Abnormal sleep may increase nurse errors

U.S. researchers say they found nurses who worked in hospital intensive care units may get less regular sleep than other nurses and may commit more errors.
Researchers at Baylor College of Medicine in Houston assessed the overall sleep quality and vigilance among intensive care unit nurses at the beginning and end of their shift. They compared their findings with similar measurements in floor nurses.
The intensive care nurses and the floor nurses completed the Pittsburgh Sleep Quality Index Questionnaire and were assessed for vigilance at the beginning and end of a 12-hour shift.
The study found the errors at either end of the shift were different only for the nurses who worked in the intensive care unit group, but not on the hospital floors.
The researchers speculated the abnormal sleep and fall in vigilance demonstrated among intensive care unit nurses may have implications for patient safety.
The findings were presented in San Diego at the annual meeting of the American College of Chest Physicians.
(United Press International. November 5th, 2009)

Sleep Deprivation Can Slow Reaction Time

Sleep deprivation can have an enormous impact on your health and happiness. Apparently, it can also affect your ability to make split-second decisions, according to a recent study in the journal SLEEP. Researchers at the University of Texas at Austin split 49 West Point cadets into two groups, 21 of whom were deprived of sleep and 28 of whom were well-rested, and tested them on tasks that require quick decisions. According to the study, participants in each group performed the tasks twice, separated by a 24-hour period. Cadets who were sleep-deprived between testing periods saw their accuracy decline by 2.4 percent, and cadets who were well-rested between testing periods improved by 4.3 percent. W. Todd Maddox, one of the researchers, told HealthDay that the type of thinking tested in this study is "critical in situations when soldiers need to make split-second decisions based about whether a potential target is an enemy soldier, a civilian or one of their own." While people vary in their need for sleep, experts agree that for most adults the amount needed to feel one's best is somewhere between seven and nine hours per night.
(National Sleep Foundation. November 23rd, 2009)


Abstract - Sleep Journal

Work-Hour Limits for Residents — But What About Attendings?

Overnight work by attending physicians with <6 hours of sleep was associated with risk for next-day operative complications.


To limit medical errors, the Institute of Medicine released, and subsequently modified, work-hour recommendations for residents. However, little attention has been paid to work hours of attending physicians who supervise residents.

Researchers conducted a matched retrospective study of obstetrical and surgical procedures at a U.S. urban tertiary care academic center. Procedures were identified as postnighttime procedures if they were performed by attending physicians who had performed additional procedures during the preceding night (midnight–6 AM). A total of 919 surgical and 957 obstetrical postnighttime procedures were matched with 3552 and 3945 control procedures (performed by the same physicians, but not after overnight work), respectively. Complications (e.g., surgical site infections, bleeding, wound failures, organ/visceral injuries) occurred in 101 postnighttime procedures (5.4%) and in 365 control procedures (4.9%). For surgical procedures, when surgeons had limited opportunity for sleep (<6 hours) before postnighttime procedures, complications occurred at a significantly higher rate than when sleep opportunity exceeded 6 hours (8.5% vs. 3.1%).

Comment: These data suggest that sleep deprivation puts patients at risk, regardless of their physicians' level of training. Whether these study results extend to other specialties and nonteaching settings is unclear. Academic institutions have struggled to comply with the work-hour limits for residents, and putting restrictions on schedules of attending physicians would be even more difficult to monitor and enforce. Therefore, we should take action ourselves. Academic centers should press faculty to avoid scheduling elective procedures following overnight call; raising awareness about the effects of sleep deprivation, promoting teamwork, and considering use of surgical nocturnists to cover nighttime on-call responsibilities also would be helpful.

