Night shift work is an unavoidable aspect of an internal medicine residency. Given the gravity of responsibility an internal medicine resident often has on night shift (eg, admitting patients, running codes, covering the intensive care unit), optimizing performance on night shift is imperative to mitigate patient safety issues that may result from poor alertness and reduced cognitive abilities. The primary goal of this study was to identify which sleep strategies employed by residents were most beneficial to performance.
In our primary outcome, we found that Sleep Banking had the highest Performance Effectiveness and less time spent above a 0.05% BAC equivalent threshold compared to all other strategies. This finding may be a product of total time slept, as Sleep Banking had an average daily sleep of 9.92 hours compared to an average of 8.28 hours for all other residents. Interestingly, this advantage appears to reach a zenith with the 9–10-hour group, as Performance Effectiveness and less time spent above a 0.05% BAC equivalent did not improve further for participants who slept > 10 hours. This could potentially have been due to multiple factors. First, only 2 participants slept a mean of > 10 hours daily prior to their first shift, which limits the power of this cohort. These 2 participants appear to have highly variable sleep in subsequent days after the first night shift, ranging from 4 to 12 hours per day, but it is difficult to draw conclusions on this given the limited power. Second, it is possible that this amount of sleep may signal a sleep-deprived state or an undiagnosed sleep disorder. Future studies may consider including medical and psychiatric comorbidities as a variable, or may consider evaluation for a previously undiagnosed sleep disorder. Additionally, we found that Performance Effectiveness and less time spent above a 0.05% BAC equivalent improved with more sleep during the first week of nights. No resident was able to sleep > 9 hours during the first week of night shifts (mean daily sleep for all residents was 6.78 hours), likely due to the time constraints of working 12-hour shifts. With over a third of total resident night shift time above 0.05% BAC, studies evaluating alternative shift duration (eg, 10-hour shifts or implementation of swing shifts) might determine if allowing residents more time for sleep improves performance.
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