Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers

Abstract

Objectives Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision‐making. Medical professionals and specifically resident physicians, who are involved in long‐term nightshift schedules during their post‐graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute‐on‐chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. Methods Thirty‐three medical and surgical residents were evaluated twice ‐ at baseline and after a 26‐hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high‐sensitivity C‐reactive protein (hs‐CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk‐taking questionnaire and the Pittsburgh Sleep Quality Index. Results Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs‐CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk‐taking tendencies which were assessed in a separate cohort. Conclusions In a real‐life setting, resident physicians exhibit increased low‐grade systemic inflammation (hs‐CRP) and impaired HPA‐axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short‐term and potential long‐term risks to physicians in training.

Cortisol and C-Reactive Protein Vary During Sleep Loss and Recovery but Are Not Markers of Neurobehavioral Resilience

“…Cortisol increased after a night of TSD in all participants, consistent with some prior studies using healthy samples ( Leproult et al, 1997 ; Wright et al, 2015 ; Choshen-Hillel et al, 2021 ; Lamon et al, 2021 ), but not with others ( Åkerstedt et al, 1980 ; Vgontzas et al, 2004 ; Frey et al, 2007 ; van Leeuwen et al, 2009 ; Pejovic et al, 2013 ; Honma et al, 2020 ). Cortisol also decreased from TSD AM to TSD PM, reflecting its well-established, time-of-day profile ( Krieger et al, 1971 ; Czeisler et al, 1999 ).…”

“…Although well investigated, the effects of sleep deprivation on cortisol, a hypothalamic–pituitary–adrenal (HPA) axis marker, and C-reactive protein (CRP), an inflammatory marker, remain inconsistent: some studies report no change in cortisol ( Vgontzas et al, 2004 ; Frey et al, 2007 ; van Leeuwen et al, 2009 ; Pejovic et al, 2013 ; Honma et al, 2020 ) or CRP ( Faraut et al, 2011 ; Irwin et al, 2016 ; Choshen-Hillel et al, 2021 ), while others report decreases in cortisol ( Åkerstedt et al, 1980 ) or CRP ( Frey et al, 2007 ; Baek et al, 2020 ), or increases in cortisol ( Leproult et al, 1997 ; Wright et al, 2015 ; Baek et al, 2020 ; Choshen-Hillel et al, 2021 ; Lamon et al, 2021 ) or CRP ( Meier-Ewert et al, 2004 ; van Leeuwen et al, 2009 ). Similarly, studies have found that both acute and prolonged stress increase cortisol ( Jönsson et al, 2010 ; Allen et al, 2014 ) and CRP ( Eraly et al, 2014 ; Kennedy et al, 2014 ), although other studies reported no change in CRP ( La Fratta et al, 2018 ; Szabo et al, 2020 ).…”

Associations of Sleep Insufficiency and Chronotype with Inflammatory Cytokines in College Students

“… 10 Specifically, sleep problems affect circadian hormonal profiles and inflammatory markers, and may damage executive function, attention and decision-making capacity. 11 …”

“…10 Specifically, sleep problems affect circadian hormonal profiles and inflammatory markers, and may damage executive function, attention and decision-making capacity. 11 Like many biological processes, sleep is associated with immunity and inflammation and changes in circulating immune cells. 11 Inflammation is a process by which the body responds to injury or infection.…”

“…11 Like many biological processes, sleep is associated with immunity and inflammation and changes in circulating immune cells. 11 Inflammation is a process by which the body responds to injury or infection. 12 Cytokines are proved to be biomarkers of chronic low-grade inflammation which transmitting information from the immune system, regulating the inflammatory processes and mediating local and systemic reactions.…”