The Relationship Between Shift Work, Sleep, and Cognition in Career Emergency Physicians

Authors

  • Mari S. Machi,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • Matthew Staum,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • Clifton W. Callaway MD, PhD,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • Charity Moore PhD,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • Kwonho Jeong,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • Joe Suyama MD,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • P. Daniel Patterson PhD,

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • David Hostler PhD

    1. From the Department of Emergency Medicine, Emergency Responder Human Performance Lab (MSM, MS, CWC, JS, PDP, DH), Department of Medicine, Center for Research on Health Care Data Center (CM, KJ), University of Pittsburgh, Pittsburgh, PA.
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  • Presented at the Doris Duke Clinical Research Fellows Meeting, Chapel Hill, NC, May 2009; and the American College of Emergency Physicians Scientific Assembly, Boston, MA, October 2009.

  • Funded by the Doris Duke Clinical Research Fellowship Program.

  • PDP—The project described was supported by Award Number KL2 RR024154 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. No other disclosures. CWC—supported in part by an NHLBI grant U01HL077871. CM—NIH CTSA award funded the support for the statistical analysis. No other disclosures. The rest of the authors have no disclosures or conflicts of interest to report.

  • Supervising Editor: Jacob Ufberg, MD.

Address for correspondence and reprints: David Hostler, PhD; e-mail: hostdp@upmc.edu.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:85–91 © 2012 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The 24-hour physician coverage of the emergency department (ED) requires shift work, which can result in desynchronosis and cognitive decline. We measured changes in cognition and sleep disturbance in attending emergency physicians (EPs) before and after day and overnight shifts.

Methods:  Thirteen EPs were tested before and after day and overnight shifts using the Paced Auditory Serial Addition Test (PASAT), the University of Southern California Repeatable Episodic Memory Test (REMT), the Trail Making Test (TMT), and the Stroop Color-Word Test. Sleep quality and fatigue were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Chalder Fatigue Questionnaire (CFQ). Saliva samples were collected from each physician immediately before and after day shifts and night shifts for neurohormonal assays.

Results:  Significantly fewer words were recalled on the REMT after both day (−2.4, 95% confidence interval [CI] = −4.4 to −0.4) and overnight shifts (−4.6, 95% CI = −6.4 to −2.8). There was a significant postshift increase in words recalled from the last third of the REMT list after overnight shifts (6.6, 95% CI = 2.8 to 10.4). Sleep quality was worse in EPs (mean PSQI = 4.8, SD ± 2.5) compared to the normal population, with 31% of subjects reporting poor sleep quality. Postshift fatigue was correlated with the perceived difficulty of the shift. Salivary cortisol and melatonin demonstrated diurnal variation consistent with normal circadian rhythms. Morning cortisol peak was decreased or delayed in samples from physicians after a night shift.

Conclusions:  These data indicate that short-term memory appears to decline after day and overnight shifts and confirms the high incidence of disturbed sleep in this population.

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