Effects of partial sleep deprivation following night shift on cognitive functions of Egyptian anesthesiologists; prospective observational study

Abstract

Background: Anesthesiologists in Egypt as a representative of developing countries with large populations and shortage of trained personnel and extended working hours that may reach 30 continuous hours are susceptible victims of fatigue and sleep deprivation. Objectives: To evaluate and compare differences in cognitive function of anesthesia residents before and after the 24 hours work shift. Methods: Prospective, observational, cohort study that was conducted in tertiary care hospital (Kasr El-Aini Hospital, Faculty of Medicine, Cairo University). Fifty anesthesia residents with 24 hours working shift participated in the study. The cognitive function was assessed before and after the shift using Psychomotor Vigilance Task, Karolinska Sleepiness Scale, Epworth Sleepiness Scale and Trail Making Test before and after the shift. Results: Psychomotor Vigilance Task mean reaction time before and after shift was 302.1 ± 35.2 ms and 371.9 ± 55.4 ms, respectively (P value < 0.001). Karolinska Sleepiness Scale mean before and after shift was 3.34 ± 1.189 and 6.24 ± 1.589, respectively (P value < 0.001). Epworth Sleepiness Scale mean before and after shift was 6.68 ± 2.759 and 14.86 ± 3.423, respectively (P value < 0.001). Trail Making Test mean times in both parts A and B, before shifts were 38.82 ± 8.458 and 63.16 ± 11.557 s, respectively. While, post shifts mean times were 44.86 ± 9.370 and 72.60 ± 12.294 s, respectively (P value < 0.001 for both parts). Conclusions: Sleep deprivation in night shifts increases the day-time sleepiness and affects the anesthesiologist' cognitive processes, such as reaction time, alertness, rapid problem solving, psychomotor skills, attention, mental flexibility, and executive functions.Clinical trial registration ID: clinicaltrials.gov: NCT03784560.

The effects of work on cognitive functions: a systematic review

“…Among 64 studies included in the systematic review, 39 were related to the effect of shift work on cognitive functions ( Table 4 ) ( Deary and Tait, 1987 ; Orton and Gruzelier, 1989 ; Lingenfelser et al, 1994 ; Smith et al, 1995 ; Petru et al, 2005 ; Rouch et al, 2005 ; Saricaoğlu et al, 2005 ; Griffiths et al, 2006 ; Chang et al, 2011 , 2013a , b ; Anderson et al, 2012 ; Shwetha and Sudhakar, 2012 , 2014 ; Niu et al, 2013 ; Özdemir et al, 2013 ; Veddeng et al, 2014 ; Kazemi et al, 2016 , 2018 ; Maltese et al, 2016 ; Titova et al, 2016 ; Vajravelu et al, 2016 ; Haidarimoghadam et al, 2017 ; Soares and de Almondes, 2017 ; Williams et al, 2017 ; Persico et al, 2018 ; Taylor et al, 2019 ; Abdelhamid et al, 2020 ; Adams and Venter, 2020 ; Athar et al, 2020 ; James et al, 2021 ; Prasad et al, 2021 ; Stout et al, 2021 ; Sun et al, 2021 ; Zhao et al, 2021 ; An et al, 2022 ; Benítez-Provedo et al, 2022 ; Esmaily et al, 2022 ; Peng et al, 2022 ).…”

“… Abdelhamid et al (2020) evaluated the differences in cognitive functions among 50 anaesthesia residents before and after a 24-h shift and found that after the shift their cognitive processes were impaired. Adams and Venter (2020) wanted to quantify the effects of shift work on cognitive functions in anaesthesiology trainees and observed that after 14-h night shift they had a decline in reaction time, psychomotor functions and attention.…”

“…Many studies focused their attention on the negative effects of shift work on circadian rhythm ( Schettini et al, 2023 ) and consequently on sleep and cognitive functions. Particularly, most studies highlighted detrimental effects: such among healthcare workers, medical professionals, as anaesthesiologists had a decline in reaction time, problem-solving, attention, and mental flexibility after night shift ( Saricaoğlu et al, 2005 ; Griffiths et al, 2006 ; Williams et al, 2017 ; Abdelhamid et al, 2020 ; Adams and Venter, 2020 ; Prasad et al, 2021 ), nurses had affected reaction time, motor ability, attention, cognitive flexibility, working memory, and decision making after work shift ( Chang et al, 2011 , 2013a , b ; Niu et al, 2013 ; James et al, 2021 ; Sun et al, 2021 ; An et al, 2022 ; Esmaily et al, 2022 ; Peng et al, 2022 ), other categories of physicians(intensivists, emergency doctors, gynaecologists, junior doctors, hospital doctors, medical house officers, postgraduate year one physicians) had a deficit in attention, executive function, memory, motor function, and reaction time after night shift ( Deary and Tait, 1987 ; Orton and Gruzelier, 1989 ; Lingenfelser et al, 1994 ; Anderson et al, 2012 ; Özdemir et al, 2013 ; Veddeng et al, 2014 ; Maltese et al, 2016 ; Persico et al, 2018 ; Benítez-Provedo et al, 2022 ). Other workers, such as security staff ( Vajravelu et al, 2016 ; Athar et al, 2020 ), control room operators ( Kazemi et al, 2016 , 2018 ; Haidarimoghadam et al, 2017 ), business process outsourcing employees ( Shwetha and Sudhakar, 2012 , 2014 ), power plant workers ( Smith et al, 1995 ), petrochemical workers ( Soares and de Almondes, 2017 ), firefighters ( Stout et al, 2021 ), police employees ( Taylor et al, 2019 ), miners ( Zhao et al, 2021 ), and generic groups of workers ( Rouch et al, 2005 ; Titova et al, 2016 ) had an impairment in one or more cognitive functions.…”

Effect of Sleep Hygiene Orientation on Social Cognition Impairments Due to Chronic Sleep Restriction in Mexican Medical Residents

“…Even acute exposure to sleep deprivation affects the cognitive performance of health personnel. Egyptian anesthesiologists exposed to 24-hour working shifts had increased daytime sleepiness and RTs and performed poorly on tasks that assess alertness, problem-solving, psychomotor skills, attention, and mental flexibility [18].…”