Sleep Quality and Related Factors in Medical Residents

Introduction: The aim of this study was to assess the sleep quality and daytime sleepiness of resident doctors, to compare the sleep quality between surgical and medical branch residents and to examine effects of working hours, number of duties, clinical branches and some other daily habits on the sleep quality of resident doctors in a hospital in Turkey. Methods: A survey was conducted to gather data on (i) demographics, lifestyle and daily habits as well as to determine (ii) Epworth sleepiness scale (ESS) score and (iii) Pittsburgh sleep quality index (PSQI) scores of the participants. Data collection was based on the use of a self-administered questionnaire. Results: Of 138 resident doctors, 45.7% were classified as having good sleep quality based on a cut-off score of 5 in PSQI. The mean ESS and PSQI scores were 6.59 ±3.92 and 6.30 ±3.22, respectively. Significantly positive correlations were found between Epworth score and the number of night duties (p=0.010), working hours per week (p=0.006), total cigarettes per day (p=0.033), and daily tea consumption (p=0.013). Also, there were statistically significant positive correlations between PSQI scores and the number of night duties (p<0.001), working hours per week (p=0.007), total cigarettes per day (p=0.013) and daily coffee consumption (p=0.002). Surgical residents had significantly poor sleep quality (p=0.015). ESS score was higher in female residents and surgical residents, with a significant difference in these two sub-groups (p=0.018, p=0.008 respectively). Conclusions: Sleep quality and daytime sleepiness of the resident doctors were closely related to lifestyle factors including working hours, number of night duties and branch of residency as well as to certain demographic factors and daily habits.  Giriş: Bu çalışmanın amacı bir hastanede çalışan asistanların uyku kalitesini ve gün içi uykululuk durumunu değerlendirmek, cerrahi ve medikal branşlar arasında uyku kalitesini karşılaştırmak ve haftalık çalışma saatleri, nöbet sayıları , bazı günlük alışkanlıklar ve yaşam tarzının uyku kalitesi üzerine etkisini araştırmaktır. Yöntem: Çalışma üç bölümden oluşan veriler ile yapılmıştır; (i) demografik özellikler, günlük yaşam tarzı ve alışkanlıklarla ilgili bilgiler, (ii) Epworth uykululuk ölçeği (ESS) skoru, (iii) Pittsburgh uyku kalitesi ölçeği (PSQI) .Veriler katılımcılardan anket yoluyla ve etik kurallara uygun olarak alınmıştır. Bulgular: 138 asistan doktorun % 45.7’sinin uyku kalitesi PSQI   kesme puanı olan 5’e göre uyku kalitesi iyi olarak değerlendirildi. Ortalama ESS ve PSIQ puanları sırasıyla 6.59 ±3.92 ve 6.30 ±3.22 olarak bulundu. Epworth skoru ile gece nöbet sayısı (p=0.010), haftalık çalışma saatleri (p=0.006), günlük içilen sigara sayısı (p=0.033), günlük çay tüketimi (p=0.013) arasında anlamlı pozitif korelasyon bulundu. PSQI skorları ile, gece nöbeti sayıları (p<0.001), haftalık çalışma saatleri (p=0.007), günde içilen sigara sayısı (p=0.013), günlük kahve tüketimi (p=0.002) arasında anlamlı pozitif korelasyon saptandı. Cerrahi bölüm asistanlarının uyku kalitesi daha düşük rapor edildi (p=0.015). ESS skorları kadın asistanlarda ve cerrahi bölüm asistanlarında daha yüksek gözlendi ve bu farklar istatistiksel olarak anlamlı bulundu (sırasıyla p=0.018, p=0.008). Sonuç: Asistan doktorların uyku kalitesi ve gün içi uykululuk durumu, demografik faktörler ve günlük alışkanlıklarla ilgili olduğu kadar, haftalık çalışma saatlerinin uzunluğu, nöbet sayıları ve asistanlık yapılan bölüm gibi yaşam tarzı faktörleriyle de yakından ilişkilidir.  

___

  • 1. Drake CL, Roehrs T, Richardson G, Walsh JK, Roth T. Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep 2004;27:1453-62.
  • 2. Website of American Sleep Association [accessed March 25, 2017], http:/www.sleepassociation.org/patients-general-public/what-is-sleep/
  • 3. Mohammed A. Alsaggaf, Siraj O. Wali, Roah A. Merdad, Leena A. Merdad.Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Saudi Med J. 2016 Feb; 37(2): 173–182. doi: 10.15537/smj.2016
  • 4. Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residency training: a reappraisal. JAMA 2002;288:1116-24.
  • 5. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991;14:540-5.
  • 6. Buysse DJ, Reynolds CF, 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
  • 7. Mota MC, De-Souza DA, Rossato LT, et al. Dietary patterns, metabolic markers and subjective sleep measures in resident physicians. Chronobiol Int 2013;30:1032-41.
  • 8. Siddiqui AF, Al-Musa H, Al-Amri H, Al-Qahtani A, Al-Shahrani M, Al-Qahtani M. Sleep Patterns and Predictors of Poor Sleep Quality among Medical Students in King Khalid University, Saudi Arabia. Malays J Med Sci. 2016 Nov;23(6):94-102. doi: 10.21315/mjms2016.23.6.10. Epub 2016 Dec 7.
  • 9. Giri PA, Bavishar MP, Phalke DB. Study of Sleep Habits and Sleep Problems Among Medical Students of Pravara Institute of Medical Sciences Loni, Western Mahastrashra, India. Annals of Medical and Health Sciences Research, 2013 Jan:3(1):51-4. Doi: 10.4103/2141-9248.109488.
  • 10. Nojomi M, Ghalhe Bandi MF, Kaffashi S. Sleep pattern in medical students and residents. Arch Iran Med 2009;12:542-9.
  • 11. Murthy VS, Nayak AS, Assessment of sleep quality in post-graduate residents in a tertiary hospital and teaching institute .Ind Psychiatry J. 2014 Jan-Jun; 23(1): 23–26.
  • 12. Blum AB, Shea S, Czeisler CA, Landrigan CP, Leape L. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety. Nat Sci Sleep 2011;3:47-85.
  • 13. Barger LK, Ayas NT, Cade BE, et al. Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med 2006;3:e487.
  • 14. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med 2004;351:1838-48.
  • 15. Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med 2004;351:1829-37.
  • 16. Comodore VR, Wenner JB, Ayas NT. The impact of sleep deprivation in resident physicians on physician and patient safety: Is it time for a wake-up call? BCMJ 2008;50:560-4.
  • 17. Ellman PI, Law MG, Tache-Leon C, et al. Sleep deprivation does not affect operative results in cardiac surgery. Ann Thorac Surg 2004;78:906-11.
  • 18. Saultz JW, David AK. Is it time for a 4-year family medicine residency? Fam Med 2004;36:363-6.