The brain fog and clouded sensorium that follow a night call have long been accepted as part of the job by most anesthesiologists, but partial sleep deprivation significantly alters various aspects of mood and may ultimately affect the quality of patient care, a study has found.
“It’s a given that residents work hours and hours, but nobody has looked into what happens after residency when anesthesiologists are on night call,” explained Haleh Saadat, MD, FAAP, of Nationwide Children’s Hospital, in Columbus, Ohio. “We thought it was crucial to look into how anesthesiologists are affected, and if fatigue may jeopardize their ability to provide quality patient care.”
Significant Changes In Overall Mood
Dr. Saadat and her team assessed 21 pediatric anesthesiologists who agreed to participate in the study. Taking circadian rhythm into account, participants were evaluated at two time points over the duration of the study: once at 7 a.m. on a regular noncall day, and once at 7 a.m. after a 17-hour shift.
A 65-item questionnaire measured elements of mood status and included questions on tension and anxiety, depression and dejection, anger and hostility, vigor and activity, fatigue and inertia, and confusion and bewilderment. The participants’ “total mood disturbance” score was calculated based on the sum of all mood scores, minus vigor. Cognitive tests were similarly administered, and a two-tailed paired t test was used to compare data between both time points.
“The results were quite alarming, but not all that surprising,” Dr. Saadat noted during a presentation of her study at the 2015 New York State Society of Anesthesiologists PostGraduate Assembly (Table). “Everything was significantly affected: tension, anger, fatigue, irritability. And from a cognitive standpoint, reaction time, in particular, increased in all subjects.”
Of note, the changes appeared to affect participants across the board, independent of age, sex and experience (the study included 14 male and seven female participants; 12 doctors were between the ages of 30 and 40 years, four between 41 and 50, and five between 51 and 59).
“This was interesting to see,” Dr. Saadat said, “especially as there has been much discussion of the cognitive ability of much older anesthesiologists.”
Dr. Saadat was alluding to another presentation at the conference titled, “Cognitive Testing for The Aging Anesthesiologist,” which was presented by Jonathan D. Katz, MD, of Yale School of Medicine, in New Haven, Conn.
Dr. Katz has argued that it is difficult to test for competency, as there are limited criteria on how to distinguish a “good” anesthesiologist from one who is incompetent, or who may be affected by other debilitating factors, and sleep deprivation might only complicate the issue. Dr. Katz noted that physicians are not required to undergo annual physical performance examinations, and health care organizations don’t generally monitor the clinical performance of individual physicians.
Echoing Dr. Katz’s concern about the physical capability of anesthesiologists, Dr. Saadat further noted that her study was based at an academic center, where calls are “only” 17 hours. “In most private practices, calls are much, much longer. Sometimes doctors work 24-hour shifts, and then again the next day. If reaction time slows down that much within our setting, we have to be generally concerned about what may happen when anesthesiologists are taking care of a patient the following day.”
The consensus is that more longitudinal studies are needed to determine the effect of partial sleep deprivation on the well-being of anesthesiologists, and how any resulting cognitive impairment may affect patient safety and overall health care delivery.
Dr. Saadat noted, “We’re starting to open the study up to other physicians, like OB-GYNs, surgeons and oncologists. Many of them work long shifts, and then have to show up the next day. It’s crucial to evaluate what effect this may have on patient care.”