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A983
October 20, 2008 9:00 AM - 11:00 AM Room Hall E2-Area D, |
| Effects of Age and Fatigue on Post-Call Performance of Anesthesiologists |
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Sy-Yeu S. Chern, B.A., Thomas H. Carr, Ph.D., Steven K. Howard, M.D., Mario Davidson, Ph.D., Matthew B. Weinger, M.D. Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee |
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Introduction: The effects of sleep deprivation and fatigue on performance have been studied in residents but not in experienced physicians. Generally, older humans are more adversely affected by sleep deprivation (Reid & Dawson: Occup Environ Med. 58:58,2001), which compounds age-related deterioration in mental and behavioral function. Yet, in a recent lab study, older men felt more alert than younger men after 24 hours without sleep, and their performance on the Psychomotor Vigilance Task (PVT) was largely unaffected whereas younger men experienced a significant decline (Adam et al: Sleep. 29:55,2006). The PVT is a reliable measure of sustained vigilance (Dinges et al: Sleep. 20:267,1997), a trait relevant to anesthesiology practice. To study the interactive effects of age and fatigue in a real-world setting, we administered cognitive and psychomotor tests pre- and post-call to anesthesiology residents and attendings in a busy trauma hospital. We hypothesized that after a night on-call, older attendings would be more impaired than younger residents, when compared to pre-call performance. Methods: After IRB approval and informed consent, 13 residents and 7 attendings completed a survey of their usual sleep patterns and level of fatigue. They practiced the performance battery and were randomized to either the pre-call or post-call initial test condition. Sleep was monitored during the study through self-reported daily sleep logs and wrist Actigraphs to corroborate the logs. During the two early morning test sessions, subjects completed a 15-minute mood and performance battery. Subjective measures were the Stanford Sleepiness Scale, Epworth Sleepiness Scale, Profile of Mood States (37-item version), and NASA-TLX workload scales. Objective measures were the PVT (5-min version), a test of Probed Recall Memory, and the Paced Auditory Serial Addition Task. Data were analyzed with a multivariate mixed model in which age, sleep in the last 24 hours, time of day, and call status were covariates. Results: Median age was 31 years for residents (range 27-33) and 41 years (31-51) for attendings. On call nights, residents slept 183±111 min (mean±SD) while attendings slept 225±193 min (NS by Wilcox test). However, the amount of sleep before each test session was highly variable. All subjective measures showed a significant sleep effect (e.g., greater fatigue, worse mood). These effects were more pronounced in attendings, but despite feeling more fatigued, there were no meaningful differences in objective performance measures pre- vs. post-call, even after adjusting for age and sleep. On the PASAT, there was a suggestion that older subjects made fewer mistakes as the test progressed. Discussion: All anesthesiologists reported increased sleepiness and more negative mood post-call than after a typical night's sleep. Attendings were sleepier and had a more negative mood. Yet, the decline in subjective feelings did not correlate with declines in objective cognitive or psychomotor performance. Since the individual tests were brief and conducted in rapid succession, the clinicians may have been able to temporarily overcome their fatigue and complete the tasks competently (Murray & Dodds: Anaesthesia. 58:520,2003). The results highlight the difficulties of obtaining data on the effects of sleep deprivation, fatigue, and shiftwork during actual anesthesia care. Anesthesiology 2008; 109 A983 |