title: Sleep and circadian misalignment for the hospitalist: a review.
abstract: Shift work is necessary for hospitalists to provide on-site 24-hour patient care. Like all shift workers, hospitalists working beyond daylight hours are subject to a misalignment between work obligations and the endogenous circadian system, which regulates sleep and alertness patterns. With chronic misalignment, sleep loss accumulates and can lead to shift work disorder or other chronic medical conditions. Hospitalists suffering from sleep deprivation also risk increased rates of medical errors. By realigning work and circadian schedules, a process called circadian adaptation, hospitalists can limit fatigue and potentially improve safety. Adaptation strategies include improving sleep hygiene before work, caffeine use at the start of the night shift, bright light exposure and planned naps during the shift, and short-term use of a mild hypnotic after night work. If these attempts fail and chronic fatigue persists, then a diagnosis of shift work disorder should be considered, which can be treated with stronger pharmacotherapy. Night float scheduling strategies may also help to limit chronic sleep loss. More research is urgently needed regarding the sleep patterns and job performance of hospitalists working at night to improve scheduling decisions and patient safety.
authors.affiliation: Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. eschaefe@nmh.org
authors.forename: Eric W
authors.initials: EW
authors.lastname: Schaefer
authors.forename: Mark V
authors.initials: MV
authors.lastname: Williams
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
mesh_terms: D002492:Central Nervous System Depressants / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D005221:Fatigue / Q000150:complications / Q000209:etiology / Q000517:prevention & control*; D020445:Hospitalists / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D012890:Sleep / Q000187:drug effects* / Q000502:physiology; D012892:Sleep Deprivation / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D020178:Sleep Disorders, Circadian Rhythm / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D014940:Work Schedule Tolerance
chemical_list: D002492:Central Nervous System Depressants; D000697:Central Nervous System Stimulants; D006993:Hypnotics and Sedatives