Choshen-Hillel Shoham, Ishqer Ahmad, Mahameed Fadi, Reiter Joel, Gozal David, Gileles-Hillel Alex, Berger Itai
School of Business Administration and the Federmann Center for the Study of Rationality, Hebrew University of Jerusalem, Jerusalem, Israel.
Pediatric Pulmonary and Sleep Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Med Educ. 2021 Feb;55(2):174-184. doi: 10.1111/medu.14296. Epub 2020 Aug 28.
Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision-making. Medical professionals and specifically resident physicians, who are involved in long-term nightshift schedules during their post-graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute-on-chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures.
Thirty-three medical and surgical residents were evaluated twice - at baseline and after a 26-hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high-sensitivity C-reactive protein (hs-CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk-taking questionnaire and the Pittsburgh Sleep Quality Index.
Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs-CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk-taking tendencies which were assessed in a separate cohort.
In a real-life setting, resident physicians exhibit increased low-grade systemic inflammation (hs-CRP) and impaired HPA-axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short-term and potential long-term risks to physicians in training.
睡眠不足会影响昼夜激素水平和炎症标志物，并可能调节注意力、执行功能和决策能力。医学专业人员，尤其是住院医师，在研究生培训期间需要长期值夜班，容易出现急性和慢性睡眠剥夺及睡眠紊乱，这使他们面临医疗差错的风险。本研究的目的是评估住院医师慢性及急性加慢性睡眠剥夺和紊乱对选定的生理和认知指标的影响。
33名内科和外科住院医师在基线时和连续值26小时班后接受了两次评估。18名不参与值夜班的年轻主治医师作为对照组，仅接受了一次评估。测量指标包括晨间皮质醇和高敏C反应蛋白（hs-CRP）、注意力和行为的计算机化测试、执行功能行为评定量表、冒险问卷以及匹兹堡睡眠质量指数。
住院医师报告存在慢性睡眠紊乱和剥夺，而主治医师则没有。与主治医师相比，住院医师在基线时晨间皮质醇水平降低，hs-CRP水平升高。与主治医师相比，住院医师在基线时整体执行功能受损。一次伴有急性睡眠剥夺的夜班进一步降低了住院医师的执行功能。与主治医师相比，住院医师在基线时和值夜班后表现出更高的冲动性和更长的处理时间。在另一组队列中评估的冒险倾向方面，住院医师和主治医师没有差异。
在实际工作环境中，住院医师表现出低度全身炎症（hs-CRP）增加和下丘脑-垂体-肾上腺（HPA）轴功能受损。他们的慢性睡眠减少与更高的冲动性、更慢的认知处理速度和执行功能受损有关。有必要进行进一步研究，以了解通过增加睡眠时间来改善工作时间表如何能将培训中的医师面临的短期和潜在长期风险降至最低。
