It is well understood that resident, intern and attending physicians do not receive an adequate amount of sleep at night. Long on call hours, 24-hour shifts within the hospital and limited time off all contribute to poor quantity and quality of sleep. Research seems to suggest a potential effect on the quality of patient care as a result of such sleep deprivation.

A 2011 study that took place in Korea scored a number of residents and interns on sleep deprivation. Nearly 71% of participants were sleep deprived with a mean of only 5 (+/- 1.2) hours of sleep per night while working an average of 14.9 (+/- 2.7) hours a day. Among the most sleep deprived of participants, scores for attention deficit were higher than average, suggesting a potential difficulty in focusing on treatment and diagnoses of patient condition. Additionally, sleep deprivation made it more difficult for participants to learn new information, which may make the continuing education of such physicians more difficult.

Further research into sleep deprivation in general may also illustrate another potential barrier in professional performance. A literature analysis by Kamphuis illustrates that there is significant evidence to support a relationship between sleep deprivation and increased levels of aggression. In numerous studies, participants who reported a low quantity and/or quality of sleep also scored higher on indexes of anger, hostility and impulsivity compared to control groups. Interestingly, there appears to be a physiological component to such increased anger.

Prefrontal cortical functioning is impaired in sleep deprived individuals. This functioning is responsible for a person’s ability to regulate emotional and behavioral responses to stimuli. In one particular study, subjects with an average sleep deprivation of 30 hours were less likely to be able to recognize human facial emotions for moderate happiness or anger, suggesting an inability to empathize from sheer lack of recognition alone.

This link between sleep deprivation and aggression could be helpful in explaining the reasons why some physicians are considered short-tempered by non-physician healthcare staff. The inability to empathize could certainly be to blame for this phenomenon; however, this author was unable to find current research attempting to test such a correlation, suggesting a need for further investigation into this specific area.

As the physician shortage in America continues to worsen, the effects of sleep deprivation on physicians could become more marked. To mitigate this potential barrier to quality patient care, healthcare institutions must find ways of filling gaps with more mid-level providers, interns, and residents to spread the workload among a larger group of individuals. Sleep deprivation is linked with a wide range of physical and emotional health problems and may be directly affecting patient care. There is much work still to be done to identify the specific risks to patients as well as strategies to reduce such risks.

References

Kamphuis J, Meerlo P, Koolhaas JM, & Lancel M (2012). Poor sleep as a potential causal factor in aggression and violence. Sleep medicine, 13 (4), 327-34 PMID: 22305407

Kim HJ, Kim JH, Park KD, Choi KG, & Lee HW (2011). A survey of sleep deprivation patterns and their effects on cognitive functions of residents and interns in Korea. Sleep medicine, 12 (4), 390-6 PMID: 21388879

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