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To bed or not to bed: the sleep question?
  1. Chris Brown1,
  2. Tarig Abdelrahman1,
  3. Wyn Lewis1,
  4. John Pollitt1,
  5. Richard Egan2
  6. on behalf of the members of the Welsh Surgical Research Initiative
    1. 1School of Surgery, Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
    2. 2Department of Surgery, Morriston Hospital, Swansea, United Kingdom
    1. Correspondence to Dr Chris Brown, Cardiff University School of Postgraduate Medical and Dental Education, Cardiff CF144XW, UK; chrisbrown87{at}


    Background Sleep deprivation and fatigue from long-shift work impacts doctors' personal safety, inhibits cognitive performance and risks clinical error. The aim of this study was to assess the sleep quality of surgical trainees participating in European Working Time Directive-compliant training rotations within a UK deanery.

    Methods A trainee cohort numbering 38 (21 core, 17 higher surgical trainees, 29 men and 9 women, median age 31 (25–44 years)) completed a sleep diary over 30 days using the Sleep Time (Azumio) smartphone application and triangulated with on-call rosters to identify shift patterns. The primary outcome measure was sleep quality related to rostered clinical duties.

    Results Consecutive 1152 individual sleep episodes were recorded. The median time asleep (hours:min) was 6:29 (5:27–7:19); the median sleep efficiency was 86% (80%–93%); the median light sleep (hours:min) was 2:50 (1:50–3:49); and the median rapid eye movement (REM) sleep (hours:min) was 3:20 (2:37–4:07). Significant adverse sleep profiles were observed in trainees undertaking emergency on-call duty when compared with elective (non-on-call) duty; the median time asleep (hours:min) 5:49 vs 6:43 (p<0.001); the median sleep efficiency was 85% vs 87% (p<0.001); the median light sleep (hours:min) was 2:16 vs 2:58 (p<0.001); and REM sleep (hours:min) was 2:57 vs 3:27 (p<0.001). Recovery of sleep duration, efficiency and quality necessitated five full days of time.

    Conclusion Surgical emergency on-call duty adversely influences sleep quality. Proper consideration of fail-safe rota design, prioritising sleep hygiene, recovery and well-being, allied to robust patient safety and quality of care should be made a priority.

    • medical education & training
    • sleep medicine
    • surgery
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    • Collaborators Sabria Abdulal, Jake Ahmed, Adnan Ahmad, Nicola Allen, James Ansell, Stefan Arnaudov, Rachael Barnett, Andrew Beamish, David Bosanquet, David Chan, Susan Chandler, Madlen Dewi, Sam Dwalesena, Andrew Gardner, Gianluca Gonzi, Rhiannon Harries, Luke Hopkins, Michael Hopkins, Osian James, Ali Jawad, Dylan Jones, Huw Jones, Rod Jones, Oliver Luton, Christopher Marusza, Harshul Measuria, Samir Mehta, Jack Pearce, Tito Petralia, Arfon Powell, Anna Powell-Chandler, Nicola Reeves, David Selwyn, Zoe Seymour, Ronak Ved.

    • Contributors CB: data acquisition, drafting, final approval and submission. TA: data analysis, drafting and final approval. WL: data interpretation, critical revision and final approval. JP: data interpretation, critical revision and final approval. RE: study conception, drafting and final approval prior to submission. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Welsh Surgical Research Initiative: data collection.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for this study was granted by the NHS Research Authority and Health and Care Research Wales (IRAS 254658).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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