APGO

Robert V. Higgins

Susan M. Kullstam, BS, Marcy L Nussbaum MS

Purpose: Compare fatigue related to sleep deprivation of PGY-1 residents (group 1) limited to 16 hours/shift to upper level residents (group 2) who worked 24-30 hours/shift. Methods: All residents (n=24) between July 1, 2010 and June 30, 2011 were asked to complete a validated sleep survey, the Pittsburgh Sleep Quality Index (PSQI) at the completion of each month-long clinical rotation. Group 1 was assigned work hours the ACGME planned to implement on July 1, 2011. Duty hours for group 1 were limited a maximum of 16 hours/shift and 5 days off/month. The duty hours for group 2 followed the ACGME duty hour rules effective during the 2010 academic year. The PSQI 10-item questionnaire queried about the following topics: duration of sleep, sleep disturbance, sleep latency, number of days dysfunctional due to sleepiness, sleep efficiency, overall sleep quality, and need for medication to assist with sleep. Residents recorded their work hours/ week in an electronic database. Standard statistical analysis was used to compare the responses of the 6 residents in group 1 to the 18 residents in group 2. A p-value of <0.05 was considered statistically significant.

Results: Each resident completed an average of 6 surveys. The duty hours/week for group 1 averaged 59.8 hours and for group 2 averaged 61.9 hours. Group 1 averaged 1.6 days off/week compared to 1.4 days/week for group 2. An average of 30 night shifts were completed by group 1 compared to 60 night shifts for group 2. Kruskal-Wallis was used to analyze the difference is responses between group 1 and group 2 for items on PSQI. There were no statistical differences in response rates (p >0.05) between the two groups for the following items: duration of sleep, number of days dysfunctional due to sleepiness, sleep efficiency, and need for medication to sleep. Group 1 reported less sleep disturbance (p=0.063) but more sleep latency (p=0.076) than group 2. The overall quality of sleep was significantly worse for group 1 compared to group 2 (p=0.029).

Conclusions: PGY-1 residents, group 1, restricted to a maximum 16-hour shift did not report less sleep dysfunction compared to upper level residents, group 2, who worked 24-30 hours/shift. Group 1 experienced significantly poorer quality of sleep and were more likely to report more difficulty with sleep latency than group 2. This study suggests the ACGME duty-hour rules for academic year 2011 may not result in less sleep dysfunction for PGY-1 residents compared to upper level residents.