《比较重症监护与普通内科轮训住院医师的睡眠与警觉性：iCOMPARE 试验的二次分析》

Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations: A Secondary Analysis of the iCOMPARE Trial.

机构信息

is a Lecturer, University of Pennsylvania.

is a Professor, University of Pennsylvania.

出版信息

J Grad Med Educ. 2021 Oct;13(5):717-721. doi: 10.4300/JGME-D-21-00045.1. Epub 2021 Oct 15.

DOI:10.4300/JGME-D-21-00045.1

PMID:34721802

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8527933/

Abstract

BACKGROUND

Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear.

OBJECTIVE

To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations.

METHODS

This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed.

RESULTS

Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, < .001) and 6am-12pm (2.6 vs 1.9, = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, < .001).

CONCLUSIONS

Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.

摘要

背景

医学实习生由于工作时间长且经常轮班，存在睡眠不足的风险。然而，特定轮班对睡眠的影响尚不清楚。

目的

比较内科住院医师在住院重症监护病房（ICU）与普通内科（GM）轮班期间的睡眠时间和警觉性差异。

方法

本二次分析比较了来自 12 个内科住院医师培训计划的随机试验（2015-2016 年）中 GM 或 ICU 轮班期间的实习生，这些计划被分配到不同的工作时间限制政策（标准 16 小时轮班或无轮班时间限制）。主要结果是使用连续手腕活动记录仪在 13 天内测量的 24 小时睡眠时间。在同时进行活动记录仪测量的每个早晨评估的次要结果包括睡眠（卡罗林斯卡睡眠量表[KSS]）、警觉性（简短精神运动 vigilance 测试[PVT-B]失误次数）和过去 24 小时内过度嗜睡的自我报告。线性混合效应模型具有随机程序截距，通过控制年龄、性别和遵循的工作时间政策，确定了每个结果与旋转之间的关联。

结果

在 398 名实习生中，386 名被纳入（GM 组 n = 261，ICU 组 n = 125）。平均睡眠时间分别为 7.00±0.08h 和 6.84±0.10h，PVT-B 失误次数分别为 5.5±0.5 和 5.7±0.7（均>0.05）。两种旋转的 KSS 均为 4.8±0.1。与 GM 相比，ICU 实习生报告从 12am-6am（2.6 比 1.7，<0.001）和 6am-12pm（2.6 比 1.9，=0.013）过度嗜睡的天数更多，并且睡眠时间<6 小时的天数百分比更高（27.6%比 23.4%，<0.001）。GM 实习生报告无过度嗜睡的天数更多（5.3 比 3.7，<0.001）。