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        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
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