title: Does sleep deprivation impair orthopaedic surgeons' cognitive and psychomotor performance?
abstract: BACKGROUND
  Sleep deprivation may slow reaction time, cloud judgment, and impair the ability to think. Our purpose was to study the cognitive and psychomotor performances of orthopaedic trauma surgeons on the basis of the amount of sleep that they obtained.
  
  
  METHODS
  We prospectively studied the performances of thirty-two orthopaedic trauma surgeons (residents, fellows, and attending surgeons) over two four-week periods at an urban academic trauma center. Testing sessions used handheld computers to administer validated cognitive and psychomotor function tests. We conducted a multivariate analysis to examine the independent association between test performance and multiple covariates, including the amount of sleep the night before testing.
  
  
  RESULTS
  Our analysis demonstrated that orthopaedic surgeons who had slept four hours or less the night before the test had 1.43 times the odds (95% confidence interval, 1.04 to 1.95; p = 0.03) of committing at least one error on an individual test compared with orthopaedic surgeons who had slept more than four hours the previous night. The Running Memory test, which assesses sustained attention, concentration, and working memory, was most sensitive to deterioration in performance in participants who had had four hours of sleep or less; when controlling for other covariates, the test demonstrated a 72% increase in the odds of making at least one error (odds ratio, 1.72 [95% confidence interval, 1.02 to 2.90]; p = 0.04). No significant decrease in performance with sleep deprivation was shown with the other three tests.
  
  
  CONCLUSIONS
  Orthopaedic trauma surgeons showed deterioration in performance on a validated cognitive task when they had slept four hours or less the previous night. It is unknown how performance on this test relates to surgical performance.
authors.affiliation: Department of Orthopaedics, University of Maryland, Baltimore, MD, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: O'Brien
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
authors.forename: Mary Zadnik
authors.initials: MZ
authors.lastname: Newell
authors.forename: Alison D
authors.initials: AD
authors.lastname: Lydecker
authors.forename: Jason
authors.initials: J
authors.lastname: Nascone
authors.forename: Marcus
authors.initials: M
authors.lastname: Sciadini
authors.forename: Andrew
authors.initials: A
authors.lastname: Pollak
authors.forename: Clifford
authors.initials: C
authors.lastname: Turen
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Eglseder
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D034201:Computers, Handheld; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000592:standards*; D011446:Prospective Studies; D011597:Psychomotor Performance / Q000502:physiology*; D012892:Sleep Deprivation / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D000078329:Workforce