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The Risks and Implications of Excessive Daytime Sleepiness in Resident Physicians

Howard, Steven K. MD; Gaba, David M. MD; Rosekind, Mark R. PhD; Zarcone, Vincent P. MD

Academic Medicine:
Special Theme: Medical Errors: SPECIAL THEME RESEARCH REPORTS
Abstract

Purpose. To assess the levels of physiologic and subjective sleepiness in residents in three conditions: (1) during a normal (baseline) work schedule, (2) after an in-hospital 24-hour on-call period, and (3) following a period of extended sleep.

Method. In 1996, a within-subjects, repeated-measures study was performed with a volunteer sample of 11 anesthesia residents from the Stanford University School of Medicine using three separate experimental conditions. Sixteen residents were recruited and 11 of the 16 completed the three separate experimental conditions. Daytime sleepiness was assessed using the Multiple Sleep Latency Test (MSLT).

Results. MSLT scores were shorter in the baseline (6.7 min) and post-call (4.9 min) conditions, compared with the extended-sleep condition (12 min, p = .0001) and there was no significant difference between the baseline and post-call conditions (p = .07). There was a significant main effect for both condition (p = .0001) and time of day (p = .0003). Subjects were inaccurate in subjectively identifying sleep onset compared with EEG measures (incorrect on 49% of EEG-determined sleep episodes).

Conclusion. Residents' daytime sleepiness in both baseline and post-call conditions was near or below levels associated with clinical sleep disorders. Extending sleep time resulted in normal levels of daytime sleepiness. The residents were subjectively inaccurate determining EEG-defined sleep onset. Based on the findings from this and other studies, reforms of residents' work and duty hours are justified.

Author Information

Dr. Howard is associate professor of anesthesia, and Dr. Gaba is professor of anesthesia, both at the Patient Safety Center of Inquiry, VA Palo Alto Health Care System, and the Department of Anesthesia, Stanford University School of Medicine, Stanford, California. Dr. Zarcone is professor emeritus of psychiatry and behavioral science at the VA Palo Alto Health Care System and Stanford University School of Medicine. Dr. Rosekind, formerly director, Fatigue Countermeasures Program, NASA Ames Research Center, is currently president and chief scientist, Alertness Solutions, Inc., Cupertino, California.

Correspondence and requests for reprints should be addressed to Dr. Howard, Patient Safety Center of Inquiry, 112A, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304; telephone: (650) 858-3938; fax: (650) 852-3423; e-mail: 〈showard@stanford.edu〉.

The authors gratefully acknowledge Belinda Jump, MD, Tim Porath, MD, and Edward Wakabayashi for their technical assistance. This study was funded by a grant from the Anesthesia Patient Safety Foundation.

© 2002 Association of American Medical Colleges