Effects of Call on Sleep and Mood in Internal Medicine Residents

Abstract

Residents on call experience decreased total sleep time (TST) and increased dysphoria. This study monitored changes in mood and sleepiness for 3 post-call days. Fifty-two internal medicine residents participated in the study. The residents wore actigraphs for the 4 to 9 days of the study. Each morning resident completed mood scales, a sleepiness scale, and estimated their prior night TST. The residents were on a 1-in-4 schedule. Call decreased subjective- and actigraphy-derived TST to less than 4 hr. During the 3 days post call, mood measures improved. Tension, depression, and anxiety stabilized on the first post-call day following the first night of off-call sleep during which the residents obtained about 7 hr of sleep. Vigor, fatigue, and confusion stabilized on the second post-call day. The Epworth Sleepiness Scale dropped to less than 11 after 1 post-call night and continued to decrease up to 3 post-call days. The effects of call linger past the first recovery night. For these residents, recovery sleep appeared inadequate, and the negative effects of call persisted across succeeding off-call days. Thus, for these residents on a 1-in-4 schedule, call affects their mood for much of the time when off call and potentially their personal and professional interactions during this period as well.

Physicians' attentional performance following a 24-hour observation period: do we need to regulate sleep prior to work?

“…Neurocognitive effects of resident and faculty physician sleep deprivation have been shown in many small studies including effects on fine motor skills,10 simulated surgical skills,11 psychomotor vigilance3 10 12–14 and a variety of cognitive outcomes 1–3 14–17. One resident study demonstrated prolonged neurobehavioural effects of sleep deprivation past the first night of recovery sleep after call shifts, suggesting that inadequate sleep was not recouped by one night of sleep postcall 18. This requires further study in larger studies examining overnight call in physicians and night shifts to see if adequate sleep prior to starting 24-hour call duties, or night shifts may help in minimising cognitive effects of physician sleep deprivation.…”

Sleep Quality as a Mediator Between Technology-Related Sleep Quality, Depression, and Anxiety

“…14 Sleep, depression, and anxiety: emerging associations with technology use It is well documented that poor sleep quality is related to higher levels of depression. 20,21 According to the ACHA-NCHA, 22 12 percent of students reported experiencing depression during their college years. Even more college students (19 percent) have been diagnosed with anxiety disorders during their college years.…”

Expectation of a loud alarm is not associated with changes in on-call sleep in the laboratory

“…The average score was 12.2 ± 4.6 (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] placing them within the normal range for their age and sex according to norms [26]. Therefore, pre-study PSS-10 scores indicate that the participants were not a high-stress group.…”

“…This is well supported in the literature, particularly the medical industry, where it is not uncommon to see sleep durations \2-4 h across on-call duty periods (e.g. [3][4][5]). Similar patterns have been observed in other industries, with ship engineers in one study taking approximately 32 min to action each alarm during on-call nights and as a result, experienced significantly shorter sleep [12].…”

“…The nature of overnight on-call work is that work is prioritised, which means that sleep can be significantly reduced during an on-call period (e.g. [3][4][5][6]). One consequence of inadequate sleep, particularly if accumulating over a number of nights, is cognitive performance impairment [7,8], which has implications for daily functioning both at work and at home.…”