Nav: Home

Eliminating extended work shifts improves sleep duration for senior resident physicians

May 20, 2019

Getting a good night's sleep is important for everyone -- including physicians. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) set a limit on first-year resident physician shifts of 16 or fewer continuous hours of work. This policy change was based primarily on the results of studies comparing outcomes for first-year residents who worked extended-duration work shifts (24 hours or more) to those who worked rapid-cycling work shifts.

But data for more senior resident physicians has been lacking. Currently, resident physicians are permitted to work extended-duration shifts of up to 28 hours after their first postgraduate year. A new study led by investigators from Brigham and Women's Hospital is the first multi-center randomized clinical trial of senior resident physicians (postgraduate year two and higher) to compare the work hours and sleep obtained by those working extended shifts with those whose scheduled shift lengths were limited to no more than 16 consecutive hours. The team found that hours of sleep per week increased by 8 percent for pediatric resident physicians working under the modified schedule. The team's results are presented today at the American Thoracic Meeting and simultaneously published in Sleep.

"Sleep deficiency impairs performance and patient safety, adversely affects the mental and physical health of resident physicians and increases their risk of occupational injury and motor vehicle crashes," said senior author Charles Czeisler, PhD, MD, FRCP, chief of the Division of Sleep and Circadian Disorders at the Brigham, who presented the findings at the meeting. "This operational trial, conducted in six pediatric intensive care units across the country, showed that rosters eliminating scheduled extended-duration shifts reduced weekly work hours and improved sleep of resident physicians."

The current study enrolled 302 resident physicians working in pediatric intensive care units at six U.S. academic medical centers. Sleep was measured using wrist-worn actigraphs, and work hours and sleep data were collected using electronic diaries. In the clustered-randomized crossover clinical trial, resident physicians were randomized to an Extended Duration Work Roster (EDWR), with extended-duration (24 hours or more) shifts, or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours.

Resident physicians worked 10 percent fewer total hours per week during the RCWR compared to the EDWR and obtained significantly more sleep per week. Weekly sleep duration increased nearly four hours overall in the RCWR as compared to the EDWR.

The authors note that the RCWR schedule was implemented differently across the six hospitals and that more information is needed about optimal scheduling practices that ensure enough opportunity for residents to sleep.

"There is a compelling need for the design of schedules that enable sufficient sleep in settings that require safety-sensitive 24-hour operations," said corresponding author Laura Barger, PhD, an associate physiologist in the Division of Sleep and Circadian Disorders. "These findings extend the evidence from our previous single-site study, provide data on more senior resident physicians, and indicate that eliminating extended-duration shifts may improve sleep duration for senior resident physicians."
-end-
Funding for this work was provided by the National Heart, Lung, and Blood Institute (U01-HL-111478 and U01-HL-111691), National Institutes of Health (K24-HL-105664, R01-HL-128538, R01-HL-114088, R01-GM-105018, R21-HD-086392, P01-AG-009975 and NSBRI HFP-02802, HFP-0006, and HFP-04201) and the National Institute of Occupational Safety and Health (R01-OH-010300).

Paper cited: Barger, L et al. "Effects on Resident Work Hours, Sleep Duration and Work Experience in a Randomized Order Safety Trial Evaluating Resident-physician Schedules (ROSTERS)" Sleep.

Brigham and Women's Hospital

Related Sleep Articles:

Short sleep duration and sleep variability blunt weight loss
High sleep variability and short sleep duration are associated with difficulties in losing weight and body fat.
Nurses have an increased risk of sleep disorders and sleep deprivation
According to preliminary results of a new study, there is a high prevalence of insufficient sleep and symptoms of common sleep disorders among medical center nurses.
Opioids are not sleep aids, and can actually worsen sleep research finds
Evidence that taking opioids will help people with chronic pain to sleep better is limited and of poor quality, according to an interdisciplinary team of psychologists and medics from the University of Warwick in partnership with Lausanne University Hospital, Switzerland.
Common sleep myths compromise good sleep and health
People often say they can get by on five or fewer hours of sleep, that snoring is harmless, and that having a drink helps you to fall asleep.
New evidence on the association of shortened sleep time and obstructive sleep apnea with sleepiness and cardiometabolic risk factors
A new study in the journal CHEST® may change the way we think about sleep disorders.
More Sleep News and Sleep Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...