Sleep Loss and Performance of Anaesthesia Trainees and Specialists

Show simple item record Gander, Philippa en Miller, MA en Webster, Craig en Merry, Alan en 2012-04-02T00:51:28Z en 2014-10-28T22:56:08Z en 2008 en
dc.identifier.citation Chronobiology International, 2008, 25 (6), pp. 1077 - 1091 (15) en
dc.identifier.issn 0742-0528 en
dc.identifier.uri en
dc.description.abstract Fatigue risk associated with work schedules of hospital doctors is coming under increasing scrutiny, with much of the research and regulatory focus on trainees. However, provision of 24 h services involves both trainees and specialists, who have different but interdependent work patterns. This study examined work patterns, sleep (actigraphy, diaries) and performance (psychomotor vigilance task pre- and post-duty) of 28 anaesthesia trainees and 20 specialists across a two-week work cycle in two urban public hospitals. Trainees at one hospital worked back-to-back 12 h shifts, while the others usually worked 9 h day shifts but periodically worked a 14 h day (08:00–22:00 h) to maintain cover until arrival of the night shift (10 h). On 11% of day shifts and 23% of night shifts, trainees were working with 2 h of acute sleep loss. However, average sleep loss was not greater on night shifts, possibly because workload at night in one hospital often permitted some sleep. Post-night shift performance was worse than post-day shift performance for the median (t(131) ¼ 3.57, p , 0.001) and slowest 10% of reaction times (t(134) ¼ 2.91, p , 0.01). At the end of night shifts, poorer performance was associated with longer shift length, longer time since waking, greater acute sleep loss, and more total work in the past 24 h. Specialists at both hospitals had scheduled clinical duties during the day and were periodically scheduled on call to cover after-hours services. On 8% of day shifts and 14% of day þ call schedules, specialists were working with 2 h of acute sleep loss. They averaged 0.6 h less sleep when working day shifts (t(23.5) ¼ 2.66, p ¼ 0.014) and 0.8 h less sleep when working day shifts þ call schedules (t(26.3) ¼ 2.65, p ¼ 0.013) than on days off. Post-duty reaction times slowed linearly across consecutive duty days (median reaction time, t(131) ¼ 23.38, p , 0.001; slowest 10%, t(160)¼23.33, p , 0.01; fastest 10%, t(138) ¼ 22.67, p , 0.01). Poorer post-duty performance was associated with greater acute sleep loss and longer time since waking, but better performance was associated with longer day shifts, consistent with circadian improvement in psychomotor performance across the waking day. This appears to be the first study to document sleep loss among specialist anaesthetists. Consistent with observations from experimental studies, the sleep loss of specialists across 12 consecutive working days was associated with a progressive decline in post-duty PVT performance. However, this decline occurred with much less sleep restriction (, 1 h per day) than in laboratory studies, suggesting an exacerbating effect of extended wakefulness and/or cumulative fatigue associated with work demands. For both trainees and specialists, robust circadian variation in PVT performance was evident in this complex work setting, despite the potential confounds of variable shift durations and workloads. The relationship between PVT performance of an individual and the safe administration of anaesthesia in the operating theater is unknown. Nevertheless, the findings reinforce that any schedule changes to reduce work-related fatigue need to consider circadian performance variation and the potential transfer of workload and fatigue risk between trainees and specialists. en
dc.publisher Informa Healthcare en
dc.relation.ispartofseries Chronobiology International en
dc.relation.replaces en
dc.relation.replaces 2292/16322 en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from: en
dc.rights.uri en
dc.title Sleep Loss and Performance of Anaesthesia Trainees and Specialists en
dc.type Journal Article en
dc.identifier.doi 10.1080/07420520802551428 en
pubs.issue 6 en
pubs.begin-page 1077 en
pubs.volume 25 en
dc.rights.holder Copyright: Informa Healthcare en
dc.identifier.pmid 19005906 en en
pubs.end-page 1091 en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 79486 en Medical and Health Sciences en School of Medicine en Cent Medical & Hlth Sci Educat en
dc.identifier.eissn 1525-6073 en
pubs.record-created-at-source-date 2010-09-01 en
pubs.dimensions-id 19005906 en

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