34th Annual Scientific Meeting proceedings

Sleep deprivation is a prevalent but largely underappreciated condition, and inadequate sleep leads to important but often unseen ramifications for health and safety.  Medical professionals may be particularly susceptible to the impacts of sleep deprivation due to the caretaker nature of many who enter the profession and historically flippant attitudes regarding sleep.  Sleep deprivation during medical training has often been viewed as a mark of resilience; those who do not function adequately with minimal sleep are viewed as weak or unqualified.  In reality, it is impossible for anyone to function optimally with acute or chronic sleep deprivation, both at home and at work.  Because surgery as a profession is often associated with overnight emergency duty and on-call, many surgeons experience substantial acute and chronic sleep deprivation during post-graduate training and potentially beyond. 

As medical errors have gained attention and patient safety has become a paramount concern, focus has shifted toward highlighting the role of prolonged work hours and sleep health on physician performance.  For example, extended working hours and demanding on-call schedules among resident physicians have been shown to result in impairment comparable to a blood alcohol concentration of 0.04 – 0.05%.  Similarly, higher rates of medical errors have be associated with sleeping 6 hours or less per night or working 70 hours or more per week.

In addition to implications for risks to patient health, sleep deprivation creates both a substantial physical and mental threat to health professionals.  The role of adequate sleep in maintaining and optimizing both physical and mental health is poorly understood among the general population, and education regarding basic sleep health is often completely lacking from advanced medical training.  As a result, many physicians remain ignorant to the dangers of sleep loss and continue to subject themselves to unnecessary risks, believing that the benefit of losing sleep in exchange for performing work-related tasks outweighs the costs of sleep deprivation.  This behavior is frequently repeated in medical school and post-graduate training and may shape harmful behaviors that persist throughout one’s career.

Physical risks of sleep deprivation are wide and varied.  Because of the cellular repair processes that occur during sleep, chronic sleep deprivation is associated with increased risk of cardiovascular disease and cancer.  In the acute setting, sleep deprivation increases the incidence of “microsleeps” and slows reaction time.  This is particularly relevant for surgeons driving after an overnight surgery: resident physicians in the United States are at an increased risk of motor vehicle accidents after working extended shifts, and 19% of emergency medicine residents have reported being in volved in a motor vehicle accident caused by falling asleep.  Interns are also more likely to suffer percutaneous injuries after working a night shift.

Awareness of mental health among veterinarians has increased dramatically over the past decade with burnout and suicide plaguing the profession.  In addition to the physical effects listed above, sleep plays an important role in modulating mood and behavior; sleep deprivation has been shown to increase activity in regions of the brain associated with both strong emotions and impulsivity while decreasing activity in the prefrontal cortex associated with logical thought and decision-making.  This relationship provides a potential explanation for how sleep deprivation may contribute to excessive swings between negative and positive emotions and thus may contribute to the incidence of mental health challenges in our profession.

In a recent survey of small animal diplomates of the American College of Veterinary Surgeons, 70% of respondents reported having after-hours on-call responsibility.  Although 67% of respondents said they had right of refusal for an after-hours emergency, the vast majority of surgeons reported that they rarely or never use this option to defer an after-hours case, and only 36% felt that they could sustain their current on-call practices indefinitely.  Although the Center for Disease Control and National Sleep Foundation recommend 7 to 9 hours of sleep per night for healthy adults, 53% of surveyed veterinary surgeons reported obtaining 6 hours of sleep or less during a typical night on clinics.  This suggests that the majority of veterinary surgeons suffer from chronic sleep deprivation which may have important implications for the health of the profession.