Dr. Shea is professor of medicine-clinician educator and associate dean of medical education research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Dinges is professor of psychology in psychiatry and chief of the division of sleep and chronobiology, department of psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Small is associate professor, department of statistics, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Basner is assistant professor of sleep and chronobiology in psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Mr. Zhu is assistant director of data analytics, LDI Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Ms. Norton is research project manager, CHERP, Philadelphia VA Medical Center, and CHIBE, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Mr. Ecker is a senior information technology project leader, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Ms. Novak was research coordinator, CHERP, Philadelphia VA Medical Center, and CHIBE, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, at the time this study was conducted. Currently she is a second-year medical student, Temple University School of Medicine, Philadelphia, Pennsylvania. Dr. Bellini is professor of medicine, and vice chair for education, department of medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Dine is assistant professor of medicine, division of pulmonary and critical care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Mollicone is president and CEO of Pulsar Informatics, Inc., Philadelphia, Pennsylvania. Dr. Volpp is staff ph
Acad Med. 2014 Mar;89(3):452-9. doi: 10.1097/ACM.0000000000000144.
Protected sleep periods for internal medicine interns have previously resulted in increased amount slept and improved cognitive alertness but required supplemental personnel. The authors evaluated intern and patient outcomes associated with protected nocturnal nap periods of three hours that are personnel neutral.
Randomized trial at Philadelphia Veterans Affairs Medical Center (PVAMC) Medical Service and Hospital of the University of Pennsylvania (HUP) Oncology Unit. During 2010-2011, four-week blocks were randomly assigned to a standard intern schedule (extended duty overnight shifts of up to 30 hours), or sequential protected sleep periods (phone sign-out midnight to 3:00 AM [early shift] intern 1; 3:00 to 6:00 AM [late shift] intern 2). Participants wore wrist Actiwatches, completed sleep diaries, and performed daily assessments of behavioral alertness. Between-group comparisons of means and proportions controlled for within-person correlations.
HUP interns had significantly longer sleep durations during both early (2.40 hours) and late (2.44 hours) protected periods compared with controls (1.55 hours, P < .0001). At PVAMC sleep duration was longer only for the late shift group (2.40 versus 1.90 hours, P < .036). Interns assigned to either protected period were significantly less likely to have call nights with no sleep and had fewer attentional lapses on the Psychomotor Vigilance Test. Differences in patient outcomes between standard schedule months versus intervention months were not observed.
Protected sleep periods of three hours resulted in more sleep during call and reductions in periods of prolonged wakefulness, providing a plausible alternative to 16-hour shifts.
内科实习医生的保护睡眠期以前曾导致睡眠时间增加和认知警觉性提高，但需要额外的人员。作者评估了与 3 小时的无人员保护夜间小睡期相关的实习医生和患者结果。
在费城退伍军人事务医疗中心（PVAMC）医疗服务和宾夕法尼亚大学医院（HUP）肿瘤科进行的随机试验。在 2010-2011 年期间，四周的块被随机分配到标准实习医生时间表（延长的夜间值班时间长达 30 小时）或连续的保护睡眠期（午夜到凌晨 3 点的电话交接班[早班]1 名实习医生；凌晨 3 点到 6 点的电话交接班[晚班]2 名实习医生）。参与者佩戴腕部活动记录仪，填写睡眠日记，并进行每日行为警觉性评估。对均值和比例进行组间比较，控制了个体内相关性。
与对照组（1.55 小时，P <.0001）相比，HUP 实习医生在早（2.40 小时）和晚（2.44 小时）保护期内的睡眠时间明显更长。在 PVAMC，只有晚班的睡眠时间更长（2.40 小时比 1.90 小时，P <.036）。分配到保护睡眠期的实习医生更不可能有整夜无眠的夜班，并且在精神运动警觉测试中注意力不集中的次数更少。在标准时间表月份与干预月份之间，未观察到患者结果的差异。
3 小时的保护睡眠期可在值班期间增加睡眠时间，并减少长时间清醒的时间，为 16 小时轮班制提供了一种可行的替代方案。
