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Effect of Pharmacological Enhancement on the Cognitive and Clinical Psychomotor Performance of Sleep-Deprived Doctors: A Randomized Controlled Trial

Sugden, Colin MBChB, MRCS*; Housden, Charlotte R. MSc; Aggarwal, Rajesh PhD*; Sahakian, Barbara J. PhD; Darzi, Ara MD*

doi: 10.1097/SLA.0b013e3182306c99
Randomized Controlled Trials

Objectives: To investigate the effect of modafinil 200 mg on the performance of a cohort of healthy male doctors after 1 night of supervised sleep deprivation.

Summary Background Data: Sleep-deprived and fatigued doctors pose a safety risk to themselves and their patients. Yet, because of the around-the-clock nature of medical practice, doctors frequently care for patients after periods of extended wakefulness or during circadian troughs. Studies suggest that a group of substances may be capable of safely and effectively reversing the effects of fatigue. However, little work has been done to investigate their role within our profession.

Methods: We conducted a parallel, double-blind, randomized, and placebo-controlled study to investigate the effect of pharmacological enhancement on performance doctors. Thirty-nine healthy male resident doctors received either lactose placebo (n = 19) or modafinil 200 mg (n = 20) after 1 night of sleep deprivation. A selection of CANTAB neuropsychological tests was used to assess higher cognitive function. Clinical psychomotor performance was assessed using the Minimally Invasive Surgical Trainer Virtual Reality. Assessments were carried out between 6.00 AM and approximately 8.00 AM.

Results: Modafinil improved performance on tests of higher cognitive function; participants in the modafinil group worked more efficiently when solving working memory (F1,38 = 5.24, P = 0.028) and planning (F1,38 = 4.34, P = 0.04) problems, were less-impulsive decision makers (F1,37 = 6.76, P = 0.01), and were more able to flexibly redirect their attention (F1,38 = 4.64, P = 0.038). In contrast, no improvement was seen in tests of clinical psychomotor performance.

Conclusions: Our results suggest that fatigued doctors might benefit from pharmacological enhancement in situations that require efficient information processing, flexible thinking, and decision making under time pressure. However, no improvement is likely to be seen in the performance of basic procedural tasks.

Sleep deprivation impairs human performance in a dose-response fashion and is linked with poor clinical decision-making and medical error. In this randomized controlled study, we show that pharmacological enhancement is effective in improving the cognitive function of fatigued doctors, but basic procedural skills remain unchanged.

*Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom

Department of Psychiatry, MRC/Wellcome Trust Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.

Reprints: Colin Sugden, MB ChB, MRCS, Department of Surgery and Cancer, Imperial College, St Mary's Hospital Campus, Praed St, London W2 1NY, United Kingdom. E-mail: c.sugden@imperial.ac.uk.

B.J.S. has consulted for several pharmaceutical companies and for Cambridge Cognition in the previous 3 years and has shares in CeNeS. C.S., C.R.H., R.A., and A.D. have had no relationship with companies that might have an interest in the submitted work. C.S., C.R.H., R.A., B.J.S., and A.D. have no spouses, partners, or children with financial relationships that may be relevant to the submitted work. C.S., C.R.H., R.A., B.J.S., and A.D. have no nonfinancial interests that may be relevant to the submitted work. C.S. and C.R.H. contributed jointly to the submitted work.

Disclosure: Funded exclusively by Imperial College London. No contribution was made to the design, data collection, analysis and interpretation of the data, the writing of the article, or the decision to submit for publication, other than by the named authors.

© 2012 Lippincott Williams & Wilkins, Inc.