的轮转过程中导致累积性睡眠不足（每天获得 6.3 小时的睡眠；平均每次延长轮班获得 2.3 小时的睡眠）。单次 24 小时至 30 小时轮班的反应时间会恶化（P < 0.0005），并且随着连续的 EDWS 也会累积恶化：第五和第六次轮班的表现明显比第一次轮班差（P < 0.01）。控制时间因素，精神运动警觉性测试反应时间存在明显的急性（轮班时间）和慢性（连续 EDWS）交互作用（P < 0.05）。
慢性睡眠不足导致住院医师的神经行为表现逐渐恶化，并加剧了住院医师排班中常用的 24 小时至 30 小时 EDWS 固有的急性睡眠缺失的影响。
