Joyce Redinger1,2, Emmad Kabil1,3, Katherine T Forkin1,4, Amanda M Kleiman1,4, Lauren K Dunn1,5. 1. All authors are with the University of Virginia Health System, Department of Anesthesiology. 2. is PGY-3 Resident. 3. is PGY-4 Resident. 4. is Associate Professor of Anesthesiology. 5. is Associate Professor of Anesthesiology and Neurological Surgery.
Abstract
Background: Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. Objective: To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. Methods: A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. Results: Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. Conclusions: Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.
Background: Residency involves demanding training with long hours that may cause fatigue and sleep deprivation and adversely impact residents and patients under their care. Objective: To identify, using a narrative review, evidence-based interventions to reduce the physiologic effects of fatigue and sleep deprivation from overnight and night shift work. Methods: A PubMed literature search was conducted through August 30, 2021, using the terms "resident" and "sleep" in the title or abstract and further narrowed using a third search term. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses of human subjects written and published in English were included. Studies that were not specific to residents or medical interns or did not investigate an intervention were excluded. Additional studies were identified by bibliography review. Due to the heterogeneity of study design and intervention, a narrative review approach was chosen with results categorized into non-pharmacological and pharmacological interventions. Results: Initially, 271 articles were identified, which were narrowed to 28 articles with the use of a third search term related to sleep. Bibliography review yielded 4 additional articles. Data on interventions are limited by the heterogeneity of medical specialty, sample size, length of follow-up, and reliance on self-report. Non-pharmacological interventions including strategic scheduling and sleep hygiene may improve sleep and well-being. The available evidence, including randomized controlled trials, to support pharmacological interventions is limited. Conclusions: Non-pharmacological approaches to mitigating fatigue and sleep deprivation have varying effectiveness to improve sleep for residents; however, data for pharmacological interventions is limited.
Authors: Laura K Barger; Jason P Sullivan; Terri Blackwell; Conor S O'Brien; Melissa A St Hilaire; Shadab A Rahman; Andrew J K Phillips; Salim Qadri; Kenneth P Wright; Jeffrey L Segar; John K McGuire; Michael V Vitiello; Horacio O de la Iglesia; Sue E Poynter; Pearl L Yu; Phyllis Zee; Amy L Sanderson; Ann C Halbower; Steven W Lockley; Christopher P Landrigan; Katie L Stone; Charles A Czeisler Journal: Sleep Date: 2019-08-01 Impact factor: 5.849
Authors: David S Black; Gillian A O'Reilly; Richard Olmstead; Elizabeth C Breen; Michael R Irwin Journal: JAMA Intern Med Date: 2015-04 Impact factor: 21.873
Authors: Kevin G Volpp; Judy A Shea; Dylan S Small; Mathias Basner; Jingsan Zhu; Laurie Norton; Adrian Ecker; Cristina Novak; Lisa M Bellini; C Jessica Dine; Daniel J Mollicone; David F Dinges Journal: JAMA Date: 2012-12-05 Impact factor: 56.272