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The Effects of On-Duty Napping on Intern Sleep Time and Fatigue

Vineet Arora, MD, MA; Carrie Dunphy, BS; Vivian Y. Chang, BA; Fawaz Ahmad, MS; Holly J. Humphrey, MD; and David Meltzer, MD, PhD
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From the University of Chicago, Chicago, Illinois, and University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Acknowledgments: The authors thank Dr. Eve Van Cauter, Dr. Kristen Knutson, and Mr. Armand Ryden of the University of Chicago Sleep Laboratory for their financial support and assistance during the study; Ms. Jennifer Higa for her assistance in manuscript preparation; and Ms. Joyce Keldsen in Paging Services at University of Chicago Hospitals for her support and assistance in obtaining paging logs. They also thank Julie Johnson, PhD; Juned Siddique, DrPH; and Paul Rathouz, PhD for their helpful commentary on analytic issues. Finally, the authors thank Dr. Harvey Golomb from the Department of Medicine for his financial support and encouragement and Dr. James Woodruff, Internal Medicine Residency Program Director, for the enthusiastic support and participation of the interns, residents, and chief residents of the 2003–2004 University of Chicago Internal Medicine Residency Program.

Grant Support: By the University of Chicago Department of Medicine and the Pritzker School of Medicine. Drs. Arora and Meltzer are supported by the National Institute for General Medical Sciences (1 R01 GM075292-01 [Effectiveness of TEACH Research]). Dr. Meltzer and Mr. Ahmad were supported by the Agency for Healthcare Research and Quality (R01 10597 [A Multicenter Trial of Academic Hospitalists]) while most of the work was performed. Ms. Dunphy was supported by the Pritzker School of Medicine Summer Research Program; Ms. Chang was supported by a short-term training grant (5 T35DK062719-16).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Vineet Arora, MD, MA, University of Chicago, 5841 South Maryland Avenue, MC 2007, AMB W216, Chicago, IL 60637; e-mail, varora@medicine.bsd.uchicago.edu.

Current Author Addresses: Drs. Arora and Meltzer: University of Chicago, 5841 South Maryland Avenue, MC 2007, AMB B200, Chicago, IL 60637.

Ms. Dunphy, Ms. Chang, and Dr. Humphrey: University of Chicago Pritzker School of Medicine, 924 East 57th Street, Chicago, IL 60637.

Mr. Ahmad: University of Arkansas for Medical Sciences College of Medicine, 4301 West Markham, Little Rock, AR 72205.

Author Contributions: Conception and design: V. Arora, F. Ahmad, H.J. Humphrey, D. Meltzer.

Analysis and interpretation of the data: V. Arora, C. Dunphy, V.Y. Chang, F. Ahmad, H.J. Humphrey, D. Meltzer.

Drafting of the article: V. Arora, C. Dunphy, V.Y. Chang, H.J. Humphrey, D. Meltzer.

Critical revision of the article for important intellectual content: V. Arora, C. Dunphy, V.Y. Chang, H.J. Humphrey, D. Meltzer.

Final approval of the article: V. Arora, C. Dunphy, F. Ahmad, H.J. Humphrey, D. Meltzer.

Provision of study materials or patients: V. Arora, F. Ahmad, H.J. Humphrey, D. Meltzer.

Statistical expertise: V. Arora, C. Dunphy, D. Meltzer.

Obtaining of funding: V. Arora, V.Y. Chang, H.J. Humphrey, D. Meltzer.

Administrative, technical, or logistic support: V. Arora, C. Dunphy, V.Y. Chang, F. Ahmad, H.J. Humphrey, D. Meltzer.

Collection and assembly of data: V. Arora, C. Dunphy, V.Y. Chang, F. Ahmad, D. Meltzer.

Ann Intern Med. 2006;144(11):792-798. doi:10.7326/0003-4819-144-11-200606060-00005
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Between July 2003 and June 2004, 38 of 40 (95%) interns who rotated on the general medicine service participated in our study for at least 1 month for a total of 119 of 178 (67%) intern-months. Participation ranged from 1 to 5 months, with an average participation of 3 months (Appendix Table). Overall, interns with the nap schedule slept for 41 minutes more than those with the standard schedule (185 minutes vs. 144 minutes; P < 0.001). Interns with the nap schedule who forwarded their pager to a night-float physician took longer naps on the nap schedule than on the standard schedule (210 minutes vs. 142 minutes; P < 0.001) (Table 2). Sleep efficiency also improved for interns with the nap schedule, even if they did not use the nap schedule. Overall, on-call interns' sleep efficiency on the nap schedule was 80%, which is higher than the sleep efficiency of 73% for interns on the standard schedule. The difference was statistically significant. In addition, because sleep efficiency less than 80% is often considered to be abnormal in the diagnosis and treatment of sleep disorders, the difference is also clinically significant (2526).


fatigue ; sleep ; napping ; intern

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Summary for Patients

Naps To Reduce Fatigue in Doctors while Working Extended Shifts

The summary below is from the full report titled “The Effects of On-Duty Napping on Intern Sleep Time and Fatigue.” It is in the 6 June 2006 issue of Annals of Internal Medicine (volume 144, pages 792-798). The authors are V. Arora, C. Dunphy, V.Y. Chang, F. Ahmad, H.J. Humphrey, and D. Meltzer.


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