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2004 (1)

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Evaluation of the cognitive, behavioral and neurophysiological consequences of a night-call in the emergency room

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Abstract

Sleepiness is medical personnel has been the subject of many studies, discussions and controversies. Even if very few firm conclusions can be derived from these studies, public authorities have taken measures to limit working hours especially as far as physicians in training are concerned. These measures are certainly full of good sense but are not based on robust scientific evidences.
Against this background, it appeared necessary to objectively assess the consequences of a night on-call on the working capacities of medical personnel.
We evaluated, in a first experiment, the cognitive and behavioural performances of twenty-four medical students in training after a night on call in the emergency room. Several tests were performed after a night on call as well as after a normal sleep night : The Brown Peterson, the classic Buschke, the semantic shifting fluencies, PVT (reaction time test) and the OSLER test (a behaviour measure of sleepiness). Objective neurophysiologic consequences of sleepiness were evaluated in a second experiment. Twenty medical students were equipped with an EEG recorder during one on-call and the following morning of work in the emergency room but also during a normal sleep night followed by a morning of work in the emergency room.
We were not able to show a decrease of cognitive performances, except for one measurement of the Buschke classic. EEG signs of sleepiness were not more frequent after a night on-call. On the other hand, the OSLER performances were significantly decreased after the night on-call.
Sleepiness is clearly increased after a night on-call but its frank expression seems limited to periods of boring and monotonous tasks in sleep prone conditions. When confronted with demanding tasks or with real-life working conditions, working performances appear as not being influenced by the previous night sleep deprivation

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