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Physicians' attentional performance following a 24-hour observation period: do we need to regulate sleep prior to work?
  1. P Smyth1,
  2. K Maximova2,
  3. J D Jirsch1
  1. 1Department of Medicine, University of Alberta, Edmonton, Canada
  2. 2School of Public Health, University of Alberta, Edmonton, Canada
  1. Correspondence to Dr P Smyth, Department of Medicine, University of Alberta FRCPC 7th Floor, Clinical Sciences Building 11350 83 Ave, Edmonton, AB, Canada T6G 2G3; penny.smyth{at}ualberta.ca

Abstract

Background The tradition of physicians working while sleep deprived is increasingly criticised. Medical regulatory bodies have restricted resident physician duty-hours, not addressing the greater population of physicians. We aimed to assess factors such as sleep duration prior to a 24-hour observation period on physicians' attention.

Methods We studied 70 physicians (mean age 38 years old (SD 10.8 years)): 36 residents and 34 faculty from call rosters at the University of Alberta. Among 70 physicians, 52 (74%) performed overnight call; 18 did not perform overnight call and were recruited to control for the learning effect of repetitive neuropsychological testing. Attentional Network Test (ANT) measured physicians' attention at the beginning and end of the 24-hour observation period. Participants self-reported ideal sleep needs, sleep duration in the 24 hours prior to (ie, baseline) and during the 24-hour observation period (ie, follow-up). Median regression models examined effects on ANT parameters.

Results Sleep deprivation at follow-up was associated with reduced attentional accuracy following the 24-hour observation period, but only for physicians more sleep deprived at baseline. Other components of attention were not associated with sleep deprivation after adjusting for repetitive testing. Age, years since medical school and caffeine use did not impact changes in ANT parameters.

Conclusions Our study suggests that baseline sleep before 24 hours of observation impacts the accuracy of physicians' attentional testing at 24 hours. Further study is required to determine if optimising physician sleep prior to overnight call shifts is a sustainable strategy to mitigate the effects of sleep deprivation.

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Footnotes

  • Contributors PS, as the corresponding author, contributed substantially to the conception and design of the study, acquisition of data and analysis and interpretation of data. She drafted the article and gave final approval of the version to be published. She agrees to act as a guarantor of the work. As co-author, KM contributed substantially to the analysis and interpretation of data and revised the article critically for important intellectual content. She gave final approval of the version to be published and agreed to act as a guarantor of the work. As the final author, JDJ contributed substantially to the conception and design of the study, acquisition of data and analysis and interpretation of data. He revised the article critically for important intellectual content. He has given final approval of the version to be published and agrees to act as a guarantor of the work.

  • Funding This study was funded by a Medical Education Grant, Department of Medicine, University of Alberta. KM holds a Career Development Award in Prevention from the Canadian Cancer Society (grant number 702936).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Human Research Ethics Board at the University of Alberta.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available on request. Requests should be submitted to the corresponding author or the Human Research and Ethics Board, University of Alberta.

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