On-Call Duty Effects on Sleep-State Physiological Stability in Male Medical Interns

PLOS ONE, Dec 2019

Background On-call duty among medical interns is characterized by sleep deprivation and stressful working conditions, both of which alter cardiac autonomic modulation. We hypothesized that sleep stability decreased in medical interns during on-call duty. We used cardiopulmonary-coupling (CPC) analysis to test our hypothesis. Methods We used electrocardiogram (ECG)-based CPC analysis to quantify physiological parameters of sleep stability in 13 medical interns during on-call and on-call duty-free periods. There were ten 33.5-h on-call duty shifts per month for interns, each followed by 2 on-call duty-free days, over 3 months. Measurements during sleep were collected before, during, and after an on-call shift. Measurements were repeated 3 months later during an on-call duty-free period. Results The medical interns had significantly reduced stable sleep, and displayed increased latency to the first epoch of stable sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights. Interns also had significantly increased rapid-eye-movement (REM) sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights. Conclusion Medical interns suffer disrupted sleep stability and continuity during on-call night shifts. The ECG-based CPC analysis provides a straightforward means to quantify sleep quality and stability in medical staff performing shift work under stressful conditions.

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On-Call Duty Effects on Sleep-State Physiological Stability in Male Medical Interns

Citation: Lin Y-H, Ho Y-C, Lin S-H, Yeh Y-H, Liu C-Y, et al. ( On-Call Duty Effects on Sleep-State Physiological Stability in Male Medical Interns Yu-Hsuan Lin 0 Yen-Cheng Ho 0 Sheng-Hsuan Lin 0 Yao-Hsien Yeh 0 Chia-Yih Liu 0 Terry B. J. Kuo 0 Cheryl C. H. Yang 0 Albert C. Yang 0 Luis Eduardo M. Quintas, Universidade Federal do Rio de Janeiro, Brazil 0 1 Department of Psychiatry, National Taiwan University Hospital , Taipei, Taiwan , 2 School of Medicine, Chang Gung University , Taoyuan County , Taiwan , 3 Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan County, Taiwan, 4 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America, 5 Department of Internal Medicine, Ren-Ai branch, Taipei City Hospital , Taipei, Taiwan , 6 Institute of Brain Science, National Yang-Ming University , Taipei, Taiwan , 7 Sleep Research Center, National Yang-Ming University , Taipei, Taiwan , 8 Division of Psychiatry, School of Medicine, National Yang-Ming University , Taipei, Taiwan , 9 Department of Psychiatry, Taipei Veterans General Hospital , Taipei , Taiwan Background: On-call duty among medical interns is characterized by sleep deprivation and stressful working conditions, both of which alter cardiac autonomic modulation. We hypothesized that sleep stability decreased in medical interns during on-call duty. We used cardiopulmonary-coupling (CPC) analysis to test our hypothesis. Methods: We used electrocardiogram (ECG)-based CPC analysis to quantify physiological parameters of sleep stability in 13 medical interns during on-call and on-call duty-free periods. There were ten 33.5-h on-call duty shifts per month for interns, each followed by 2 on-call duty-free days, over 3 months. Measurements during sleep were collected before, during, and after an on-call shift. Measurements were repeated 3 months later during an on-call duty-free period. Results: The medical interns had significantly reduced stable sleep, and displayed increased latency to the first epoch of stable sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights. Interns also had significantly increased rapid-eye-movement (REM) sleep during the on-call night shift, compared to the pre-call and on-call duty-free nights. Conclusion: Medical interns suffer disrupted sleep stability and continuity during on-call night shifts. The ECG-based CPC analysis provides a straightforward means to quantify sleep quality and stability in medical staff performing shift work under stressful conditions. - Funding: Funding was provided by NSC101-2314-B-075-041-MY3 (http://web1.nsc.gov.tw/), and NSC support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan (NSC 100-2911-I-008-001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have declared that no competing interests exist. . These authors contributed equally to this work. Medical interns typically work the greatest number of hours per week among all types of hospital trainees [1]. On-call duty among medical interns is characterized by sleep deprivation and stressful working conditions. Sleep deprivation alters cardiovascular reactivity to acute stressors [2], and increases the incidence of cardiovascular disease (CVD) [3,4,5]. Systematic reviews have reported that such long working shifts and erratic schedules lead to acute and chronic sleep deprivation and poor sleep quality in training physicians, resulting in numerous adverse consequences in patient care [6]. Moreover, early in the academic year in a traditional extended-duty shift model, each new admission during the on-call shift is associated with a reduction in the amount of oncall sleep, and an increase in the total shift duration [7]. Recent prospective studies and meta-analyses also suggest that long working hours [8] and shift work [9] increase the risk of CVD. However, few studies have compared cardiac autonomic modulation among physicians in on-call work settings [10,11,12] or during on-call sleep periods [12]. Cardiopulmonary-coupling (CPC) analysis has recently been developed to quantify sleep quality and stability using an electrocardiogram (ECG)-based technique that measures heart rate variability (HRV) and an ECG-derived respiratory signal [13]. The CPC analysis generates a sleep spectrogram that demonstrates coupled sleep oscillations with spontaneously transitioning periods of high-frequency coupling that represent stable sleep, low-frequency coupling representing unstable sleep, and very-low-frequency coupling representing rapid-eye-movement (REM) sleep or awakening states. The CPC method has been used in the analysis of sleep apnea [13,14], major depression [15], fibromyalgia [16], and heart failure [17] based solely on the continuous ECG signal [13,14]. Because on-call duty is a (...truncated)


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Yu-Hsuan Lin, Yen-Cheng Ho, Sheng-Hsuan Lin, Yao-Hsien Yeh, Chia-Yih Liu, Terry B. J. Kuo, Cheryl C. H. Yang, Albert C. Yang. On-Call Duty Effects on Sleep-State Physiological Stability in Male Medical Interns, PLOS ONE, 2013, 6, DOI: 10.1371/journal.pone.0065072