So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents
- 214 Downloads
Sleep impairment is highly prevalent among resident physicians and is associated with both adverse patient outcomes and poor resident mental and physical health. Risk factors for sleep problems during residency are less clear, and no screening model exists to identify residents at risk for sleep impairment.
The objective of this study was to assess change in resident sleep during training and to evaluate utility of baseline sleep screening in predicting future sleep impairment.
This is a prospective observational repeated-measures survey study.
The participants comprised PGY-1 residents across multiple specialties at Partners HealthCare hospitals.
Main measures used for this study were demographic queries and two validated scales: the Pittsburgh Sleep Quality Index (PSQI), measuring sleep quality, and the Epworth Sleepiness Scale (ESS), measuring excessive daytime sleepiness.
Two hundred eighty-one PGY-1 residents completed surveys at residency orientation, and 153 (54%) completed matched surveys 9 months later. Mean nightly sleep time decreased from 7.6 to 6.5 hours (p < 0.001). Mean PSQI score increased from 3.6 to 5.2 (p < 0.001), and mean ESS score increased from 7.2 to 10.4 (p < 0.001). The proportion of residents exceeding the scales’ clinical cutoffs increased over time from 15 to 40% on the PSQI (p < 0.001) and from 26 to 59% on the ESS (p < 0.001). Baseline normal sleep was not protective: 68% of residents with normal scores on both scales at baseline exceeded the clinical cutoff on at least one scale at follow-up. Greater age and fewer children increased follow-up PSQI score (p < 0.001) but not ESS score.
During PGY-1 training, residents experience worsening sleep duration, quality of sleep, and daytime sleepiness. Residents with baseline impaired sleep tend to remain impaired. Moreover, many residents with baseline normal sleep experience sleep deterioration over time. Sleep screening at residency orientation may identify some, but not all, residents who will experience sleep impairment during training.
KEY WORDSmedical education—graduate physician behavior sleep disorders self-care hospital administration
All authors have made substantial contributions to the work described, including study design and manuscript writing. All authors attest to the validity of the data and conclusions. There are no other contributors.
This study was funded by the Department of Obstetrics, Gynecology, and Reproductive Biology at Massachusetts General Hospital.
Compliance with Ethical Standards
Poster Session, Harvard Psychiatry Research Day, Harvard Medical School, Boston, MA, April 12, 2017
Poster Session, MGH Clinical Research Day, Massachusetts General Hospital, Boston, MA, October 5, 2017
Conflict of Interest
Dr. Denninger has received support for investigator-initiated studies from Onyx/Amgen and Basis/Intel. All remaining authors declare that they do not have a conflict of interest.
- 1.Accreditation Council for Graduate Medical Education. ACGME Releases Revised Common Program Requirements, Section VI, The Learning and Working Environment. Chicago, IL: ACGME; 2017:1–3. http://www.acgme.org/Portals/0/PDFs/Nasca-Community/ACGME-Common-Press-Release-3-10-2017.pdf. Accessed 3 Jan 2018.
- 5.Smyth P, Maximova K, Jirsch JD. Physicians’ attentional performance following a 24-hour observation period: do we need to regulate sleep prior to work? Occur Environ Med. 2016. doi: https://doi.org/10.1136/oemed-2015-103489.
- 12.Smith A, Jain N, Wan J, Wang L, Sebelik M. Duty hour restrictions and surgical complications for head and neck key indicator procedures. Laryngoscope. 2016. doi: https://doi.org/10.1002/lary.26464.
- 13.Taylor TS, Nisker J, Teunissen PW, Dornan T, Lingard L. Recovery of sleep or recovery of self? A grounded theory study of residents’ decision making regarding how to spend their nonclinical postcall time. Acad Med. 2016; 91(3):395–400. doi: https://doi.org/10.1097/ACM.0000000000000942.CrossRefPubMedGoogle Scholar
- 22.de Winter JCF, Dodou, D. Five-point Likert items: t test versus Mann-Whitney-Wilcoxon. Pract Assess, Res Eval. 2010; 15(11).Google Scholar
- 23.Anderson C, Sullivan JP, Flynn-Evans EE, et al. Deterioration of neurobehavioral performance in resident physicians during repeated exposure to extended duration work shifts. Sleep. 2012; 35(8). doi: https://doi.org/10.5665/sleep.2004
- 28.McCormick F, Kadzielski J, Evans BT, Landrigan CP, Herndon J, Rubash H. Fatigue optimization scheduling in graduate medical education: reducing fatigue and improving patient safety. J Grad Med Educ. 2013; 5(1): 107–11. doi: https://doi.org/10.4300/JGME-D-12-00021.1 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Roshetsky LM, Coltri A, Flores A, et al. No time for teaching? Inpatient attending physicians’ workload and teaching before and after the implementation of the 2003 duty hours regulations. Acad Med. 2013; 88(9): 1293–1298. doi: https://doi.org/10.1097/ACM.0b013e31829eb795.CrossRefPubMedGoogle Scholar