Predicting neurobehavioral performance of resident physicians in a Randomized Order Safety Trial Evaluating Resident-Physician Schedules (ROSTERS).

Objectives: Mathematical models of human neurobehavioral performance that include the effects of acute and chronic sleep restriction can be key tools in assessment and comparison of work schedules, allowing quantitative predictions of performance when empirical assessment is impractical.
Methods: Using such a model, we tested the hypothesis that resident physicians working an extended duration work roster, including 24-28 hours of continuous duty and up to 88 hours per week averaged over 4weeks, would have worse predicted performance than resident physicians working a rapidly cycling work roster intervention designed to reduce the duration of extended shifts. The performance metric used was attentional failures (ie, Psychomotor Vigilance Task lapses). Model input was 169 actual work and sleep schedules. Outcomes were predicted hours per week during work hours spent at moderate (equivalent to 16-20 hours of continuous wakefulness) or high (equivalent to ≥20 hours of continuous wakefulness) performance impairment.
Results: The model predicted that resident physicians working an extended duration work roster would spend significantly more time at moderate impairment (p = .02, effect size=0.2) than those working a rapidly cycling work roster; this difference was most pronounced during the circadian night (p < .001). On both schedules, performance was predicted to decline from weeks 1 + 2 to weeks 3 + 4 (p < .001), but the rate of decline was significantly greater on extended duration work roster (p < .01). Predicted performance impairment was inversely related to prior sleep duration (p < .001).
Conclusions: These findings demonstrate the utility of a mathematical model to evaluate the predicted performance profile of schedules for resident physicians and others who experience chronic sleep restriction and circadian misalignment.
Competing Interests: Declaration of conflict of interest Dr. Phillips has received research funding from Versalux and Delos, and he is co-founder and co-director of Circadian Health Innovations PTY LTD. He also holds a patent (US20150080756A1) for estimating arousal states from ambulatory recordings by using sleep and wake models. Dr. St Hilaire has received grant/research support from NIH, NASA, and Merrimack College. Dr. Barger reports honorariums from AAA Foundation, University of Arizona and University of British Columbia. Mr. O’Brien has no COI to report from the past 3 years. Dr. Rahman holds patents for (1) Method and device for preventing alterations in circadian rhythm (U.S. patent application Ser. No. 10/525,958), and (2) Methods and devices for improving sleep performance in subject exposed to light at night (U.S. Application No. 61/810,985); owns equity in Melcort Inc; has provided paid consulting services to Sultan & Knight Limited, Bambu Vault LLC, Lucidity Lighting Inc; and has received honoraria as an invited speaker and travel funds from Starry Skies Lake Superior, University of Minnesota Medical School, PennWell Corp, and Seoul Semiconductor Co Ltd, FALK FOUNDATION E.V.; and has received grant/research support from Seoul Semiconductor Co Ltd, Biological Innovation and Optimization Systems, LLC, Merck & Co, Inc, Pfizer Inc, Vanda Pharmaceuticals Inc, Lighting Science Group, NIH, and NASA. These interests were reviewed and managed by Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Landrigan holds equity in and has consulted with the I-PASS Patient Safety Institute, which seeks to train institutions in best handoff practices and aid in their implementation. In addition, Dr. Landrigan has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety, and has served as an expert witness in cases regarding patient safety and sleep deprivation. Dr. Lockley reports consulting fees from the Hintsa Performance AG, Stantec and View Inc, and has consulting contracts with Absolute Rest, Akili Interactive, Apex 2100 Ltd, Ashurst Risk Advisory, Consumer Sleep Solutions, KBR Wyle Services, Light Cognitive; Lighting Science Group Corporation/HealthE; and Mental Workout/Timeshifter. He has received honoraria and travel or accommodation expenses from Bloxhub, Clifton College, Danish Centre for Lighting, and University of Toronto; and travel or accommodation expenses (no honoraria) from Wiley; and royalties from Monash University and Oxford University Press. He holds equity in iSleep pty. He has received an unrestricted equipment gift and investigator-initiated grant from F. Lux Software LLC, and a Clinical Research Support Agreement and Clinical Trial Agreement with Vanda Pharmaceuticals Inc. He is an unpaid Board Member of the Midwest Lighting Institute (non-profit). He was a Program Leader for the CRC for Alertness, Safety and Productivity, Australia, through an adjunct professor position at Monash University (2015-2019). He is part-time adjunct professor at the University of Surrey, UK. He holds several pending patents (US2019366032A1; USD943612S1; US2021162164A1, US20220151552A1). He has served as a paid expert in legal proceedings related to light, sleep, and health. His interests are reviewed and managed by Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Czeisler reports that he serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc, Philips Respironics, Inc, Optum, and ResMed, Inc; research support to Brigham and Women’s Hospital from Axsome Therapeutics, Inc, Dayzz Ltd, Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc, Takeda Pharmaceutical Co, LTD, Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc, Teva Pharmaceuticals Industries, Ltd, and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc; personal consulting fees from Axsome Therapeutics, Bryte Foundation, With Deep, Inc and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Wellbeing, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the UK Biotechnology and Biological Sciences Research Council. CAC has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc; C&J Energy Services; Dallas Police Association; Delta Airlines/Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc/Motor Coach Industries/FirstGroup America; PAR Electrical Contractors, Inc; Puget Sound Pilots; the San Francisco Sheriff’s Department; Schlumberger Technology Corp; Union Pacific Railroad; United Parcel Service; and Vanda Pharmaceuticals. CAC has received travel support from Merck, Sharpe and Dohme for travel to Japan and Australia; equity interest in Vanda Pharmaceuticals, With Deep, Inc, WHOOP, Inc, and Signos, Inc; and institutional educational gifts to Brigham and Women’s Hospital from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc, Harmony Biosciences LLC, Eisai Co, LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp, Apnimed, Inc, Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, Stuart F. and Diana L. Quan Charitable Fund. Dr. Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Klerman reports consulting for the American Academy of Sleep Medicine Foundation, Circadian Therapeutics, National Sleep Foundation, Puerto Rico Science, Technology, and Research Trust, Pfizer Pharmaceuticals, Sanofi-Genzyme, Sleep Research Society Foundation, and Yale University Press; travel support from the DGSM (Germany Sleep Society), EPFL Pavilions, European Biological Rhythms Society, Gordon Research Conference, Santa Fe Research Institute, Sleep Research Society, and World Conference of Chronobiology; and being on the Scientific Advisory Board (unpaid) for Chronsulting. Other: Partner is founder, director, and chief scientific officer of Chronsulting.
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