Page 30 - Layout 1

COVID-19
WHERE TO FROM HERE

Sleep By Avie Grunspan, MD

“Sleep is overrated.” This is a not-too-uncommon remark made creased errors, and a greater risk of accidents. Associated health
by physicians trained in the days in which they felt sleep deprivation outcomes from this deficit include weight gain, obesity, diabetes,
was a right of passage allowing one to toughen up their prepared- hypertension, increased risk of heart disease and stroke, depression,
ness for the rigors of the medical field. The argument of the time and increased risk of death. (Watson, et al, Sleep;2015;38:843-4)
was staying up to monitor a patient through a rapidly evolving dis- Sleep deprivation has also been shown to lead to significant decre-
ease process such as diabetic ketoacidosis, improved understanding ments in cognitive function, lapses of attention, vigilance, and speed
of the pathophysiology of a condition and provided valuable teach- of psychomotor responses.
ing opportunities. It was a form of hazing (and pride) to stay up for There is increasing literature over the past few decades regarding
24-36 hours straight and believe we had performed our positions the effects of sleep deprivation in medical students and residents
dutifully, constructively, safely, and without self-harm. in training, though there remains less data regarding attending physi-
In the last few decades, sleep research has shown otherwise. cians. Over the past four decades, several iterations of work-hour
There is an increasing body of evidence that physician sleep habits, and on-call restrictions have been implemented after several studies
not unlike our own patient's sleep habits, are taking a significant toll revealed medical and diagnostic errors were more common in resi-
on physical and emotional well-being. Our 24/7 society around the dents working over 24 hours consecutively. In 2011, the Joint Com-
world resulted in The American Academy of Sleep Medicine and mission called on all health care organizations to embark on
the Sleep Research Society reaching a consensus recommendation mitigation efforts to reduce clinician sleep deprivation and fatigue.
in 2016. Based on review of 5314 articles in the National Library A recent article from the Journal of Clinical Sleep Medicine highlighted
of Medicine MeSH, they concluded adults should sleep more than the concern that, “sleep deprivation due to shift work schedules,
7 hours per night to promote optimal health. They based this on high workload, long hours, sleep interruptions, and insufficient re-
increasing evidence that fewer than 7 hours is associated with im- covery sleep have been implicated in the genesis of and perpetua-
paired immune function, increased pain, impaired performance, in- tion of (physician) burnout” in practicing attending physicians.

30 San Antonio Medicine • July 2020