Sleep Deprivation and Resident Fatigue - Graduate Medical 睡眠剥夺和居民的疲劳研究生医学.ppt

The Effects of Sleep Deprivation and Implications for Residency Training Tisha Wang, MD Assistant Clinical Professor UCLA Division of Pulmonary and Critical Care Overview Mechanisms regulating sleep Consequences of sleep deprivation Sleep deprivation during residency training Definition of Sleep “A normal reversible, recurring behavioral state of disengagement and unresponsiveness to the environment that is characterized by typical changes in the electroencephalogram (EEG)” “Essential physiological need state that must be satisfied to ensure survival” Sleep Stages and Normal Sleep NREM sleep - Stage 1: 3-8% - Stage 2: 45-55% - Stage 3/4 (slow wave sleep): 15-20% REM sleep: 20-25% Mechanisms Regulating Sleep Homeostatic sleep drive Circadian rhythm Autonomic nervous system balance Homeostatic Sleep Drive The pressure or drive for sleep increases proportionately to the time since last sleep Sleep deprivation increases desire for sleep Results in progressively increasing sleep propensity and concomitant degradations in alertness and performance Circadian Rhythm Approximately 24-hour cycle of sleep and wakefulness Biological clock regulating sleep and wake is located in the suprachiasmatic nucleus (SCN) in the hypothalamus SCN is regulated by zeitgebers: sunlight and eating times Autonomic Nervous System Balance and Sleep Factors that increase sympathetic nervous system activity inhibit sleep - Caffeine - Other stimulant drugs - Emotional upset - Physical activity Normal Sleep Duration? Variable with age and for each individual person Young adults would spontaneously sleep an average of 8.5 h/night if given the opportunity Adult residents sleep ~ 2 h/night less than this amount Several epidemiologic studies support an ideal of 7-8 h of sleep per night Sleep Deprivation Difficult to define for a given individual but can be a quantitative, qualitative, or timing issue Characterized as cumulative partial sleep deprivation vs. acute total sleep deprivation