Sleep Deprivation in Cardiology: A Multidisciplinary Survey

The Israel Medical Association journal : IMAJ, 2013

Prolonged working hours and sleep deprivation can exert negative effects on professional performance and health. To assess the relationship between sleep deprivation, key metabolic markers, and professional performance in medical residents. We compared 35 residents working the in-house night shift with 35 senior year medical students in a cross-sectional cohort study. The Epworth Sleepiness Scale (ESS) questionnaire was administered and blood tests for complete blood count (CBC), blood chemistry panel, lipid profile and C-reactive protein (CRP) were obtained from all participants. Medical students and medical residents were comparable demographically except for age, weekly working hours, reported weight gain, and physical activity. The ESS questionnaires indicated a significantly higher and abnormal mean score and higher risk of falling asleep during five of eight daily activities among medical residents as compared with medical students. Medical residents had lower high density lip...

Frontiers in Neurology, 2010

This review begins with the history of the events starting with the death of Libby Zion that lead to the Bell Commission, that the studied her death and made recommendations for improvement that were codified into law in New York state as the 405 law that the ACGME essentially adopted in putting a cap on work hours and establishing the level of staff supervision that must be available to residents in clinical situations particularly the emergency room and acute care units. A summary is then provided of the findings of the laboratory effects of total sleep deprivation including acute total sleep loss and the consequent widespread physiologic alterations, and of the effects of selective and chronic sleep loss. Generally the sequence of responses to increasing sleep loss goes from mood changes to cognitive effects to performance deficits. In the laboratory situation, deficits resulting from sleep deprivation are clearly and definitively demonstrable. Sleep loss in the clinical situation is usually sleep deprivation superimposed on chronic sleep loss. An examination of questionnaire studies, the literature on reports of sleep loss, studies of the reduction of work hours on performance as well as observational and a few interventional studies have yielded contradictory and often equivocal results. The residents generally find they feel better working fewer hours but improvements in patient care are often not reported or do not occur. A change in the attitude of the resident toward his role and his patient has not been salutary. Decreasing sleep loss should have had a positive effect on patient care in reducing medical error, but this remains to be unequivocally demonstrated.

Sleep Medicine, 2011

The purpose of this study is to assess excessive daytime sleepiness (EDS) among attending physicians. Emails with an embedded link to an IRB approved questionnaire were sent to attending physicians of two closely affiliated academic institutions. An online hospital directory was used to compile a list of active attending physicians who practiced clinical medicine. Two additional reminder emails, about 2 weeks apart, were also sent. Data were collected anonymously and participation was voluntary. Three hundred fifteen responses out of 506 emails were returned (responder rate of 62.2%). The average age was 47 years and the majority was married with children. The mean Epworth Sleepiness Scale score was six and only 50 (15.9%) physicians were sleepy with a score of >10. Only working longer hours (p = 0.014), habitual napping (p = 0.01) and the feeling of not getting enough sleep (p = 0.01) significantly correlated with daytime sleepiness. Hours at work, however, did not correlate with hours of sleep, and the latter surprisingly did not correlate with sleepiness. Physicians in our sample were slightly more sleep deprived than the general population but not as sleep deprived as resident physicians.

International Journal of Occupational Medicine and Environmental Health, 2015

Objectives: Sleep disorders can affect health and occupational performance of physicians as well as outcomes in patients. The purpose of this study was to assess the prevalence of excessive daytime sleepiness (EDS) measured by the Epworth Sleepiness Scale (ESS) among academic physicians at a tertiary academic medical center in an urban area in the northwest region of Turkey, and to establish a relationship between the self-perceived sleepiness and the quality of life using the Eu-roQol-5 dimensions (EQ-5D). Material and Methods: A questionnaire prepared by the researchers after scanning the literature on the subject was e-mailed to the academic physicians of a tertiary academic medical center in Istanbul. The ESS and the EQ-5D were also included in the survey. The e-mail database of the institution directory was used to compile a list of active academic physicians who practiced clinical medicine. Paired and independent t tests were used for the data analysis at a significance level of p < 0.05. Results: Three hundred and ninety six academic physicians were e-mailed and a total of 252 subjects replied resulting in a 63.6% response rate. There were 84 (33.3%) female and 168 (66.7%) male academic physicians participating in the study. One hundred and eight out of 252 (42.8%) academic physicians were taking night calls (p < 0.001). Ninety study subjects (35.7%) felt they had enough sleep and 84 (33.3%) reported napping daily (p < 0.001). In our sample, 28.6% (N = 72) of the physicians felt sleepy during the day (ESS score > 10) (p < 0.001). In the case of the EQ-5D index and visual analogue scale of the EQ-5D questionnaire (EQ-5D VAS), the status of sleepiness of academic physicians was associated with a poorer quality of life (p < 0.001). Conclusions: More than a 1/4 of the academic physicians suffered from sleepiness. There was an association between the poor quality of life and daytime sleepiness. There was also a positive relationship between habitual napping and being sleepy during the day.

