The Effect of Sleep Loss and Fatigue on Cardiovascular Perfusion Students: A Mixed Methods Study

Ashley Hodge MBA, CCP, FPPMedical University of South CarolinaCollege of Health Professions

“Nothing seems to bring as much clarity to the function of sleep as spending a night without it.”

-William Killgore

Introduction

“Sleep Loss”

Resident restrictions

Aviation / transportation

History

1896 – Patrick and Gilbert First report of decreased response time

2004- Frey et al. Arithmetic

History

Time-on-task (Lim and Dinges, 2008) Psychomotor vigilance Progressive worsening exacerbated during fatigue Single night of sleep loss

“Wake State Instability” (Doran et al., 2001) Inhibiting neurobiological systems

Individual Differences Age

Fatigue, alcohol and performance impairment

Hand-eye tracking

Performances during sleep deprivation vs. Blood Alcohol Concentration (BAC): 28 hours

17 hours: BAC 0.05%

After 24h wakefulness, corresponded to BAC 0.10%- Legal limit for intoxication

The Effects of Sleep Loss and Fatigue on Resident-Physicians

• 68.9% worked greater than 23 hours

• 17.5% worked continuously over 36 hours

Extended

Work hours

Study

Using a mixed-methods design, the current study aims to determine the effect of acute sleep deprivation on perfusion students, during performance of clinically-relevant tasks utilizing high fidelity simulation.

Study Design

Mixed methods Quantitative

▪High Fidelity Simulation Tasks Qualitative

▪Survey▪Focus Groups

Population

n = 7

Senior Perfusion Students Age: 22-37

Gender: Male: 4 Female: 3

Focus Group

Describe Personal Experiences

“2 cases per day leads to exhaustion”

“I have nodded off while on CPB… could have caused an accident while on CPB”

“Couldn’t remember if I fed my dog”

Concerned about driving home

Sleep loss affects on personal life

“I do not get to see my son”

“I am irritable with my significant other”

“I find myself venting or lashing out at loved ones because of fatigue”

“Chronic Fatigue”

“Weight gain/loss”

Coping Mechanisms

“Sleep all weekend”

“I take naps daily”

“Melatonin / 5 hour energy”

-Room available

Changes

Exam dates

Patient work-ups

End time for

activities

Stanford Sleepiness Scale

Stanford Sleepiness Scale

Baseline 12 hrs 16 hrs 24 hrs0.0

1.0

2.0

3.0

4.0

5.0

6.0

Stanford Sleepiness Scale

Stanford Sleepiness Scale

Epworth Sleepiness Scale (ESS)

Baseline 12 hrs 16 hrs 24 hrs0.0

5.0

10.0

15.0

20.0

25.0

ESS av-erage

ESS Averages vs. Time

Simulation Tasks

Surgeon Protocol

Mock OR

Mock OR

Response Time

Minute 1: Decrease in pO2

Minute 2: Decrease in venous return

Minute 3: Ventricular Fibrillation

Minute 4: Protamine Dosage Calculation

Minute 5: Decrease in MAP

Simulation Sessions

Baseline: 0600

12 hours: 1800

16 hours: 2200

24 hours: 0600 (day 2)

Baseline 12 hrs 16 hrs 24 hrs 0

0.5

1

1.5

2

2.5

3

3.5

Learning Curve

Learning Curve

Response Time

Learning Curve vs. Response Time

Decreased pO2

24 hrs

Poor Venous Return

Ventricular Fibrillation

24 hrs

Drug Calculation

Decreased MAP

Drained Venous Reservoir

Baseline 12 hours 16 hours 24 hours 0

0.5

1

1.5

2

2.5

3

3.5

Number of Oc-curances

Incorrect Drug Calculation

Baseline 12 hours 16 hours 24 hours 0

1

2

3

4

5

6

7

Number of Oc-curances

Conclusions

Sleep loss negatively impacts our participants interpersonal relationships, their health and mental well being and caused irritability in most cases

Over time, the self-assessed alertness decreased

Sleep loss affects performance over time, specifically high functioning cognitive tasks

Study Limitations

Discussion

Inactivity

Student participants

Sample size

Thank You