Ruan Alexandra, Klein Alexandra, Jhita Preya, Hasan-Hill Natalya, Shafer Steven L, Flood Pamela D
From the Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California.
Anesth Analg. 2023 Apr 1;136(4):701-710. doi: 10.1213/ANE.0000000000006261. Epub 2022 Nov 7.
Night float call systems are becoming increasingly common at training programs with the goal of reducing fatigue related to sleep deprivation and sleep disturbance. Previous studies have shown that trainees obtain less sleep during the night float rotation and have decreased sleep efficiency for several days after the rotation. The impact on physical and emotional well-being has not been documented.
Twenty-seven anesthesia residents were enrolled in a study using wearable sleep and activity trackers and National Institutes of Health Patient-Reported Outcome Measurement Information System (NIH PROMIS) surveys for sleep disturbance, fatigue, and positive affect to record data the week before ("baseline"), during ("night float"), and 1 week after ("recovery") their night float rotation. Each subject's data during the night float week and recovery week were compared to his or her own baseline week data using a paired, nonparametric analysis. The primary outcome variable was the change in average daily sleep hours during the night float week compared to the baseline week. Average daily rapid eye movement (REM) sleep, daily steps, and NIH PROMIS scores comparing night float and recovery weeks to baseline week were prespecified secondary outcomes. NIH PROMIS scores range from 0 to 100 with 50 as the national mean and more of the construct having a higher score.
There was no difference in average daily sleep hours between the night float and the baseline weeks (6.7 [5.9-7.8] vs 6.7 [5.5-7.7] hours, median [interquartile range]; P = .20). Residents had less REM sleep during the night float compared to the baseline weeks (1.1 [0.7-1.5] vs 1.4 [1.1-1.9] hours, P = .002). NIH PROMIS fatigue scores were higher during the night float than the baseline week (58.8 [54.6-65.1] vs 48.6 [46.0-55.1], P = .0004) and did not return to baseline during the recovery week (51.0 [48.6-58.8], P = .029 compared to baseline). Sleep disturbance was not different among the weeks. Positive affect was reduced after night float compared to baseline (39.6 [35.0-43.5] vs 44.8 [40.1-49.6], P = .0009), but returned to baseline during the recovery week (43.6 [39.6-48.2], P = .38).
The residents slept the same number of total hours during their night float week but had less REM sleep, were more fatigued, and had less positive affect. All of these resolved to baseline except fatigue, that was still greater than the baseline week. This methodology appears to robustly capture psychophysiological data that might be useful for quality initiatives.
夜间轮值呼叫系统在培训项目中越来越普遍，其目的是减少与睡眠剥夺和睡眠干扰相关的疲劳。先前的研究表明，实习生在夜间轮值期间睡眠较少，且轮值后的几天内睡眠效率下降。对身心健康的影响尚未有文献记载。
27名麻醉科住院医师参与了一项研究，使用可穿戴睡眠和活动追踪器以及美国国立卫生研究院患者报告结果测量信息系统（NIH PROMIS）进行睡眠干扰、疲劳和积极情绪方面的调查，以记录他们夜间轮值前一周（“基线”）、期间（“夜间轮值”）和轮值后1周（“恢复”）的数据。使用配对非参数分析将每位受试者夜间轮值周和恢复周的数据与其自身基线周的数据进行比较。主要结局变量是夜间轮值周与基线周相比平均每日睡眠时间的变化。将夜间轮值周和恢复周与基线周相比的平均每日快速眼动（REM）睡眠、每日步数和NIH PROMIS评分预先设定为次要结局。NIH PROMIS评分范围为0至100，全国平均分为50，该指标得分越高越好。
夜间轮值周与基线周的平均每日睡眠时间无差异（6.7[5.9 - 7.8]小时 vs 6.7[5.5 - 7.7]小时，中位数[四分位间距]；P = 0.20）。与基线周相比，住院医师在夜间轮值期间的REM睡眠较少（1.1[0.7 - 1.5]小时 vs 1.4[1.1 - 1.9]小时，P = 0.002）。夜间轮值期间NIH PROMIS疲劳评分高于基线周（5
