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Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers.

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Title: Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers.
Authors: Choshen‐Hillel, Shoham, Ishqer, Ahmad, Mahameed, Fadi, Reiter, Joel, Gozal, David, Gileles‐Hillel, Alex, Berger, Itai
Source: Medical Education. Feb2021, Vol. 55 Issue 2, p174-184. 11p. 5 Charts.
Subjects: Biomarkers, C-reactive protein, Chronic diseases, Cognition, Hospital medical staff, Hydrocortisone, Inflammation, Questionnaires, Shift systems, Sleep deprivation, Psychological stress, Acute diseases, Executive function
Abstract: Objectives: Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision‐making. Medical professionals and specifically resident physicians, who are involved in long‐term nightshift schedules during their post‐graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute‐on‐chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. Methods: Thirty‐three medical and surgical residents were evaluated twice ‐ at baseline and after a 26‐hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high‐sensitivity C‐reactive protein (hs‐CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk‐taking questionnaire and the Pittsburgh Sleep Quality Index. Results: Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs‐CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk‐taking tendencies which were assessed in a separate cohort. Conclusions: In a real‐life setting, resident physicians exhibit increased low‐grade systemic inflammation (hs‐CRP) and impaired HPA‐axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short‐term and potential long‐term risks to physicians in training. The authors demonstrate that not only does chronic sleep deprivation impair a variety of mental and physical functions, but some effects are further aggravated by the acute sleep restriction of night calls. [ABSTRACT FROM AUTHOR]
Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers.
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  Data: <searchLink fieldCode="AR" term="%22Choshen‐Hillel%2C+Shoham%22">Choshen‐Hillel, Shoham</searchLink><br /><searchLink fieldCode="AR" term="%22Ishqer%2C+Ahmad%22">Ishqer, Ahmad</searchLink><br /><searchLink fieldCode="AR" term="%22Mahameed%2C+Fadi%22">Mahameed, Fadi</searchLink><br /><searchLink fieldCode="AR" term="%22Reiter%2C+Joel%22">Reiter, Joel</searchLink><br /><searchLink fieldCode="AR" term="%22Gozal%2C+David%22">Gozal, David</searchLink><br /><searchLink fieldCode="AR" term="%22Gileles‐Hillel%2C+Alex%22">Gileles‐Hillel, Alex</searchLink><br /><searchLink fieldCode="AR" term="%22Berger%2C+Itai%22">Berger, Itai</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Medical+Education%22">Medical Education</searchLink>. Feb2021, Vol. 55 Issue 2, p174-184. 11p. 5 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Biomarkers%22">Biomarkers</searchLink><br /><searchLink fieldCode="DE" term="%22C-reactive+protein%22">C-reactive protein</searchLink><br /><searchLink fieldCode="DE" term="%22Chronic+diseases%22">Chronic diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Cognition%22">Cognition</searchLink><br /><searchLink fieldCode="DE" term="%22Hospital+medical+staff%22">Hospital medical staff</searchLink><br /><searchLink fieldCode="DE" term="%22Hydrocortisone%22">Hydrocortisone</searchLink><br /><searchLink fieldCode="DE" term="%22Inflammation%22">Inflammation</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Shift+systems%22">Shift systems</searchLink><br /><searchLink fieldCode="DE" term="%22Sleep+deprivation%22">Sleep deprivation</searchLink><br /><searchLink fieldCode="DE" term="%22Psychological+stress%22">Psychological stress</searchLink><br /><searchLink fieldCode="DE" term="%22Acute+diseases%22">Acute diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Executive+function%22">Executive function</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision‐making. Medical professionals and specifically resident physicians, who are involved in long‐term nightshift schedules during their post‐graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute‐on‐chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. Methods: Thirty‐three medical and surgical residents were evaluated twice ‐ at baseline and after a 26‐hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high‐sensitivity C‐reactive protein (hs‐CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk‐taking questionnaire and the Pittsburgh Sleep Quality Index. Results: Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs‐CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk‐taking tendencies which were assessed in a separate cohort. Conclusions: In a real‐life setting, resident physicians exhibit increased low‐grade systemic inflammation (hs‐CRP) and impaired HPA‐axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short‐term and potential long‐term risks to physicians in training. The authors demonstrate that not only does chronic sleep deprivation impair a variety of mental and physical functions, but some effects are further aggravated by the acute sleep restriction of night calls. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Medical Education is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1111/medu.14296
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      – Code: eng
        Text: English
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      Pagination:
        PageCount: 11
        StartPage: 174
    Subjects:
      – SubjectFull: Biomarkers
        Type: general
      – SubjectFull: C-reactive protein
        Type: general
      – SubjectFull: Chronic diseases
        Type: general
      – SubjectFull: Cognition
        Type: general
      – SubjectFull: Hospital medical staff
        Type: general
      – SubjectFull: Hydrocortisone
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      – SubjectFull: Inflammation
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Shift systems
        Type: general
      – SubjectFull: Sleep deprivation
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      – SubjectFull: Psychological stress
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      – SubjectFull: Acute diseases
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      – SubjectFull: Executive function
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      – TitleFull: Acute and chronic sleep deprivation in residents: Cognition and stress biomarkers.
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              Text: Feb2021
              Type: published
              Y: 2021
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