Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Sleep Health. 2024 Feb;10(1S):S25-S33. doi: 10.1016/j.sleh.2023.10.018. Epub 2023 Nov 25.
Mathematical models of human neurobehavioral performance that include the effects of acute and chronic sleep restriction can be key tools in assessment and comparison of work schedules, allowing quantitative predictions of performance when empirical assessment is impractical.
Using such a model, we tested the hypothesis that resident physicians working an extended duration work roster, including 24-28 hours of continuous duty and up to 88 hours per week averaged over 4weeks, would have worse predicted performance than resident physicians working a rapidly cycling work roster intervention designed to reduce the duration of extended shifts. The performance metric used was attentional failures (ie, Psychomotor Vigilance Task lapses). Model input was 169 actual work and sleep schedules. Outcomes were predicted hours per week during work hours spent at moderate (equivalent to 16-20 hours of continuous wakefulness) or high (equivalent to ≥20 hours of continuous wakefulness) performance impairment.
The model predicted that resident physicians working an extended duration work roster would spend significantly more time at moderate impairment (p = .02, effect size=0.2) than those working a rapidly cycling work roster; this difference was most pronounced during the circadian night (p < .001). On both schedules, performance was predicted to decline from weeks 1 + 2 to weeks 3 + 4 (p < .001), but the rate of decline was significantly greater on extended duration work roster (p < .01). Predicted performance impairment was inversely related to prior sleep duration (p < .001).
These findings demonstrate the utility of a mathematical model to evaluate the predicted performance profile of schedules for resident physicians and others who experience chronic sleep restriction and circadian misalignment.
包含急性和慢性睡眠限制影响的人类神经行为表现数学模型，可以成为评估和比较工作时间表的关键工具，允许在经验评估不切实际的情况下对性能进行定量预测。
我们使用这样的模型来检验一个假设，即连续工作 24-28 小时且每周平均工作 88 小时超过 4 周的住院医师，其预测表现将比连续工作 24 小时且每周平均工作 88 小时超过 4 周的住院医师更差，后者接受了快速循环工作时间表干预，旨在缩短延长班次的持续时间。使用的性能指标是注意力失败（即精神运动警觉任务失误）。模型输入是 169 个实际工作和睡眠时间表。结果是在工作时间内每周预测的中度（相当于 16-20 小时连续清醒）或高度（相当于≥20 小时连续清醒）表现受损时间。
模型预测，连续工作时间长的住院医师将花费更多的时间处于中度损伤状态（p=0.02，效应量=0.2），而不是那些快速循环工作时间表的住院医师；这种差异在昼夜节律夜间最为明显（p<0.001）。在两种时间表下，性能都预计从第 1 周+2 到第 3 周+4 下降（p<0.001），但在延长工作时间的时间表上下降速度明显更快（p<0.01）。预测的性能损伤与先前的睡眠持续时间呈反比（p<0.001）。
这些发现表明，数学模型可用于评估慢性睡眠限制和昼夜节律失调的住院医师和其他人员的时间表的预测表现情况，具有实用性。
