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SLEEP
MEDICINE

The Cost of Sleep Deprivation

in Medical Residents

By Victoria Ayodele

S leep is an essential component of human life. The average adult increases the risk of uncontrolled disease in people with Type 2 Dia-

betes. While the pathophysiology of this association is still being in-
requires seven to nine hours of sleep per day to promote optimal
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function and health. Despite the fact that many people place a
as well as sympathetic nervous system activity are believed to play a
high importance on sleep, many struggle to maintain a healthy sleep vestigated, changes in the hypothalamo-pituitary-adrenal (HPA) axis
schedule. Medical professionals have long been concerned about sleep role.
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deprivation, particularly as it relates to medical residents who put in The most commonly recognized benefit of sleep is its ability to pre-
long, demanding hours. In a survey performed by Baldwin and col- serve cognitive function. Sleep is necessary for a number of processes,
leagues, 66 percent of medical residents reported getting less than six including language, coordination, memory consolidation and decision-
hours of sleep per night. Lack of sleep can have an impact on patient making. Chronic sleep deprivation can affect cognitive function in sev-
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care, but it is also necessary to understand how it might affect health. eral ways, including reduced alertness, slowed processing speed and
The purpose of this article is to highlight potential short- and long- short-term memory loss. Although the exact mechanisms underlying
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term health risks associated with sleep deprivation. this hypothesis are still being studied, neuroimaging studies have
The importance of sleep on various biological systems is not com- demonstrated reduced activity following sleep deprivation in a number
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monly known to the general public. Our respiratory system, circulation of brain regions, particularly the frontal and prefrontal cortex. Mul-
system and endocrine system, to mention a few, all require sleep to tiple studies have examined how chronic sleep deprivation affects cog-
function properly. When adequate sleep is not maintained, organ sys- nitive performance, which has become a topic in research regarding
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tems such as the ones listed above are susceptible to impairment, con- patient outcomes. Barger and colleagues found that first-year resi-
sequently increasing the risk of disease. Sleep lowers heart rate and dents who worked prolonged shifts had a higher risk of adverse events,
blood pressure. This is a result of the body being in non-REM (NREM) attentional problems and serious medical errors compared to those who
sleep during most of the sleep cycle. Since the body and brain are at did not work any extended shifts. In another study, videotapes of sur-
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rest during this period, the heart does not need to pump as much blood gical residents performing surgery were observed. Surgical residents
as it would while one is conscious. NREM sleep is controlled by the with inadequate sleep took longer to finish their procedures than those
parasympathetic nervous system. During REM
sleep and waking, the sympathetic nervous system
takes over, which causes an increase in heart rate
and blood pressure. Sleep deprivation can lead to
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sympathetic nervous system hyperactivity. In-
creased heart rate, salt retention and vasoconstric-
tion due to elevated sympathetic nervous system
activity may increase one's risk of developing car-
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diovascular disease. One study reported that in-
dividuals who sleep less than six hours per night
had a 20 percent increased chance of heart
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attack. As mentioned previously, sleep is also im-
portant for metabolic function. Lack of sleep has
been associated with Type 2 diabetes mellitus. In
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one study, participants who slept for fewer than
six hours a night were more likely than those who
slept for seven to nine hours to have an impaired
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glucose tolerance. Furthermore, inadequate sleep

28 SAN ANTONIO MEDICINE • March 2024