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SLEEP AND WELL-BEING OF INTENSIVE CARE UNIT HOUSESTAFF

¹From the Section of Pulmonary and Critical Care Medicine, Southern Arizona VA Health Care System and the Department of Medicine, Sleep and Arizona Respiratory Centers, the University of Arizona, Tucson, AZ ² Loyola University Medical Center, Maywood, Illinois ³ Washington University, St. Louis, MO

spartha{at}arc.arizona.edu

Abstract

BackgroundOur understanding of the effect of Accreditation Council for Graduate Medical Education (ACGME) mandated work-hour limitation on physicians' quality of life, sleepiness, and sleep-work habits is evolving. To determine the effect of work-hour reduction on quality of life in residents and fellows (ICU housestaff) of one institution's schedule. To determine the effect of work-hour reduction on subjective and objective measures of sleepiness in ICU housestaff at a center.

MethodsSingle-center study of 34 residents and 10 fellows studied before-and-after the ACGME mandated work-hour limitation in July 2003.

ResultsIn a single-center, after work-hour reduction, residents reported statistically significant but minor improvements in sleep time, subjective sleepiness, and some aspects of quality of life (P<0.05). Both before and after work-hour limitations, subjective sleepiness and quality of life indexes deteriorated during the course of the ICU rotation. Following work-hour reductions, subjective sleepiness improved (p<0.05), but objective sleepiness was unchanged (p=0.6). Moreover, after implementation of work-hour reductions, 59%, 43%, and 25% of the ICU team had mean sleep latency less than 10, 7, and 5 minutes, respectively with 14% manifesting sleep-onset REM periods (signifying severe sleepiness) before beginning their extended work-hour period.

ConclusionsIn ICU housestaff, at a single-center, small benefits to quality of life and subjective sleepiness were realized by an ACGME-compliant work-hour schedule. Significant levels of objective sleepiness, however, remained. Further measures may need to be undertaken to address the persistence of sleepiness in ICU housestaff. These findings may not be generalized outside of the scheduling system studied.

Key Words: Quality of Life • sleep deprivation • Work Schedule Tolerance • Internship and Residency • patient safety

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