New research from the Perelman School of Medicine at the University of Pennsylvania and the Philadelphia VA Medical Center indicates that the implementation of protected sleep periods for residents who are assigned to overnight shifts in a hospital could possibly help to prevent fatigue and alleviate some of the physiological and behavioral effects of sleep deprivation among these doctors in training.
“Decades of research from the sleep medicine community have shown that prolonged periods of wakefulness and no sleep impact the performance and health of professionals who must be awake when much of the rest of the world sleeps, such as pilots, first responders and medical professionals,” senior study author David F. Dinges, PhD, said in a Penn press release. He is professor of psychology in psychiatry and chief of the Division of Sleep and Chronobiology in the Department of Psychiatry at Penn. “This study provides the first evidence that contrary to long held cultural beliefs within the medical community, young doctors are embracing the importance of sleep and looking for ways to increase their own performance to better treat their patients.”
The study, “Effect of a Protected Sleep Period on Hours Slept During Extended Overnight In-hospital Duty Hours Among Medical Interns: A Randomized Trial,” was published in the Dec. 5 edition of the Journal of the American Medical Association (JAMA). The study involved two randomized controlled trials conducted simultaneously between July 2009 and June 2010. The research team recruited 106 interns from the Hospital of the University of Pennsylvania and the Philadelphia VA Medical Center to one of two groups – either a standard intern shift of 30 hours overnight or a protected sleep period shift – during twelve 4-week blocks. Participants had to give their work cell phone to another resident to ensure appropriate coverage and patient care and also wore a wrist Actiwatch (a wristwatch-like device that monitors rest/activity cycles and light) and complete a sleep diary during the study.
Ninety-eight percent of the participants signed out their cell phones to covering residents as designed and the amount of time they slept while on call was increased by 50 percent (from two to three hours on average). Participants also decreased the overall amount of time they were awake, reducing periods of no sleep while on extended duty. The study participants reported far less sleep disturbances, helping to improve overall sleep quality.
In July 2011, medical residency programs across the country revamped physician-trainees’ schedules to comply with new work-hour restrictions imposed by the Accreditation Council for Graduate Medical Education (ACMGE). Under these regulations, first-year residents are no longer permitted to work more than 16 hours at a time. The changes were intended to enhance supervision of trainees by experienced physicians, improve transitions in patient care from one provider to another and alleviate concerns about residents’ fatigue during continuous periods of duty – which previously lasted up to 30 hours.
As the current study was not powered to look directly at patient outcomes, the authors say that additional comparative effectiveness research into this area will be important when considering widespread adoption of protected sleep periods in health care settings.
