TY - JOUR
T1 - Sleep and Alertness Among Interns in Intensive Care Compared to General Medicine Rotations
T2 - A Secondary Analysis of the iCOMPARE Trial
AU - Cordoza, Makayla
AU - Basner, Mathias
AU - Asch, David A.
AU - Shea, Judy A.
AU - Bellini, Lisa M.
AU - Carlin, Michele
AU - Ecker, Adrian J.
AU - Malone, Susan K.
AU - Desai, Sanjay V.
AU - Katz, Joel T.
AU - Bates, David W.
AU - Small, Dylan S.
AU - Volpp, Kevin G.
AU - Mott, Christopher G.
AU - Coats, Sara
AU - Mollicone, Daniel J.
AU - Dinges, David F.
N1 - Publisher Copyright:
© 2021, Accreditation Council for Graduate Medical Education. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - Background Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. Objective To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. Methods This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015–2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. Results Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00+0.08h and 6.84+0.10h, and number of PVT lapses were 5.5+0.5 and 5.7+0.7 for GM and ICU, respectively (all P >.05). KSS was 4.8+0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12AM–6AM (2.6 vs 1.7, P < .001) and 6AM–12PM (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P, .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). Conclusions Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.
AB - Background Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. Objective To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) rotations. Methods This secondary analysis compared interns during a GM or ICU rotation from a randomized trial (2015–2016) of 12 internal medicine residency programs assigned to different work hour limit policies (standard 16-hour shifts or no shift-length limits). The primary outcome was sleep duration/24-hour using continuous wrist actigraphy over a 13-day period. Secondary outcomes assessed each morning during the concomitant actigraphy period were sleepiness (Karolinska Sleepiness Scale [KSS]), alertness (number of Brief Psychomotor Vigilance Test [PVT-B] lapses), and self-report of excessive sleepiness over past 24 hours. Linear mixed-effect models with random program intercept determined associations between each outcome by rotation, controlling for age, sex, and work hour policy followed. Results Of 398 interns, 386 were included (n = 261 GM, n = 125 ICU). Average sleep duration was 7.00+0.08h and 6.84+0.10h, and number of PVT lapses were 5.5+0.5 and 5.7+0.7 for GM and ICU, respectively (all P >.05). KSS was 4.8+0.1 for both rotations. Compared to GM, ICU interns reported more days of excessive sleepiness from 12AM–6AM (2.6 vs 1.7, P < .001) and 6AM–12PM (2.6 vs 1.9, P = .013) and had higher percent of days with sleep duration < 6 hours (27.6% vs 23.4%, P, .001). GM interns reported more days with no excessive sleepiness (5.3 vs 3.7, P < .001). Conclusions Despite ICU interns reporting more excessive sleepiness in morning hours and more days of insufficient sleep (<6 hours), overall sleep duration and alertness did not significantly differ between rotations.
KW - Critical Care
KW - Humans
KW - Internship and Residency
KW - Sleep
KW - Wakefulness
KW - Work Schedule Tolerance
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U2 - 10.4300/JGME-D-21-00045.1
DO - 10.4300/JGME-D-21-00045.1
M3 - Article
C2 - 34721802
AN - SCOPUS:85121335002
SN - 1949-8349
VL - 13
SP - 717
EP - 721
JO - Journal of graduate medical education
JF - Journal of graduate medical education
IS - 5
ER -