Lack of sleep is common and hinders work performance in cardiologists, survey finds

Many cardiologists are sleep deprived, with at least 25% reporting sleep disorders and 46% saying lack of sleep hinders work performance, according to results of a survey presented at the American College of Cardiology 67th Annual Scientific Session, held March 10-12, 2018, in Orlando, FL.

Cardiologists are prone to sleep deprivation mainly because they are frequently on call, explained presenter Angie S. Lobo, MD, internal medicine resident, Abbott Northwestern Hospital, Minneapolis, MN. Nearly all cardiologists surveyed (91%) had call responsibilities, with 43% having 7 or more call nights per month.

“Our survey showed that during non-call days, around one-third of respondents sleep 6 hours or less, whereas during call days nearly 85% reported sleeping 6 hours or less,” Dr. Lobo told MDLinx. “Expert consensus recommendations suggest that a minimum of 7 hours of sleep are required per night for optimal health.”

Interventional cardiologists are prone to sleep deprivation because they often perform percutaneous coronary interventions or other cases after regular working hours, wrote Dr. Lobo and coauthors in an article, published in Catheterization & Cardiovascular Interventions, that preceded this survey.

The purpose of this survey was to better understand the impact of sleep deprivation among cardiology care providers. Survey respondents included 481 cardiovascular physicians, nurses, and technicians—80% were men and 70% were interventional cardiologists.

“Historically, sleep deprivation has been [seen as] a ‘badge of honor,’” Dr. Lobo said of interventional cardiologists. “Our research has led people to think whether we should change our perceptions about such.”

The authors used the International Classification of Sleep Disorders’ definition of chronic sleep deprivation, which they defined as “a disorder characterized by excessive daytime sleepiness caused by shortened sleep almost every day for at least 3 months.”

Results of the study showed that the main factors diminishing the quality and/or quantity of sleep were related to work (66%), family and/or personal activities (56%), and staying up late at night writing or studying (48%). Sleep deprivation was associated with irritability (68%), difficulty concentrating (58%), and lack of motivation (56%), respondents reported.

Additional survey findings:

• 25% of respondents reported sleep disorders
• 25% used sleep-inducing medications (8.4% used them once per week)
• 46% felt that sleep deprivation hindered work performance
• 8.6% reported a complication and/or negative patient outcome likely related to sleep deprivation
• 19% of those reporting sleep deprivation were allowed to go home early the following day
• 85% agreed that policies should exist to allow sleep-deprived individuals to go home early post-call
• 56% reported feeling burned out
• 79% consumed coffee, and 24% used energy drinks or supplements
• 42% often used digital devices at bedtime
• 65% reported that they were not routinely required to disclose sleep deprivation to patients, yet 48% felt that disclosure should occur if the provider had limited sleep

“It's important to note that studies in interventional cardiology have not shown an increase in major complications,” due to lack of sleep, Dr. Lobo said. “However, other studies have suggested increase in medical errors and other issues like attention and vigilance, for example. For these reasons, while sleep deprivation is intrinsic to our field as it is necessary to deliver care to emergencies occurring around the clock, we suggest that a culture-change would be helpful in which we embrace these issues and allow for team-members to rest and go home early or, if possible, take over and help with their other day duties.”

She acknowledged that one possible limitation of the study is that respondents more impacted by sleep deprivation could have had a greater interest in completing the survey, potentially overestimating the impact of sleep deprivation.

The researchers concluded that further study is needed to identify measures that would lighten the burden for providers as well as to better understand the impact of sleep deprivation on both providers and patient outcomes.

In the meantime, “It appears reasonable to suggest that it is the responsibility of clinicians to either alert their colleagues of the presence of significant fatigue due to sleep deprivation and have a partner perform the procedure, or defer the procedure to the following day on the basis of a risk-benefit balance, if possible,” the authors advised.