Our next poster is titled Sleep in Orthopaedic Surgeons: A Prospective Longitudinal Study of the Effect of Home Call on Orthopedic Attending and Resident Sleep. Recurrent episodes of partial sleep deprivation resulting from call schedules are commonly seen in physicians. This has been shown to cause decreased mental effectiveness while at work, which corresponds with a blood alcohol level of 0.08%. 

Sleep deprivation has been associated with adverse personal health events, with an increased risk of diabetes, heart disease, stroke and risk of death. Additionally, sleep deprivation has been demonstrated to have a negative clinical impact, including decreased surgical performance, increased errors, and greater risks of accidents.

Despite the known negative impacts of poor sleep, the effect of home orthopedic call on surgeon sleep has not been well quantified.  The purpose of the study was to quantify the impact of resident and attending physician home call on sleep performance – specifically total sleep, slow-wave sleep and rapid eye movement sleep – as well as heart rate variability. 

Sixteen orthopedic residents and 14 attendings at a level 1 academic trauma hospital wore WHOOP 3.0 straps for a period of 1 year. The WHOOP strap is wearable device that tracks all 4 stages of sleep and monitors wake events, efficiency and respiratory rate. The authors recorded total sleep, slow-wave sleep and REM sleep.  Slow-wave sleep is considered to be the most restorative sleep stage and plays an important role in growth, memory and immune function.

This study showed that overall, attendings slept significantly less than residents, at 6 hours compared to 6.7 hours.  When on home call, resident total sleep decreased by 20%, REM sleep decreased by 12%, and slow-wave sleep decreased by 12%.  For attendings, total sleep on-call decreased by 10%, REM sleep decreased by 7% and slow-wave sleep decreased by 4%.

The authors concluded that orthopedic surgery residents and attendings exhibit low baseline sleep, and taking home call reduces this even further.  On home call nights, Residents and Attendings experienced a significant decrease in total sleep, REM sleep and short wake sleep.  The authors suggested that further research is required in order to determine how to ensure excellent patient care, maximize educational environments and develop strategies for resilience.