RICERCA ITALIANA     

Sleep-debt effects on procedural learning and on clinical and cognitive performance in resident physicians: the protective function of naps

Università degli Studi di Bologna

Abstract

The project will examine two of the most crucial worldwide problems of the new programs of postgraduate medical education: the estimate of the consequences of sleep debt due to working overnight on clinical activities and learning processes, and the evaluation of the efficacy of different nap strategies in counteracting the effects of sleep loss and fatigue in resident physicians. There are estimated to be about 5,000 resident physicians per year in Italy.
Decreases in vigilance during long periods of sustained wakefulness are a serious problem for activities in industrial and transport areas as well as in public health. Both field surveys and laboratory studies have shown that alterations of the sleep-wake cycle almost inevitably leads to an increase of “human errors” as well as to a deterioration of cognitive and professional performance and of learning processes.
Working overnight is a prominent feature of medical residency as part of a comprehensive 24-hour medical service to patients, and is included in educational programs of post-graduate training for young physicians (residents). This training also requires an involvement in on-call duties and urgencies.
Several studies have emphasized the effects of sleepiness on medical errors of commission and, to a lesser extent, omission. These errors are consequent to decrements in vigilance and in psychomotor abilities as well as in executive functions and cognitive flexibility (needed to correct errors >>>

Principal Investigator

Carlo Cipolli Università degli Studi di BOLOGNA

Research Objectives

The project will examine two of the most crucial worldwide problems of the new programs of postgraduate medical education, namely the estimate of the consequences of sleep debt due to working overnight on the clinical activities and learning processes, and the evaluation of the efficacy of different nap strategies in counteracting the effects of sleep loss and fatigue in resident physicians. Their number can be estimated in about 5,000 per year in Italy. The formal procedure of involvement of resident physicians in the clinical activities of all divisions of the hospitals included in the network of each postgraduate program has been recently approved and will be applied in the present academic year (see D.P.C. M. 6/7/2007). Consequently, this will lead to an increase of the risk of an heavy exposure to working night as a routine and, thus, of the interest in better designing the work-schedule within clinical division and in suggesting strategies to better counteract the negative effects of sleep debt.

The present project attempts at gathering pertinent and consistent evidence on both these issues by examining a large sample (more than 1200) of resident physicians. The 5 Research Units will apply the same experimental design in order to assess resident physicians at the same hours and with the same timing on distinct tasks. The main aim is to gather coherent indications about the deterioration, as a consequence of sleep debt induced by working overnight, of >>>

First Results

The project will lead to collect a great amount of data, a large part of which of potential interest to deepen our knowledge of the temporary and delayed (and perhaps permanent) effects of sleep deprivation on learning of new skills by resident physicians (reducing, in this way, the scope of the postgraduate programs). Moreover, the data will allow to establish for the first time the effectiveness of three nap strategies in counteracting the negative influence of sleep deprivation and, thus, providing important indications as to the basic questions of the protective function of naps, their optimal duration and circadian location.

Each Unit will provide potentially important findings, and more information will come from the integration of the findings of the 5 Units. In general terms, the analysis of the subjective and objective data of sleepiness, fatigue and stress collected by all Units of the project may provide further insight into the relationship between sleep deprivation (in controlled situations) and clinical performance. In particular, they will be useful to estimate the prediction power of subjective measures of sleepiness and of deprivation- and fatigue-related stress with respect to the deterioration of cognitive and clinical performance and of learning processes.
Given that the same experimental design is shared by all the research units and the homogeneity of the samples, it seems legitimate to argue from the data collected by distinct >>>

Timescale

24 months

National and international background

It has been estimated that about one sixth of the workforce in western countries operates outside standard daytime hours, with a large proportion of night-time work hours (Boivin et al., 2007). The social and economic effects of working within atypical schedules and with sleep curtailment have been long outlined, as leading to increased risk of accidents, impaired performance and negative effects on health, well-being and life satisfaction (Rosekind, 2005). Shift work, in particular, has also shown to be associated with an increased perception of mental and physical fatigue and, not rarely, with sleep disorders, such as excessive sleepiness and/or sleep disruption (Am Acad Sleep Medicine, 2005, 2nd Ed, 2005).
In particular, decreases in vigilance during sustained wakefulness are a serious problem for applied areas such as public health and medical care. Working overnight is a prominent feature of medical residency as part of a comprehensive 24-hour medical service to patients and is a prominent feature of educational programs of post-graduate training for young doctors (interns and residents). This training also consists of a progressive involvement in on-call duties and urgencies in the teaching hospitals. In these clinical activities time pressure is usually high, also because fatigue is associated with reduced alertness as a consequence of sleep debt and with a high level of stress in taking decisions regarding newly acquired or unfamiliar diagnostic and >>>