Sleep deprivation and clinical performance.

PHYSICIANS’ ABILITY TO PROVIDE high-quality care can be adversely affected by many factors, including sleep deprivation. Concerns about the danger of physicians who are sleep deprived and providing care have led state legislatures and academic institutions to try to constrain the work hours of physicians in training (house staff). Unlike commercial aviation, for example, medicine is an industry in which public safety is directly at risk but does not have mandatory restrictions on work hours. Legislation before the US Congress calls for limiting resident work hours to 80 hours per week and no more than 24 hours of continuous work. Shifts of residents working in the emergency department would be limited to 12 hours. The proposed legislation, which includes public disclosure and civil penalties for hospitals that violate the work hour restrictions, does not address extended duty shifts of attending or private practice physicians. There is still substantial controversy within the medical community about the magnitude and significance of the clinical impairment resulting from work schedules that aggravate sleep deprivation. There is extensive literature on the adverse effects of sleep deprivation in laboratory and nonmedical settings. However, studies on sleep deprivation of physicians performing clinically relevant tasks have been less conclusive. Opinions have been further influenced by the potential adverse impact of reduced work schedules on the economics of health care, on continuity of care, and on quality of care. This review focuses on the consequences of sleep loss both in controlled laboratory environments and in clinical studies involving medical personnel.