So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents

Jonathan P. Zebrowski, Samantha J. Pulliam, John W. Denninger, Lori R. Berkowitz

Sleep impairment is highly prevalent among resident physicians and is associated with both adverse patient outcomes and poor resident mental and physical health. Risk factors for sleep problems during residency are less clear, and no screening model exists to identify residents at risk for sleep impairment. The objective of this study was to assess change in resident sleep during training and to evaluate utility of baseline sleep screening in predicting future sleep impairment. This is a prospective observational repeated-measures survey study. The participants comprised PGY-1 residents across multiple specialties at Partners HealthCare hospitals. Main measures used for this study were demographic queries and two validated scales: the Pittsburgh Sleep Quality Index (PSQI), measuring sleep quality, and the Epworth Sleepiness Scale (ESS), measuring excessive daytime sleepiness. Two hundred eighty-one PGY-1 residents completed surveys at residency orientation, and 153 (54%) completed matched surveys 9 months later. Mean nightly sleep time decreased from 7.6 to 6.5 hours (p < 0.001). Mean PSQI score increased from 3.6 to 5.2 (p < 0.001), and mean ESS score increased from 7.2 to 10.4 (p < 0.001). The proportion of residents exceeding the scales' clinical cutoffs increased over time from 15 to 40% on the PSQI (p < 0.001) and from 26 to 59% on the ESS (p < 0.001). Baseline normal sleep was not protective: 68% of residents with normal scores on both scales at baseline exceeded the clinical cutoff on at least one scale at follow-up. Greater age and fewer children increased follow-up PSQI score (p < 0.001) but not ESS score. During PGY-1 training, residents experience worsening sleep duration, quality of sleep, and daytime sleepiness. Residents with baseline impaired sleep tend to remain impaired. Moreover, many residents with baseline normal sleep experience sleep deterioration over time. Sleep screening at residency orientation may identify some, but not all, residents who will experience sleep impairment during training.