title: Objective and quantitative analysis of daytime sleepiness in physicians after night duties.
abstract: BACKGROUND
  Work place studies often have the disadvantage of lacking objective data less prone to subject bias. The aim of this study was to contribute objective data to the discussion about safety aspects of night shifts in physicians. For this purpose we applied the Pupillographic Sleepiness Test (PST).
  
  
  METHODS
  The PST allows recording and analyses of pupillary sleepiness-related oscillations in darkness for 11 min in the sitting subject. The parameter of evaluation is the Pupillary Unrest Index (PUI; mm/min). For statistical analysis the natural logarithm of this parameter is used (lnPUI). Thirty-four physicians were examined by the PST and subjective scales during the first half of the day. Data taken during a day work period (D) were compared to those taken directly after night duty (N) by a Wilcoxon signed rank test.
  
  
  RESULTS
  Night duty caused a mean sleep reduction of 3 h (Difference N-D: median 3 h, minimum 0 h, maximum 7 h, p < 0.001). Time since the last sleep period was about equal in both conditions (Difference N-D: median -0.25 h, min. -4 h, max. 20 h, p = 0.2). The lnPUI was larger after night duty (Difference N-D: median 0.19, min. -0.71, max. 1.29, p = 0.03). The increase of physiologically measured sleepiness correlated significantly with changes in subjective measures (PUI/SSS, Spearman Rho 0.41, p = 0.02; PUI/VAS, Spearman Rho 0.38, p = 0.02).
  
  
  CONCLUSIONS
  Despite a mean sleep duration of 4 h, considerable sleepiness in physicians after nights on duty was found, implying lower safety levels for both patients (if physicians remaining on duty) and physicians while commuting home.
authors.affiliation: STC Biomed at the Centre for Ophthalmology, UniversityTübingen, Schleichstr. 12-16, D-72076 Tübingen, Germany. barbara.wilhelm@stz-biomed.de
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Wilhelm
authors.forename: Anja
authors.initials: A
authors.lastname: Widmann
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Durst
authors.forename: Christian
authors.initials: C
authors.lastname: Heine
authors.forename: Gerhard
authors.initials: G
authors.lastname: Otto
mesh_terms: D000328:Adult; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010561:Personnel Staffing and Scheduling; D010820:Physicians / Q000523:psychology*; D011680:Pupil / Q000502:physiology; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000503:physiopathology; D020178:Sleep Disorders, Circadian Rhythm / Q000503:physiopathology*; D014940:Work Schedule Tolerance / Q000502:physiology*; D055815:Young Adult