Chest
Volume 135, Issue 1, January 2009, Pages 81-85
Journal home page for Chest

Original Research
Sleep Medicine
Sleepiness in Medical ICU Residents

https://doi.org/10.1378/chest.08-0821Get rights and content

Background and methods

Sleepiness in medical residents has crucial implications for the safety of both patients and residents. Measures to improve this have primarily included an Accreditation Council for Graduate Medical Education-mandated reduction in work hours in residency programs. The impact of these work-hour limitations has not been consistent. The purpose of this study was to provide an objective assessment of daytime sleepiness in medical residents working in the medical ICU. Sleep times for 2 days/nights prior to on call and on the day/night of being on call were assessed by actigraphy and sleep diaries. On-call and post-call measurements of residents' sleepiness were measured both objectively, by means of a modified multiple sleep latency test (MSLT) [two nap sessions], as well as subjectively, by the Stanford Sleepiness Scale.

Results

Our data showed that despite an average sleep time of 7.15 h on nights leading to being on call, the mean sleep latency (MSL) on the on-call day was (± SD) 9 ± 4.4 min, and 4.8 ± 4.1 min (p < 0.001) on the post-call day. On the post-call day, 14 residents (70%) had an MSL of < 5 min, suggesting severe sleepiness, compared to 6 residents (30%) on the on-call day.

Conclusion

Our results demonstrate that residents working in the ICU despite reductions in work hours demonstrate severe degree of sleepiness post-call.

Section snippets

Setting

This institutional review board-approved protocol study was conducted at Ben Taub General Hospital, a tertiary care hospital affiliated with the Baylor College of Medicine, between August 2006 and February 2007. Consecutive internal medicine residents (postgraduate years 1, 2, and 3) rotating through the medical ICU (MICU) were recruited to participate in the study. A total of 21 residents were screened for the study. Signed informed consent forms were obtained from the subjects. One resident

Results

A total of 14 men and 6 women were studied (mean [± SD] age, 27.4 ± 2.21 years; mean body mass index, 24.3 ± 2.6).

Discussion

In 2003, in response to an accumulating body of evidence showing the deleterious influence of long work hours on resident sleepiness and its relationship to medical errors, the ACGME mandated a work-hour reduction. The standards limit the following: (1) the maximum number of hours a resident physician can work is limited to 80 h per week, averaged over 4 weeks; and (2) continuous duty time is limited to 24 h.5 The standards also require rest periods between duty shifts and that the resident has

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The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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