Effect of Naps on Decision Making of Residents.

Study Overview
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Brief Summary
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Sleep deprivation produces changes including alteration of mood, irritability, fatigue, less focus and disorientation, also perceptive distortions, visual hallucinations and considering tasks harder and less pleasant. In resident physicians, these alterations have been shown to affect their work performance. Naps have proved to improve arousal and attention, alertness and performance. Those longer than 90 minutes promote a learning process similar to that occurring in REM sleep. Therefore a nap schedule could improve the decision making of residents during their working hours.

Detailed Description
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Sleep deprivation produces changes including alteration of mood, irritability, fatigue, less focus and disorientation, also perceptive distortions, visual hallucinations and considering tasks harder and less pleasant. Extenuating working hours provoke sleep deprivation, which deteriorates work performance, produces mood disorders and increase chances of error. In a survey performed to 3600 resident physicians in the USA it was observed that working more than 24 continuous hours was related with a higher risk of traffic accidents, as well as a higher tendency towards medical mistakes due to overstress, the most common being a diminished capability of performing a previously known procedure; also there were difficulties to solve problems generated by coworkers or relatives. Other study determinated that after a night shift the levels of daytime sleepiness were similar or higher than those of patients with narcolepsy or sleep apnea. The lack of sleep affects the performance of tasks, producing alterations similar to those in alcoholic intoxication, with a decline in visual attention, reaction speed, visual memory and creative thinking. Even though the effects of sleep deprivation in resident have been difficult to quantify due to confounders, there are indicators as decline in performance, which seems higher in less experienced physicians, with a higher alteration in reasoning and reaction time. It has been found in physicians in training (anesthesiology residents) that mistakes in administration of epidural anesthesia are more frequent after sleep deprivation; and a resident performing monitoring tasks after a night shift was more liable to mistakes that after a resting night, being also less likely to recognize arrhythmias in an electrocardiogram. Sleep deprivation affects coordination and skill, as observed in laparoscopist surgeons who took more time to complete a procedure after sleep deprivation than those who had rested. This results made the ACGME to establish a limitation in working hours during the residence. Naps from 30 minutes to 4 hours improve alertness and performance. Studies comparing naps and caffeine have shown that naps not only improve arousal and attention but also helps to consolidate memory in those longer than 90 minutes. Furthermore, naps with slow wave and REM sleep are partially equivalent to a night's sleep, restoring the damage from baseline. It has been proven that naps promote a learning process similar to that occurring in a complete night sleep, which correlates with phase 2 of REM sleep. Therefore a nap schedule could improve the decision making of residents during their working hours.

Official Title
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Effect of Programmed Naps on Decision Making of Residents During Working Hours.

Conditions
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Internship and Residency, Sleep, Decision Making

Intervention / Treatment
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* Behavioral: nap from 0:00 to 3:00 hours
* Behavioral: nap from 3:00 to 6:00 hours


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Resident physician cursing the first to third year in the pulmonology or pediatric pulmonology residency of the INER. Accepts to participate in the study signing the informed consent. Exclusion Criteria: Chronic-degenerative or psychiatric disease. Sleep disorders diagnosed before recruiting. Elimination Criteria: Not performing all psychometric tests. Lack of data in questionnaire.

Ages Eligible for Study
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Minimum Age: 23 Years
Maximum Age: 32 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Nap 1<br>Subjects who take, during a night shift, first a nap from 0:00 to 3:00 hours and, after 6 weeks of lavage, another nap from 3:00 to 6:00 hours. | Behavioral: nap from 0:00 to 3:00 hours<br>* A nap from 0:00 to 3:00 hours during a night shift.<br>Behavioral: nap from 3:00 to 6:00 hours<br>* A nap from 3:00 to 6:00 hours during a night shift.<br>|
| Experimental: Nap 2<br>Subjects who take, during a night shift, first a nap from 3:00 to 6:00 hours and, after 6 weeks of lavage, another nap from 0:00 to 3:00 hours. | Behavioral: nap from 0:00 to 3:00 hours<br>* A nap from 0:00 to 3:00 hours during a night shift.<br>Behavioral: nap from 3:00 to 6:00 hours<br>* A nap from 3:00 to 6:00 hours during a night shift.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Decision making | Net total and demographically corrected percentile in the Iowa Gambling Task. | At 12:00 on the day of the nap. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alertness | Mean reaction time in the psychomotor vigilance test. | At 12:00 hours on the day of the nap. | 
| Sleep quality | Sleep efficiency as assessed by actigraphy | 3 hours. | 
| Vigilance | Slope of the reaction time in the psychomotor vigilance test. | At 12:00 hours on the day of the nap. | 
| Energy Expenditure | Total activity kcal as calculated via algorithm by actigraphy. | 22 hours around the nap. | 
| Activity | Percentages of sedentary, light, vigorous and very vigorous activity as calculated via algorithm by actigraphy. | 22 hours around the nap. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Residents, Naps, decision making