Sleep Medicine, 2007

To assess the sleepiness among Family Practice residents using subjective data, the Epworth sleepiness scale (ESS), as well as objective assessment, the multiple sleep latency test (MSLT). We conducted the study on Family Practice residents at Texas A&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;M University, Corpus Christi. Sixteen residents, aged 21-40 yrs, were recruited and divided into two groups. The study group was comprised of residents who were on night-float rotation for at least three days and underwent MSLT post-call, and the control group was comprised of residents who were not on night-float and were not post-call. Daytime sleepiness was evaluated using both the ESS and MSLT. Respondents also completed a questionnaire assessing their beliefs regarding effects of sleep loss. Sleep latencies &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 min were observed in 6 out of the 8 day shift-work interns, while only 1 out of 8 night-float residents had an average sleep latency &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;10 min (p=0.0195). Following night-float, despite less sleep, residents had sleep latencies which were higher [14.2 (+/-5.0) min] than those in the control group [8.4 (+/-5.4) min, (p=0.043)]. Despite the difference in objective sleepiness, subjective sleepiness (Epworth scores) did not differ. Over 80% of interns reported having driven while sleepy. Sleepiness continues to be a significant issue among medical residents despite recently mandated reductions in resident work hours. MSLT values in the pathologic range are seen in the majority of residents studied, but in those who were post-night call there seemed to be a paradoxical improvement.

Anaesthesia and intensive care, 2011

Healthcare workers&#39; cognitive performances and alertness are highly vulnerable to sleep loss and circadian rhythms. The purpose of this study was to investigate the changes in sleep characteristics of intensive care unit (ICU) and non-ICU physicians. Actigraphic sleep parameters, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Hamilton Depression Rating Scale were evaluated for ICU and non-ICU physicians on the day before shift-work and on three consecutive days after shift-work. Total sleep time, sleep latency, wakefulness after sleep onset, total activity score, movement fragmentation index, sleep efficiency, daytime naps and total nap duration were also calculated by actigraph. In the ICU physicians, the mean Pittsburgh Sleep Quality Index score was significantly higher than the non-ICU physicians (P = 0.001), however mean Epworth Sleepiness Scale scores were not found significantly different between the two groups. None of the scores for objective sleep paramete...

BMC Health Services Research, 2010

Background: It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group. The aim of the present study was to examine whether a 16-hour night-call schedule allowed for sufficient recovery in anaesthesiologists compared with other physician specialists handling less life-threatening conditions, when on call. Methods: Sleep, monitored by actigraphy and Karolinska Sleep Diary/Sleepiness Scale on one night after daytime work, one night call, the following first and second nights post-call, and a Saturday night, was compared between 15 anaesthesiologists and 17 paediatricians and ear, nose, and throat surgeons.

Sleep Medicine Research

Background and ObjectiveaaSleep deprivation has multiple pathophysiological, psychological and cognitive effects. The effects of sleep deprivation on anesthetists have been recognized both within and outside of the workplace. This study investigated the perceived effects of sleep deprivation on anesthetists. To document the longest time spent without sleep due to work schedule, to describe the perceptions of the effects of sleep deprivation and the degree of sleepiness and daytime fatigue symptoms using the Epworth Sleepiness Scale (ESS) and to describe measures taken by anesthetists to overcome sleepiness. MethodsaaA prospective, contextual, descriptive research design was followed for the study. A convenience sample of anesthetists completed a questionnaire regarding perceptions and effects of sleep deprivation and the ESS. Data were descriptively analyzed. resultsaaThe mean [standard deviation (SD)] longest time spent without sleep due to work schedule was 31 (9.1) hours and all anesthetists felt that they had insufficient sleep due to work schedule, with 61 (57%) stating this occurred 1 to 2 nights per week. Effects of sleep deprivation included effects on academic development, feeling tired at work, difficulty in concentrating at work and feeling stressed or irritable. Dozing off in theatre both during a night call and a day shift at different frequencies were reported. Other effects on family and social life were described. The mean (SD) ESS score was 11.5 (4.4). ConclusionsaaAnesthetists reported perceptions of inadequate sleep and the subsequent effects both at work and at home. Further research to determine the extent of sleep deprivation amongst anesthetists in South Africa is suggested.

Academic Medicine, 2004

Purpose. To identify and model the effects of sleep loss and fatigue on resident-physicians' professional lives and personal well-being. Method. In 2001-02, 149 residents at five U.S. academic health centers and from six specialties (obstetrics-gynecology, emergency medicine, family medicine, internal medicine, pediatrics, surgery) were recruited for the study. Residents were all in good standing in their programs. In a mixed-methods design, focus groups consisted of an average of seven (range, three to 14) individuals in the same year of training and residency program, for a total of 60 interns and 89 senior residents. Trained moderators conducted focus groups using a standardized, semistructured discussion guide. Participants also completed a 30item quantitative questionnaire assessing sleepiness and workplace sleep attitudes that included the Epworth Sleepiness Scale (ESS). Results. Residents described multiple adverse effects of sleep loss and fatigue on learning and cognition; job

Revista Question, 2022

Este trabajo se propone realizar una comprensión de la “violencia de género” como categoría antropológica a partir de los aportes de Rita Segato, específicamente los desarrollados en su libro Las estructuras elementales de la violencia. Ensayos sobre género entre la antropología, el psicoanálisis y los derechos humanos (2003) y se los vincula con las contribuciones de otras autoras feministas relevantes. Se indaga en las categorías de “género” y “patriarcado” para, luego, profundizar en las estructuras elementales de la “violencia de género” y sus posibles líneas de fuga hacia mundos más igualitarios. Palabras clave: violencia de género; patriarcado; género; antropología.