A review of studies concerning effects of sleep deprivation and fatigue on residentsʼ performance

Abstract

Possible effects of sleep deprivation and fatigue on the performance and well-being of residents have received little scientific examination until recently. This article is a review of the studies on this topic published since 1970. All those studies that dealt with residents' moods and attitudes demonstrated deleterious effects of sleep deprivation and fatigue. The implications of this finding for patient care deserve exploration. Residents' acuity on performance tests requiring prolonged vigilance tended to deteriorate with acute sleep loss, while their performances on most brief psychomotor tests measuring manual dexterity, reaction times, and short-term recall were not adversely affected. The data presently available suggest that sleep-deprived or fatigued house officers can compensate for sleep loss in crises or other novel situations. However, sleep-deprived residents may be more prone to errors on routine, repetitive tasks and tasks that require sustained vigilance, which form a substantial portion of residents' workload. The authors concur with the recommendation of the Executive Council of the Association of American Medical Colleges that the total working hours for residents should not exceed 80 hours per week averaged over four weeks.

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

“…2,3 Paradoxically, in the natural environment there are well-documented deficits in decision making due to sleep deprivation. 4,5 In emergency response, disaster management, military encounters, and other fast-paced situations with uncertain outcomes and imperfect information, good decision making is significantly hampered by sleep deprivation. [6][7][8] Although the lapses of sustained attention that are characteristic of sleep deprivation contribute to errors and accidents, 3,8 attentional lapses are not the whole story of sleep deprivation effects on naturalistic decision making.…”

“…2,3 Paradoxically, in the natural environment there are well-documented deficits in decision making due to sleep deprivation. 4,5 In emergency response, disaster management, military encounters, and other fast-paced situations with uncertain outcomes and imperfect information, good decision making is significantly hampered by sleep deprivation. …”

Perceived sleepiness in Canadian anesthesia residents: a national survey

“…[1][2][3][4][5][6][7] This heightened attention has been driven by a growing body of literature on the deleterious effects of sleep deprivation on residents' wellbeing and performance. 2,3,[7][8][9][10] Studies have identified many domains affected by fatigue, including professionalism, learning, errors, and completion of complex cognitive tasks. [11][12][13] The increased incidence of postcall automobile accidents among interns and residents is well documented.…”

On resident duty hour restrictions and neurosurgical training: review of the literature

“…25,31,34 Also, there has been significant interest in the impact of fatigue on surgical skills. Much of the literature supporting a decrease in physical skill and ability cited by the ACGME in the initiation of DHR was based on studies conducted in nonsurgeons (military personnel and college-aged volunteers) in the self-promoted sleep science literature.…”