Makayla Cordoza1, Mathias Basner2, David A Asch3, Judy A Shea2, Lisa M Bellini2, Michele Carlin4, Adrian J Ecker5, Susan K Malone6, Sanjay V Desai7, Joel T Katz8, David W Bates9, Dylan S Small2, Kevin G Volpp3, Christopher G Mott10, Sara Coats11, Daniel J Mollicone12, David F Dinges13. 1. is a Lecturer, University of Pennsylvania. 2. is a Professor, University of Pennsylvania. 3. is a Professor, University of Pennsylvania, and Practicing Physician, Corporal Michael J. Crescenz Veterans Affairs Medical Center. 4. is a Project Manager, University of Pennsylvania. 5. is a Senior IT Project Leader, University of Pennsylvania. 6. is an Assistant Professor, New York University. 7. is a Professor, Johns Hopkins University. 8. is Vice Chair for Education, Brigham and Women's Hospital. 9. is Division of General Internal Medicine Chief, Brigham and Women's Hospital. 10. is Chief Technology Officer, Pulsar Informatics. 11. is Lead Project Coordinator, Pulsar Informatics. 12. is Chief Executive Officer, Pulsar Informatics. 13. is a Professor, University of Pennsylvania; and iCOMPARE Research Group.
Abstract
BACKGROUND: Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. OBJECTIVE: To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. METHODS: This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. RESULTS: Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all P > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, P < .001) and 6am-12pm (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). CONCLUSIONS: Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.
BACKGROUND: Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. OBJECTIVE: To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. METHODS: This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015-2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. RESULTS: Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00±0.08h and 6.84±0.10h, and number of PVT lapses were 5.5±0.5 and 5.7±0.7 for GM and ICU, respectively (all P > .05). KSS was 4.8±0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12am-6am (2.6 vs 1.7, P < .001) and 6am-12pm (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P < .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). CONCLUSIONS: Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.
Authors: Mathias Basner; David F Dinges; Judy A Shea; Dylan S Small; Jingsan Zhu; Laurie Norton; Adrian J Ecker; Cristina Novak; Lisa M Bellini; Kevin G Volpp Journal: Sleep Date: 2017-04-01 Impact factor: 5.849
Authors: David A Kalmbach; Yu Fang; J Todd Arnedt; Amy L Cochran; Patricia J Deldin; Adam I Kaplin; Srijan Sen Journal: J Gen Intern Med Date: 2018-03-14 Impact factor: 5.128
Authors: Christopher P Landrigan; Shadab A Rahman; Jason P Sullivan; Eric Vittinghoff; Laura K Barger; Amy L Sanderson; Kenneth P Wright; Conor S O'Brien; Salim Qadri; Melissa A St Hilaire; Ann C Halbower; Jeffrey L Segar; John K McGuire; Michael V Vitiello; Horacio O de la Iglesia; Sue E Poynter; Pearl L Yu; Phyllis C Zee; Steven W Lockley; Katie L Stone; Charles A Czeisler Journal: N Engl J Med Date: 2020-06-25 Impact factor: 91.245
Authors: Jeffrey H Silber; Lisa M Bellini; Judy A Shea; Sanjay V Desai; David F Dinges; Mathias Basner; Orit Even-Shoshan; Alexander S Hill; Lauren L Hochman; Joel T Katz; Richard N Ross; David M Shade; Dylan S Small; Alice L Sternberg; James Tonascia; Kevin G Volpp; David A Asch Journal: N Engl J Med Date: 2019-03-07 Impact factor: 91.245
Authors: Yu-Hsuan Lin; Yen-Cheng Ho; Sheng-Hsuan Lin; Yao-Hsien Yeh; Chia-Yih Liu; Terry B J Kuo; Cheryl C H Yang; Albert C Yang Journal: PLoS One Date: 2013-06-04 Impact factor: 3.240