title: Relationship of neuroimaging to typical sleep times during a clinical reasoning task: a pilot study.
abstract: BACKGROUND
  Sleep deprivation and fatigue have been associated with medical errors, clinical performance decrements, and reduced quality of life for both practicing physicians and medical students. Greater understanding of the impact of sleep quantity on clinical reasoning could improve patient care. The purpose of our pilot study was to examine relationships between clinical reasoning (assessed by functional magnetic resonance imaging) and sleep time (measured in different ways by actigraphy) while answering multiple-choice questions (MCQs) from licensing agencies.
  
  
  METHODS
  Residents and faculty were administered a clinical reasoning exercise (MCQs from licensing bodies) during functional magnetic resonance imaging. Usual sleep patterns were sampled with actigraphy. Covariate analysis was used to examine the relationship between sleep duration (mean sleep, minimum sleep, maximum sleep) and brain activity during clinical reasoning (solving MCQs from licensing bodies).
  
  
  RESULTS
  The mean sleep time over the duration of monitoring for the group was 7.19 hours (SD 0.66) with a range of 6.1 to 8.1 hours (internal medicine faculty 7.1 hours, SD 0.41; internal medicine residents 7.27 hours, SD 0.92). There was a negative relationship between activation in the prefrontal cortex and minimum sleep time while reflecting on MCQs.
  
  
  CONCLUSIONS
  Our findings provide evidence that the quantity of sleep can modulate brain activity while completing a clinically meaningful task that should be confirmed in larger studies. Our findings suggest that the construct of sleepiness may be more complex than appreciated by many and that the most important of these sleep measures in terms of outcomes remains to be determined.
authors: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda MD 20814.
authors: Steven J
authors: SJ
authors: Durning
authors: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda MD 20814.
authors: William
authors: W
authors: Kelly
authors: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda MD 20814.
authors: Michelle E
authors: ME
authors: Costanzo
authors: Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda MD 20814.
authors: Anthony R
authors: AR
authors: Artino
authors: Department of Educational Development and Research, Maastricht University, 6200 MD Maastricht, The Netherlands.
authors: Cees
authors: C
authors: van der Vleuten
authors: Department of Internal Medicine, Division of General Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905.
authors: Thomas J
authors: TJ
authors: Beckman
authors: Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda MD 20814.
authors: Michael J
authors: MJ
authors: Roy
authors: American Board of Internal Medicine, 510 Walnut Street Suite 1700 Philadelphia, PA 19106-3699.
authors: Eric S
authors: ES
authors: Holmboe
authors: Department of Internal Medicine, Division of General Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN 55905.
authors: Christopher M
authors: CM
authors: Wittich
authors: School of Medicine, Flinders University, GPO Box 2100, Adelaide 5001, South Australia.
authors: Lambert
authors: L
authors: Schuwirth
mesh_terms: D056044:Actigraphy / Q000379:methods; D000328:Adult; D002983:Clinical Competence; D005180:Faculty, Medical; D005221:Fatigue / Q000523:psychology; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008279:Magnetic Resonance Imaging / Q000379:methods; D059906:Neuroimaging / Q000379:methods*; D010865:Pilot Projects; D017397:Prefrontal Cortex / Q000503:physiopathology; D012890:Sleep / Q000502:physiology*; D012892:Sleep Deprivation / Q000503:physiopathology / Q000523:psychology*; D013337:Students, Medical / Q000523:psychology; D013647:Task Performance and Analysis; D013850:Thinking / Q000502:physiology*; D013997:Time Factors