The Relationship Between Shift Work, Sleep, and Cognition in Career Emergency Physicians
Abstract
ACADEMIC EMERGENCY MEDICINE 2012; 19:85–91 © 2012 by the Society for Academic Emergency Medicine Objectives: The 24‐hour physician coverage of the emergency department (ED) requires shift work, which can result in desynchronosis and cognitive decline. We measured changes in cognition and sleep disturbance in attending emergency physicians (EPs) before and after day and overnight shifts. Methods: Thirteen EPs were tested before and after day and overnight shifts using the Paced Auditory Serial Addition Test (PASAT), the University of Southern California Repeatable Episodic Memory Test (REMT), the Trail Making Test (TMT), and the Stroop Color‐Word Test. Sleep quality and fatigue were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Chalder Fatigue Questionnaire (CFQ). Saliva samples were collected from each physician immediately before and after day shifts and night shifts for neurohormonal assays. Results: Significantly fewer words were recalled on the REMT after both day (−2.4, 95% confidence interval [CI] = −4.4 to −0.4) and overnight shifts (−4.6, 95% CI = −6.4 to −2.8). There was a significant postshift increase in words recalled from the last third of the REMT list after overnight shifts (6.6, 95% CI = 2.8 to 10.4). Sleep quality was worse in EPs (mean PSQI = 4.8, SD ± 2.5) compared to the normal population, with 31% of subjects reporting poor sleep quality. Postshift fatigue was correlated with the perceived difficulty of the shift. Salivary cortisol and melatonin demonstrated diurnal variation consistent with normal circadian rhythms. Morning cortisol peak was decreased or delayed in samples from physicians after a night shift. Conclusions: These data indicate that short‐term memory appears to decline after day and overnight shifts and confirms the high incidence of disturbed sleep in this population.
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Shift work is very frequently associated with abbreviated or otherwise disturbed sleep.
“shift work is very frequently associated with abbreviated or otherwise disturbed sleep (Ferguson et al., 2012; Lin et al., 2012; Machi et al., 2012; Mahan et al., 1990; Roach et al., 2012).”
From Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease? (2014) · cites this paper as Machi et al., 2012
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- Authors
- Machi, M. S., Staum, M., Callaway, C. W., Moore, C., Jeong, K., Suyama, J., Patterson, P. D., & Hostler, D.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Patterson, P. Daniel
- Hostler, David
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2012-01
- Volume
- 19
- Issue
- 1
- Pages
- 85-91
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- OpenAlex
- W2104733269
- Cited by
- 143
- References
- 24
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 8 · 2023: 8 · 2022: 13 · 2021: 11 · 2020: 13 · 2019: 15 · 2018: 9 · 2017: 5 · 2016: 7 · 2015: 11 · 2014: 11 · 2013: 6 · 2012: 6
- FWCI
- 14.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01hl077871-11)
- National Heart, Lung, and Blood Institute (U01-HL077871)
- National Center for Research Resources (KL2RR024154)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- shift work, emergency physicians, sleep disorders, cognitive performance, short-term memory, fatigue, circadian rhythm, salivary cortisol, salivary melatonin, jet lag, night shift work, day shift, episodic memory
- MeSH terms
- Adult, Career Choice, Circadian Rhythm, Cognition, Emergency Medicine, Female, Humans, Male, Medical Staff, Hospital, Middle Aged, Neuropsychological Tests, Prospective Studies, Mental Recall, Sleep Wake Disorders, Work Schedule Tolerance
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