0628 On-Call Nights Lead to Executive Function Deficits in Medical Residents

Abstract

Introduction: Research into the cognitive effects of sleep deprivation in medical residents has yielded mixed results. Most studies have used between-group designs aimed at comparing on call to “non-call” nights. As interindividual differences in cognitive performance are known to be quite large, we used a within-group design to better understand the effects of sleep loss due to on-call nights in medical residents. Methods: Twenty medical residents (11M/9F; mean age 33.4 ± 2.6 years) from four different residency programs within Sheba Hospital (10 internal medicine, 6 neurology, 3 ER, 1 psychiatry) completed the study. Participants” sleep was tracked for 5 nights: 3 baseline nights (BL), 1 on-call night (OC) and 1 recovery night (RC) with BL and OC/RC nights being counterbalanced. Sleep was monitored using actigraphy (Ambulatory Monitoring, Ardsley, NY) and sleep diaries. Each resident performed a computerized neuropsychological assessment battery (NeuroTrax™, Houston, TX) following each sleep condition (BL, OC, RC). Self-reported mood, behavior, and sleepiness were also tracked. Results: Participants slept on average 6h 43m (± 1h 55m) on BL nights, 1h 57m (± 1h 16m) on the OC night, and 6h 45m (±1h 12m) on the RC night. Performance on the Expanded Go-NoGo test was found to be significantly poor in OC compared to RC (F1, 18=7.73, p=.012) with residents” showing lower accuracy (p=.003), slower response time (RT) (p=.012), and more commission errors (CE) (p=.006). Post hoc analysis revealed that on the easy task, accuracy (p=.048) and RT were lower (p=.031), while on more difficult tasks, no differences in accuracy were found, but RT was slower on 2 out of 3 tasks (p=.016 and p=.020, respectively). Moreover, residents made significantly more CE on the easy (p=.042) and one of the harder tasks during which there were many distractors (p=.035). No significant differences were found on the Stroop Interference Test. Conclusion: Our findings suggest deficits in attention, response time, and inhibitory capacity in medical residents after sleep deprivation due to being on-call. Such cognitive deficits may affect operational performance on on-call nights and should be further explored.