Müdigkeit nach Bereitschaftsdienst - subjektive Wahrnehmung oder objektives Faktum?

Einleitung Die Auswirkungen von akutem Schlafmangel auf die chirurgische Leistungsfähigkeit werden kontrovers diskutiert. Die vorliegende Studie wurde konzipiert, um physiologische Parameter der Übermüdung mit objektiven, technischen und kognitiven Fähigkeiten und mit subjektiv empfundener Schläfri...

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Bibliographic Details
Main Author: Kupietz, Eva Anna
Contributors: Schlosser, Katja (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Language:German
Published: Philipps-Universität Marburg 2015
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Table of Contents: Background The effect of acute partial sleep deprivation on surgical proficiency is still controversially discussed. The present study correlated physiological parameters of fatigue with objective technical and cognitive skills as well as subjective sleepiness of surgical residents. The aim of this study was to assess the effect of acute partial sleep deprivation on surgical performance. Methods Thirty-eight surgeons were explored on three consecutive mornings: prior to a 24 hour call, post call and after 24 hours resting. Reported hours of sleep were recorded. Subjective alertness was assessed using the standardized Stanford Sleepiness Scale (SSS). Saliva cortisol concentrations and pupillary activity were measured by standardized ELISA (Enzyme Linked Immunosorbent Assay) and pupillography. The virtual reality (VR) simulator LapSim® was used to assess technical skills through low fidelity VR tasks (“cutting”, “clip applying”) and cognitive skills through high fidelity VR tasks (“intracorporal suturing”, “VR cholecystectomy”). Objective alertness was measured by the standardized d2 Paper Pencil Test. Results Recorded hours of sleep (p = 0.001) and subjective alertness (SSS) decreased (p = 0.001) significantly post call. Neither saliva cortisol concentrations (p = 0.80), pupillary activity (p = 0.64) nor VR performances of low fidelity VR tasks differed significantly between assessments. Surprisingly, VR performance of high fidelity VR tasks (“error score” p = 0.045, “time to complete task” p = 0.0001, “economy of instrument motion” p = 0.0001) and objective alertness (d2 Paper Pencil Test p = 0.027) significantly improved in the post call setting. Conclusion Acute call associated fatigue seems to be a predominant subjective perception. Physiological factors seem to outbalance an anticipated fatigue-associated impairment of technical performances within low fidelity VR tasks. In surgical residents, acute partial sleep deprivation seems to have a positive short term effect on cognitive skills, leading to enhanced technical performance and increased objective alertness within complex tasks. Foresight The data concerning the effect of sleep deficiency after 24 hours on call is still contradictory. However a derogation of the residents’ reliability is to assume. The work hour limitation is an important step towards the improvement of the residents’ working conditions and a warranty for the safe patient care. Nevertheless further research is needed to enumerate the effects of sleep deficiency for being able to optimize the existing directives.