Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help?

Full Abstract

BACKGROUND:
Because of concerns regarding sleep deprivation, the Accreditation Council for Graduate Medical Education limits duty hours and endorses education regarding sleep loss for residents. We assessed the effectiveness of a 60- to 90-minute lecture, the Sleep, Alertness, and Fatigue Education in Residency (SAFER) program, on sleep loss and recovery sleep in residents adhering to Accreditation Council for Graduate Medical Education duty hours.

METHODS:
From July 1, 2003, through June 24, 2005, interns from the inpatient medicine service at the University of Chicago were asked to wear wristwatch activity monitors. In March 2005, interns received the SAFER program intervention. We used fixed-effects linear regression to estimate within-subject mean sleep per call day (on-call, precall, postcall, and second-day postcall sleep). These estimates were compared with recommended minimum levels of preventive (7 hours of precall) and recovery (16 hours during the 2 days after call) sleep in healthy populations using 2-tailed t tests. These analyses were repeated to test the effect of the SAFER program.

RESULTS:
Fifty-eight of 81 interns (72%) participated for 147 intern-months (63%). Interns on call slept an average of 2.84 hours (95% confidence interval, 2.75-2.93 hours). Interns obtained less than recommended amounts of recovery sleep (14.06 hours [95% confidence interval, 13.84-14.28 hours]; P < .001). Intern preventive sleep was also less than recommended (6.47 hours [95% confidence interval, 6.39-6.56 hours]; P < .001). Interns attempted to compensate for their acute sleep loss; for each hour of on-call sleep loss, they received 18 minutes (95% confidence interval, 7-30 minutes) more recovery sleep (P = .003). The SAFER program had no significant beneficial effect on intern sleep.

CONCLUSIONS:
Under the current duty-hour regulations of the Accreditation Council for Graduate Medical Education, residents continue to be sleep deprived. The SAFER program has no impact on resident precall or postcall sleep.

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Author information

Author/s: Arora, Vineet M (VM); Georgitis, Emily (E); Woodruff, James N (JN); Humphrey, Holly J (HJ); Meltzer, David (D);

Affiliation: Department of Medicine, University of Chicago, 5841 S Maryland Ave, Mail Code 2007, Ste AMB W216, Chicago, IL 60637, USA. varora(-atsign-)medicine.bsd.uchicago.edu

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2007-Sep; vol 167 (issue 16) : pp 1738-44

Dates: Created 2007/09/11; Completed 2007/10/16; Revised 2008/07/01;

PMID: 17846392, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Arch Intern Med. 2008 Feb 25;168(4):435. (PMID: 18299503)

CommentIn: Arch Intern Med. 2008 Jun 9;168(11):1229-30; author reply 1230. (PMID: 18541835)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Clinical Competence
Dyssomnias - epidemiology; etiology; prevention & control
Education, Medical, Graduate
Follow-Up Studies
Humans
Hygiene
Illinois - epidemiology
Incidence

Incidence
Internal Medicine - education
Internship and Residency
Mental Fatigue - complications; epidemiology; prevention & control
Prognosis
Prospective Studies
Sleep - physiology
Time Factors

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