Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review

Abstract

ObjectivesFor physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue.DesignWe systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively.Data sourcesWe searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites.Eligibility criteria for selecting studiesEnglish or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients.ResultsOf 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous.ConclusionsFatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.

Doctors’ Mental Health in the Midst of COVID-19 Pandemic: The Roles of Work Demands and Recovery Experiences

“…Fatigue among doctors is also associated with less enjoyment in work [ 18 ] and high turnover intention [ 19 ]. Other consequences include adverse health and wellbeing, work-life dissatisfaction, low quality of life, job dissatisfaction, and poor skill performance [ 20 ]. On the other hand, depressed doctors have been associated with improper medical treatment and adversely affect the attitudes towards patient care [ 21 ].…”

Informal fatigue-related risk management in the emergency department: A trade-off between doing well and feeling well

“…Multiple studies also demonstrated that mortality and morbidity rates were unaffected by the 2003 changes to duty hours (de Virigilio et al, 2006;Salim et al, 2007;Morrison et al, 2009). In a more recent meta-analysis, Gates et al (2018) concluded that fatigue and sleep deprivation are associated with detrimental physician health and well-being outcomes, but that there is insufficient evidence regarding the potential associations with clinical performance and patient safety.…”

“…Aside from methodological weaknesses and heterogeneity across studies, it has also been suggested that the inconsistency of these results may reside in the ability of some physicians to compensate fatigue-related impairments (Czeisler, 2009;Sade, 2015;Gates et al, 2018). Dawson and McCulloch (2005) first introduced the notion of fatigue proofing strategies (FPS) to refer to any compensatory strategies aiming to reduce the likelihood a sleep-deprived operator will make an error.…”

“…Although many investigations have looked at the detrimental effect of sleep deprivation (SD) on physician performance (Gates et al, 2018), as yet no studies have systematically evaluated the potential moderating role of informal FPS. The ability of some physicians to compensate for fatigue-related impairments may explain the inconsistency of the association between SD and clinical performance demonstrated in naturalistic studies (Czeisler, 2009;Sade, 2015).…”

Avaliação da sonolência do estudante de Medicina no Brasil e sua influência na qualidade de vida e ambiente de ensino

“…O sono adequado traz benefícios ao funcionamento cerebral e cognição, promove aprendizado e consolidação da memória, e reestabelece processos homeostáticos, como a conexão sináptica e a restauração física (Diekelmann and Born, 2010;Walker and Stickgold, 2016 (Belenky et al, 2003). A explicação para isso é que existe uma adaptação cerebral para sustentar um desempenho estável das funções motoras, embora pouco reduzidas (Gates et al, 2018).…”