The Impact of Night Float on Anesthesiology Resident Sleep Patterns

Residency training requires hospital presence twenty-four hours a day. At times this
necessitates working extended shifts, including night shifts, resulting in altered sleep
patterns and sleep deprivation. Since 2003, the Accreditation Council for Graduate Medical
Education (ACGME) has enforced duty hour regulations limiting shift length, the amount of
weekly hours worked, and other variables governing shift work. Numerous studies have sought
to determine the impact of duty hour regulations on the quality of patient care and resident
education.

In addition to affecting patient care, medical resident sleep deprivation also has the
potential to affect residents' well-being and their ability to perform basic tasks. A study
in surgical residents showed reduced efficiency and safety in performing simulated
laparoscopy following a period of sleep deprivation that was worse with novices compared to
experienced residents. Recently, UVA found that resident physicians have greater difficulty
controlling speed and driving performance with increased reaction times and minor and major
lapses in attention in the driving simulator following six consecutive night shifts.

To comply with duty hour restrictions, residency programs have adopted various strategies
including the creation of night float systems where residents are required to work multiple
nights in a row. Reduced shift length has been associated with decreased medical errors,
motor vehicle collisions, and percutaneous injuries.Surgical residents who transitioned to a
night float system from 24-hour call every 3rd day reported reduced fatigue, more time for
sleep and independent reading and increased family time, while nurses and patients reported
improved communication and quality of patient care. In a pilot study of urology residents
assigned to a 12-hour day shift (Monday-Friday), 12-hour night float (Sunday-Friday) or
24-hour home call, actigraphy was used to measure total sleep time, sleep latency and depth
of sleep. Night float did not impact total sleep time or quality of sleep. However, these
studies did not establish the optimal shift duration