Sleep Duration and Health in Young Adults

CONTEXT In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries. OBJECTIVE To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States. DESIGN, SETTING, AND PARTICIPANTS National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed. MAIN OUTCOME MEASURES Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm). RESULTS From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11). CONCLUSION Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

[1]  Charles A Czeisler,et al.  Effects of sleep inertia on cognition. , 2006, JAMA.

[2]  M. Carskadon,et al.  Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. , 2005, JAMA.

[3]  F. Speizer,et al.  Extended work shifts and the risk of motor vehicle crashes among interns. , 2005, The New England journal of medicine.

[4]  J. Rothschild,et al.  Effect of reducing interns' weekly work hours on sleep and attentional failures. , 2004, The New England journal of medicine.

[5]  D. Bates,et al.  Effect of reducing interns' work hours on serious medical errors in intensive care units. , 2004, The New England journal of medicine.

[6]  D. Baldwin,et al.  Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. , 2004, Sleep.

[7]  D. Dinges,et al.  The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. , 2003, Sleep.

[8]  J. Gerberding.  Occupational Exposure to HIV in Health Care Settings , 2003 .

[9]  T. Grantcharov,et al.  Laparoscopic performance after one night on call in a surgical department: prospective study , 2001, BMJ : British Medical Journal.

[10]  M. Smolensky,et al.  DAY-NIGHT PATTERN IN ACCIDENTAL EXPOSURES TO BLOOD-BORNE PATHOGENS AMONG MEDICAL STUDENTS AND RESIDENTS , 2000, Chronobiology international.

[11]  M Maclure,et al.  Should we use a case-crossover design? , 2000, Annual review of public health.

[12]  D. Dijk,et al.  EEG and ocular correlates of circadian melatonin phase and human performance decrements during sleep loss. , 1999, American journal of physiology. Regulatory, integrative and comparative physiology.

[13]  D. Dawson,et al.  Fatigue, alcohol and performance impairment , 1997, Nature.

[14]  Derk-Jan Dijk,et al.  Paradoxical timing of the circadian rhythm of sleep propensity serves to consolidate sleep and wakefulness in humans , 1994, Neuroscience Letters.

[15]  M. Carskadon,et al.  Multiple sleep latency tests during the constant routine. , 1992, Sleep.

[16]  R. Wolfe,et al.  Circadian Incidence of Labor Onset Hour in Preterrn Birth and Chorioarnnionitis , 1987, Obstetrics and gynecology.

[17]  T. Åkerstedt,et al.  Sleepiness on the job: continuously measured EEG changes in train drivers. , 1987, Electroencephalography and clinical neurophysiology.

[18]  A. Berger.  FUNDAMENTALS OF BIOSTATISTICS , 1969 .