Ernst Florian, Rauchenzauner Markus, Zoller Heinz, Griesmacher Andrea, Hammerer-Lercher Angelika, Carpenter Roger, Schuessler Gerhard, Joannidis Michael
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.
Department of Pediatrics, Saint Vincent Hospital Zams, Zams, Austria; Department of Pediatrics IV, Medical University Innsbruck, Innsbruck, Austria.
Psychoneuroendocrinology. 2014 Sep;47:221-31. doi: 10.1016/j.psyneuen.2014.05.019. Epub 2014 Jun 2.
On-call duty (OCD) is frequently associated with health and safety risks for both physicians and patients. The lack of studies conducted in clinical care environments and the ongoing public dialogue concerning OCD led to a detailed investigation of a working schedule including sleep fragmentation and extended work hours.
Within-person randomized cross-over trial.
Comparison of a 24h on-call shift (OCD) compared to a routine working-day (non on call, NOC) in hospital.
30 residents and senior physicians of the Department of Internal Medicine, Neurology and Otorhinolaryngology at the University Hospital Innsbruck.
Sleep variables, cognitive performance (Concentration-Endurance d2 test), emotional status (Eigenschaftswoerterliste 60S), serum-cortisol, urinary cortisol and noradrenaline, heart-rate variability, and saccadic eye movements were determined before and after OCD and NOC respectively.
Concentration-endurance performance was significantly reduced after OCD as compared to NOC by 16.4% (p<0.001). Changes in emotional status consisted in a reduction of subjective concentration and performance related activation after OCD by 17.4% (p<0.001) and 16.0% (p<0.001) respectively together with a 21.8% increase of general deactivation (p<0.001) and a 29.2% rise of fatigue (p<0.001). On the contrary, subjective activation and raised mood showed an 18.3% and 21.7% increase after OCD (p<0.01). Urinary noradrenaline excretion (46 μg/24 h, 19-97) was greater during OCD when compared to NOC (36 μg/24 h, 10-54, p<0.01). Sympathetic activity measured by heart rate variability was significantly higher during OCD in contrast to NOC (p<0.05). Serum-cortisol was lower in the morning after (132 ng/l, 60-273) than the morning before OCD (p<0.01). Finally, the number of short saccadic latencies was reduced after OCD (p<0.05) compared to NOC.
24 h OCD alters both, the sympathetic-adrenomedullary system as well as the hypothalamic pituitary-adrenocortical axis. Moreover, physicians' emotional state, cognitive and oculomotor performance seems to be influenced independently from sleep interruptions. The discrepancy between subjective feeling and objective cognitive impairments pose a risk for performing complex manual and cognitive tasks. Hence, our findings argue against an oversimplified interpretation of alterations in the physicians' psychoneuroendocrine structure in terms of impaired mood and neurocognitive deterioration combined with up-/dysregulated stress axes associated with OCD as a consequence of sleep deprivation.
值班（OCD）对医生和患者的健康与安全风险通常较高。临床护理环境中缺乏相关研究，且关于值班的公众讨论不断，这促使我们对一个包括睡眠碎片化和工作时间延长的工作时间表进行详细调查。
个体内随机交叉试验。
比较医院内24小时值班轮班（OCD）与常规工作日（非值班，NOC）。
因斯布鲁克大学医院内科、神经科和耳鼻喉科的30名住院医师和资深医生。
分别在OCD和NOC前后测定睡眠变量、认知表现（注意力-耐力d2测试）、情绪状态（特质词汇表60S）、血清皮质醇、尿皮质醇和去甲肾上腺素、心率变异性以及眼球跳动。
与NOC相比，OCD后注意力-耐力表现显著降低16.4%（p<0.001）。情绪状态的变化包括OCD后主观注意力和与表现相关的激活分别降低17.4%（p<0.001）和16.0%（p<0.001），同时总体失活增加21.8%（p<0.001），疲劳增加29.2%（p<0.001）。相反，OCD后主观激活和情绪高涨分别增加18.3%和21.7%（p<0.01）。与NOC（36μg/24小时，10 - 54）相比，OCD期间尿去甲肾上腺素排泄量（46μg/24小时，19 - 97）更高（p<0.01）。与NOC相比，OCD期间通过心率变异性测量的交感神经活动显著更高（p<0.05）。OCD后早晨血清皮质醇（132ng/l，60 - 273）低于OCD前早晨（p<0.01）。最后，与NOC相比，OCD后短眼球跳动潜伏期的数量减少（p<0.05）。
24小时OCD会改变交感-肾上腺髓质系统以及下丘脑-垂体-肾上腺皮质轴。此外，医生的情绪状态、认知和动眼表现似乎独立于睡眠中断受到影响。主观感觉与客观认知障碍之间的差异对执行复杂的手动和认知任务构成风险。因此，我们的研究结果反对将医生心理神经内分泌结构的改变过度简化为情绪受损、神经认知恶化以及与OCD相关的应激轴上调/失调（作为睡眠剥夺的结果）。
