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Sleep Deprivation and Clinical Performance

Matthew B. Weinger, MD; Sonia Ancoli-Israel, PhD
JAMA. 2002;287(8):955-957. doi:10.1001/jama.287.8.955.
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Physicians' ability to provide high-quality care can be adversely affected by many factors,1 including sleep deprivation. Concerns about the danger of physicians who are sleep deprived and providing care have led state legislatures and academic institutions to try to constrain the work hours of physicians in training (house staff).2 Unlike commercial aviation, for example, medicine is an industry in which public safety is directly at risk but does not have mandatory restrictions on work hours. Legislation before the US Congress3 calls for limiting resident work hours to 80 hours per week and no more than 24 hours of continuous work. Shifts of residents working in the emergency department would be limited to 12 hours. The proposed legislation, which includes public disclosure and civil penalties for hospitals that violate the work hour restrictions, does not address extended duty shifts of attending or private practice physicians.

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Figure. Effect of Sleep Deprivation on Psychomotor Performance Compared With Blood Alcohol Concentration
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The legal limit for blood alcohol concentration while driving a motor vehicle is as low as 0.08% (dotted line) in some states. Mean relative performance is expressed as percentage of performance at the start of the session. The effects of sleep deprivation on psychomotor performance become equivalent to the effects of acute alcohol intoxication in the early morning after nearly 24 hours without sleep. Reproduced with permission from Nature (http://www.nature.com/).8



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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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