This randomized trial from the University of Pennsylvania evaluating the performance of the new protected sleep time afforded to interns under ACGME rules. These authors used wrist-based sleep activity monitors to measure the cumulative sleep time on-shift for interns randomized to either traditional 30-hour blocks or blocks with a nap period between 12:30am and 5:30am. The primary outcome was sleep obtained on shift, with secondary outcomes being total hours of sleep during a call cycle, and post-call scores on the Karolinska Sleepiness Scale.
Well, protected sleep time works – 2.86 vs. 1.98 hours of sleep at the VA hospital, and 3.04 vs. 2.04 at the University hospital, with significantly fewer no-sleep nights as well. And, the Karolinska Sleepiness Scale means also favored the nap-time group 7.10 vs. 6.65 at the VA and 6.79 vs 5.91 at the University.
But, as I said before, these are surrogate markers for patient safety. One extra hour of sleep? Less than a full point on the KSS? Let's look specifically at the subjective self-reported meaning of the KSS in the range these physicians were reporting:
• 5 = neither alert nor sleepy
• 6 = some signs of sleepiness
• 7 = sleepy, but no effort to keep awake
• 8 = sleepy, some effort to keep awake
Regardless of intervention group, they're ... pretty much a little sleepy, but not generally struggling to stay awake. I remain a little skeptical this will account for a substantial improvement in patient safety – at least, at this single-residency experience.
"Effect of a Protected Sleep Period on Hours Slept During Extended Overnight In-hospital Duty Hours Among Medical Interns"