— Neil H. Winawer, MD, FHM (Hospital Medicine - Journal Watch)

Artículo original - JAMA

Escala para identificar pacientes con Apnea del Sueño: Escala CENTRES

Objetivo: Construir una escala basada en datos demográficos y antropométricos para identificar personas con el Síndrome de Apnea-Hipopnea del Sueño (SAHS) en población que acude a nuestro centro y priorizar la realización de las polisomnografías de noche partida (diagnóstico y titulación en una misma noche). Metodología: Se realizó historia clínica completa, Escala de Somnolencia de Epworth (ESE) y polisomnografía completa. Escala CENTRES (puntaje 0-20): género (mujer=0 varón=2), ronquido (>5 días/semana y/o pausas respiratorias=4), hipertensión arterial (PA≥140/90) o medicación hipertensiva (Si=2), perímetro cuello (PC) (mujer≥40cm=2 ó varón≥43cm=2), ESE>10 (Si=2), índice de masa corporal (IMC) (<25 kg/m2=0, ≥25 a 30 kg/m2=2 y ≥30kg/m2=4) y Clasificación de Mallampati (I/II=0 y III/IV=4). Se usaron dos puntos de corte para el Índice Apnea-Hipopnea (IAH): ≥10 y ≥20. Se generaron curvas ROC y se calculó el área bajo la curva (ABC). Resultados: Participaron 180 pacientes, hubo 42 (23%) mujeres. Edad 47,6 +/-12,5 (18–88) años. PC 39,5 +/- 4,3 (29-49) cm. IMC 28,1 +/- 4,3 (19,4-47,6) kg/m2. Sesenta y nueve (38%) no tenían diagnóstico de SAHS (IAH<5). El resto tenía SAHS leve IAH 5 a <15: 63 (35%); moderado IAH 15 a < 30: 18 (16%); y severo IAH≥30: 20 (11%). Para IAH≥10, el ABC fue 0,767 (IC95% 0,699-0,834); usando punto de corte de Escala CENTRES >=10 para mejor sensibilidad (descarte de enfermedad): sensibilidad 94% y especificidad 42%. Para IAH≥20, el ABC fue 0,700 (IC95% 0,607-0,793); usando punto de corte de Escala CENTRES >=16 para mejor especificidad (sospecha de enfermedad): sensibilidad 47% y especificidad 79%. Conclusiones: La aplicación de la Escala CENTRES podría servir para identificar pacientes con SAHS (IAH≥10) en la población evaluada y para priorizar programación de pacientes con polisomnografía de noche partida (IAH≥20). Se necesita confirmar prospectivamente estos hallazgos en una población nueva de pacientes.

Autores: Rey de Castro J, Rosales E, Ferreyra J.

Presentado como abstract en el VI Congreso Latinoamericano de Medicina Interna (SOLAMI) 2009 y XXXI Curso Internacional de Medicina Interna (SPMI) - 28 - 31 de octubre de 2009

EEUU: Campaña para no manejar con somnolencia... y en el Perú?

Anualmente en EEUU se celebra la semana de prevención para no manejar con somnolencia (Annual Drowsy Driving Prevention Week) organizado por la National Sleep Foundation (NSF) entre el 2 y 8 de noviembre. Y en el Perú?... bien gracias.
Acá es nuestro país, las estadísticas "oficiales" no registran como una causa de los accidentes de tránsito que el chofer haya estado cansado, pero la literatura internacional y los pocos estudios que se han hecho acá en el Perú están demostrando que la somnolencia (o cansancio si queremos usar un término más coloquial, aunque haciendo la salvedad que no significa lo mismo) es una causa muy importante de accidentes de tránsito.
En el nuevo Reglamento Nacional de Tránsito, en el artículo 89 dice lo siguiente: "El conductor debe abstenerse de conducir, si muestra cansancio o si ha estado tomando medicamentos que puedan causarle efectos secundarios e inducirlo al sueño", pero esto se cumple acá? como siempre las leyes son letra muerta. Cuántas veces uno ha subido a un medio de transporte público (combi, couster o incluso un taxi) y ha visto bostezar o incluso "cabecear" al conductor? Pero hacemos algo para que no siga suciendo eso, muchas veces no, por no decir nunca.
Empecemos haciendo pequeñas cosas, al igual que no dejar conectado el cargador del celular cuando no se lo utiliza, bueno.., díganle al conductor o a la persona que vean somnolienta que se de una siesta de media hora, quizás hayan salvado decenas de vidas si evitaron un accidente de tránsito con esa acción... eso no lo sabremos, pero quizás van a dormir un poco más tranquilos esas noche.
A continuación dos enlaces que les servirá para informarse más acerca de la semana de prevención que organiza la NSF en EEUU.

National Sleep Foundation - Drowsy Driving Prevention Week

Y la página principal DrowsyDriving.org