Sleep and stress before and after duty across residency years under 2017 ACGME hours - 20/11/19

Doi : 10.1016/j.amjsurg.2019.10.049

Benjamin McManus ^a , James W. Galbraith ^b , Karen Heaton ^c , Sylvie Mrug ^a , Brent A. Ponce ^d , John R. Porterfield ^e , Mark C. Schall ^f , Despina Stavrinos ^a,^⁎
^a University of Alabama at Birmingham, Department of Psychology, United States
^b University of Mississippi Medical Center, Department of Emergency Medicine, United States
^c University of Alabama at Birmingham, School of Nursing, United States
^d University of Alabama at Birmingham, Department of Orthopaedic Surgery, United States
^e University of Alabama at Birmingham, Department of Surgery, United States
^f Auburn University, Industrial and Systems Engineering, United States

^∗Corresponding author. University of Alabama at Birmingham, Department of Psychology, 916 19th Street South, Birmingham, AL, 35294, United StatesUniversity of Alabama at BirminghamDepartment of Psychology916 19th Street SouthBirminghamAL35294United States

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 20 November 2019

Abstract

Introduction

Residents may differentially experience high stress and poor sleep across multiple post-graduate years (PGYs), negatively affecting safety. This study characterized sleep and stress among medical and surgical residents across multiple PGYs and at specific times surrounding duty.

Method

Thirty-two medical and surgical residents (M_age = 28.6 years; 56% male) across PGYs 1–5 participated in 3 appointments (immediately before duty, after duty, and on an off day) providing 96 data points. Sleep, stress, and occupational fatigue were measured by both self-report and objectively (actigraphy, salivary coritsol).

Results

Residents averaged 7 h of actigraphy-estimated sleep per night but varied ±3 h day-to-day. Residents reported clinically poor sleep quality. Life stress decreased by PGY-2. All residents averaged elevated life stress values. Poor sleep quality did not differ among PGY cohorts.

Discussion

Poor sleep quality is similar between early residency cohorts (PGY-1) and later residency cohorts (PGY-3+). Persistent fatigue is highest in later residency cohorts. Even the most experienced residents may struggle with persisting fatigue. Current hour policies may have shortcomings in addressing this risk.

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Highlights

•	Sleep duration varies plus or minus 3 h from day-to-day in residents.
•	Later residency cohorts show similar poor sleep quality as earlier cohorts.
•	Life-stress levels decrease in the second year of residency.
•	Persistent fatigue is higher in later residency cohorts compared to earlier cohorts.

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Keywords : Sleep, Stress, Burnout risk, Occupational, Safety, Health, Residency, ACGME