Nishida Masaki, Kikuchi Senichiro, Miwakeichi Fumikazu, Suda Shiro
a Department of Psychiatry , Jichi Medical University , Shimotsuke , Japan.
b Faculty of Sports Science , Waseda University , Tokorozawa , Japan.
Med Educ Online. 2017;22(1):1379345. doi: 10.1080/10872981.2017.1379345.
Overwork, fatigue, and sleep deprivation due to night duty are likely to be detrimental to the performance of medical residents and can consequently affect patient safety.
The aim of this study was to determine the possibility of deterioration of cerebral function of sleep-deprived, fatigued residents using neuroimaging techniques.
Six medical residents were instructed to draw blood from artificial vessels installed on the arm of a normal cooperator. Blood was drawn at a similar time of the day, before and after night duty. To assess sleep conditions during night duty, the participants wore actigraphy units throughout the period of night duty. Changes in cerebral hemodynamics, during the course of drawing blood, were measured using a wearable optical topography system.
The visual analogue scale scores after night duty correlated negatively with sleep efficiency during the night duty (ρ = -0.812, p = 0.050). The right prefrontal cortex activity was significantly decreased in the second trial after night duty compared with the first (p = 0.028). The extent of [oxy-Hb] decrease, indicating decreased activity, in the right dorsolateral prefrontal cortex correlated negatively with the Epworth sleepiness score after night duty (ρ = -0.841, p = 0.036).
Sleep deprivation and fatigue after night duty, caused a decrease in the activity of the right dorsolateral prefrontal cortex of the residents, even with a relatively easy routine. This result implies that the brain activity of medical residents exposed to stress on night duty, although not substantially sleep-deprived, was impaired after the night duty, even though they apparently performed a simple medical technique appropriately. Reconsideration of the shift assignments of medical residents is strongly advised.
DLPFC: Dorsolateral prefrontal cortex; ESS: Epworth sleepiness scale; PSQI: Pittsburgh sleep quality index; ROI: Regions of interest; VAS: Visual analogue scale; WOT: Wearable optical topography.
由于值夜班导致的过度劳累、疲劳和睡眠剥夺可能对住院医师的工作表现产生不利影响，进而影响患者安全。
本研究旨在使用神经影像学技术确定睡眠不足、疲劳的住院医师脑功能恶化的可能性。
六名住院医师被要求从安装在正常合作者手臂上的人造血管中抽血。在值夜班前后的同一天相似时间进行抽血。为了评估值夜班期间的睡眠状况，参与者在整个值夜班期间佩戴活动记录仪。使用可穿戴光学地形图系统测量抽血过程中脑血流动力学的变化。
值夜班后的视觉模拟量表评分与值夜班期间的睡眠效率呈负相关（ρ = -0.812，p = 0.050）。与第一次相比，值夜班后的第二次试验中右侧前额叶皮质活动显著降低（p = 0.028）。右侧背外侧前额叶皮质中表明活动减少的[氧合血红蛋白]下降程度与值夜班后的爱泼华嗜睡量表评分呈负相关（ρ = -0.841，p = 0.036）。
即使是相对简单的日常工作，值夜班后的睡眠剥夺和疲劳也会导致住院医师右侧背外侧前额叶皮质活动减少。这一结果表明，尽管值夜班的住院医师没有严重睡眠不足，但在值夜班后，即使他们显然正确地执行了一项简单的医疗技术，其大脑活动仍受到损害。强烈建议重新考虑住院医师的轮班安排。
DLPFC：背外侧前额叶皮质；ESS：爱泼华嗜睡量表；PSQI：匹兹堡睡眠质量指数；ROI：感兴趣区域；VAS：视觉模拟量表；WOT：可穿戴光学地形图
