Sleep deprivation in interventional cardiology: Implications for patient care and physician‐health

Abstract

The burden and impact of sleep deprivation on both patient care and on the health of interventional cardiologists is not well understood. Due to the nature of emergent procedures occurring in the cardiac catheterization laboratory, interventionalists are prone to suffer from acute and/or chronic sleep deprivation. Sleep deprivation has been associated with numerous adverse effects, such as impaired performance, cognitive deficits, reduced psychomotor vigilance, and workplace errors and injuries, among many others. Although sleep deprivation has been linked to more errors in trainees, there is paucity of data addressing outcomes in interventional cardiology. The purpose of this overview is to explore the possible impact of sleep deprivation on interventional cardiology in relation to patient care and physician health, and examine potential approaches to this issue.

Impact of sleep deprivation on the outcomes of percutaneous coronary intervention

“…It is therefore possible that sleep deprivation in other team members, or lack thereof, may affect outcomes in ways that we were not able to measure . Finally, there are many potential effects of sleep deprivation that we could not study, such as physician demeanor and physician health . While effects in these areas may not directly affect patient outcomes, they remain important areas for future research.…”

“…Additionally, although PCI is performed by a team that usually includes fellows, nurses, and technicians, the CathPCI Registry records only the primary operator. It is therefore possible that sleep deprivation in other team members, or lack thereof, may affect outcomes in ways that we were not able to measure . Finally, there are many potential effects of sleep deprivation that we could not study, such as physician demeanor and physician health .…”

“…However, younger physicians may be able to tolerate sleep deprivation better. Moreover interventional cardiologists may have lower sleep requirements than the general population . Some individuals, known as short sleepers, appear to be resistant to the effects of sleep deprivation .…”

“…Based on the results of our study, we do not recommend any formal restriction on physician call schedules in interventional cardiology. Given the lack of clear evidence that patient care is affected by physician sleep deprivation, the logistical challenges that come along with additional regulation are difficult to justify, especially as they would disproportionately affect smaller practices with less physicians to share call . Additionally, it is not clear that altering call schedules would decrease sleep deprivation in interventional cardiologists, as many physicians have personal and academic responsibilities that could potentially lead to sleep deprivation.…”

“…However, even in the absence of formal guidelines, there are measures that can be taken to help limit any potential risk of procedures performed by post‐call physicians. For example, complex and high risk procedures should not be scheduled on days following night call by the interventionalist, and post‐call physicians who feel sleep deprived should be allowed to have a shortened workday the following day if at all possible .…”