Williams George W, Shankar Bairavi, Klier Eliana M, Chuang Alice Z, El Marjiya-Villarreal Salma, Nwokolo Omonele O, Sharma Aanchal, Sereno Anne B
Dept. of Anesthesiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States; Dept. of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States.
Dept. of Neuroscience, Rice University, Houston, TX 77005, United States; Dept. of Neurobiology and Anatomy, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States.
J Clin Anesth. 2017 Aug;40:110-116. doi: 10.1016/j.jclinane.2017.04.002.
Medical residents working overnight call shifts experience sleep deprivation and circadian clock disruption. This leads to deficits in sensorimotor function and increases in workplace accidents. Using quick tablet-based tasks, we investigate whether measureable executive function differences exist following a single overnight call versus routine shift, and whether factors like stress, rest and caffeine affect these measures.
A prospective, observational, longitudinal, comparison study was conducted.
An academic tertiary hospital's main operating room suite staffed by attending anesthesiologists, anesthesiology residents, anesthesiologist assistants and nurse anesthetists.
Subjects were 30 anesthesiology residents working daytime shifts and 30 peers working overnight call shifts from the University of Texas Health Science Center at Houston.
Before and after their respective work shifts, residents completed the Stanford Sleepiness Scale (SSS) and the ProPoint and AntiPoint tablet-based tasks. These latter tasks are designed to measure sensorimotor and executive functions, respectively.
The SSS is a self-reported measure of sleepiness. Response times (RTs) are measured in the pointing tasks.
Call residents exhibited increased RTs across their shifts (post-pre) on both ProPoint (p=0.002) and AntiPoint (p<0.002) tasks, when compared to Routine residents. Increased stress was associated with decreases in AntiPoint RT for Routine (p=0.007), but with greater increases in sleepiness for Call residents (p<0.001). Further, whether or not a Call resident consumed caffeine habitually was associated with ProPoint RT changes; with Call residents who habitually drink caffeine having a greater Pre-Post difference (i.e., more slowing, p<0.001) in ProPoint RT.
These results indicate that (1) overnight Call residents demonstrate both sensorimotor and cognitive slowing compared to routine daytime shift residents, (2) sensorimotor slowing is greater in overnight Call residents who drink caffeine habitually, and (3) increased stress during a shift reduces (improves) cognitive RTs during routine daytime but not overnight call shifts.
值夜班的住院医生会经历睡眠剥夺和昼夜节律紊乱。这会导致感觉运动功能缺陷，并增加工作场所事故。我们使用基于平板电脑的快速任务，调查在单次值夜班与常规轮班后，是否存在可测量的执行功能差异，以及压力、休息和咖啡因等因素是否会影响这些测量结果。
进行了一项前瞻性、观察性、纵向比较研究。
一家学术型三级医院的主手术室，由主治麻醉医生、麻醉住院医生、麻醉医生助理和麻醉护士组成。
受试者为来自休斯顿德克萨斯大学健康科学中心的30名值白班的麻醉住院医生和30名值夜班的同行。
在各自轮班前后，住院医生完成斯坦福嗜睡量表（SSS）以及基于平板电脑的ProPoint和AntiPoint任务。后两项任务分别旨在测量感觉运动和执行功能。
SSS是一种自我报告的嗜睡程度测量方法。在指向任务中测量反应时间（RTs）。
与常规轮班的住院医生相比，值夜班的住院医生在ProPoint（p = 0.002）和AntiPoint（p < 0.002）任务中的轮班期间（后 - 前）反应时间均增加。压力增加与常规轮班住院医生的AntiPoint反应时间减少相关（p = 0.007），但与值夜班住院医生的嗜睡程度增加相关（p < 0.001）。此外，值夜班的住院医生是否习惯性饮用咖啡因与ProPoint反应时间变化相关；习惯性饮用咖啡因的值夜班住院医生在ProPoint反应时间上的前后差异更大（即减慢更多，p < 0.001）。
这些结果表明，（1）与常规白班住院医生相比，值夜班的住院医生表现出感觉运动和认知功能减慢，（2）习惯性饮用咖啡因的值夜班住院医生感觉运动减慢更明显，（3）轮班期间压力增加会降低（改善）常规白班期间的认知反应时间，但不会降低值夜班期间的认知反应时间。
