Rested/sleep-deprived residents perform equally

By Elaine Fiedler

Researchers reporting on a pilot study found no significant difference in neurocognitive testing performance between residents who were well-rested and those who had spent a night on call. They presented their findings yesterday in Paper 122.

It is widely assumed that sleep deprivation affects neurocognitive performance, and this assumption was invoked when restrictions were placed on orthopaedic residents’ work hours. Although there is a great deal of data on the adverse effect of sleep deprivation on the general population, studies of residents have yielded conflicting data.

This Institutional Review Board-approved investigation, which used ImPACT (Immediate Post-concussion Assessment and Cognitive Testing) to determine the effect of sleep deprivation on various performance parameters, involved 32 orthopaedic residents.

A baseline evaluation for all 32 residents was done before call; 16 residents (14 men and 2 women) completed a second evaluation after serving a night on call for adult orthopaedic trauma. Five objective parameters—verbal memory, visual memory, reaction time, processing speed and impulse control—were measured, and severity of 22 subjective symptoms were determined.

No significant difference was found in the five measured objective parameters between the baseline and post-call states. “Difference in subjective symptoms—particularly feeling more emotional, irritability, difficulty remembering, feeling slowed down, sadness and fatigue—were noted between subjects at baseline and post-call,” reported the authors. “The symptomatology increased with decreased sleep on call.”

Researchers noted that “when compared to normative data of male college athletes, orthopaedic residents at baseline scored comparably to those in the lower 50 percent for three of the four composite scores; this might be indicative of chronic sleep deprivation.”

Although this sample size is too small to draw general conclusions, investigators suggested that ImPACT, which is quick, inexpensive, accurate, and does not require an administrator or exhibit practice effects, might be a useful and reliable tool for assessing residents’ function following sleep deprivation. ImPACT has been validated for assessing post-concussive effects in athletes, but has not been validated to detect sleep deprivation specifically.

The presenters recommended investigating residents training in different clinical areas to explore psychomotor deficits found in similar studies of anesthesia residents and obstetrics and gynecology residents. They also addressed plans for a larger scale study to measure the effect of resident sleep deprivation on neurocognitive performance.

The researchers included Rachel S. Rohde, MD; Michael W. Collins, PhD; Mark Lovell, PhD; Freddie H. Fu, MD; and Molly T. Vogt, PhD, all of Pittsburgh.

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