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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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L'activité médicale dans les services dits de « Soins Continus » est spécifique de par la réalisation de gardes cumulant deux caractéristiques : un travail de nuit et une durée de travail de 24 heures consécutives. Dès lors, la qualité et la quantité du sommeil peuvent se trouver perturbées tant de façon aiguë le lendemain d'une garde que de façon chronique par la répétition de gardes avec la constitution d'une dette de sommeil.Le médecin du travail a pour rôle la prévention des risques professionnels, l'amélioration des conditions de travail et de vie dans l'entreprise. Ce rôle implique une surveillance individuelle, une information, éducation et formation des travailleurs , ainsi qu'une surveillance épidémiologique.L'objectif de l'étude est de comparer dans une population d'anesthésistes-réanimateurs, en fonction de leur ancienneté, la qualité et la quantité du sommeil avant, pendant et après la réalisation d'une garde durant 24 heures, en salle de surveillance post-interventionnelle prenant en charge des urgences vitales médicales et chirurgicales. L'hypothèse était que les médecins seniors auraient plus de troubles de sommeil au cours de la garde, une récupération moins bonne de la qualité et de la quantité de sommeil et une somnolence plus importante au décours de celle-ci, que les médecins juniors.Méthode.Le consentement des praticiens anesthésistes participants a été recueilli avant l'étude après une information.L'étude a été réalisée sur trois nuits consécutives (N-1, NO et N+1), centrées sur une nuit de garde (NO) et l'analyse a consisté en une comparaison entre les anesthésistes seniors(chef de clinique, praticiens hospitaliers) et juniors (internes en formation).Une auto-évaluation du sommeil par l'échelle de Spiegel (annexe 1) qui évalue le sommeil de la nuit précédente et une auto-évaluation de la somnolence par l'échelle d'Epworth (annexe 2) ont été réalisées après chacune des trois nuits étudiées.Une mesure objective du sommeil par l'actimétrie (annexe 3) a été effectuée pendant ces trois nuits consécutives.En outre, une auto-évaluation du sommeil par le Questionnaire adapté du MedicalOutcomes Score-Sleep Scale (annexe 4) qui pose 12 questions concernant le sommeil,des 4 dernières semaines, était remplie par les participants avant les trois nuits étudiées.Cet auto-questionnaire cherche à identifier les troubles de sommeil préexistants.
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"The regularly recurring incidence of natural sleep forms one of the most important subjects for physiological investigation. Were it an event of rare occurrence, it would excite a degree of astonishment and alarm equal to the agitation now experienced by the spectator of an ordinary attack of syncope or of epileptic convulsion. But, so completely does the recurrence of sleep harmonize with all the other facts of life that we are as indifferent to its nature--that is, until one is faced with insomnia. In this text, insomnia, and other disorders of sleep, are examined in an attempt to uncover the various ways in which such disorders can be treated/prevented. The following topics are highlighted: the nature and cause of sleep; insomnia, or wakefulness; remedies for insomnia; treatment of insomnia in particular diseases; dreams; somnambulism; and artificial somnambulism or hypnotism." (PsycINFO Database Record (c) 2005 APA, all rights reserved)".
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Sleep Deprivation, Stimulant Medications, and Cognition provides a review, synthesis and analysis of the scientific literature concerning stimulant medications and neurobehavioral performance, with an emphasis on critically evaluating the practical utility of these agents for maintaining cognitive performance and alertness in sleep-deprived (but otherwise healthy) individuals. The book explores the nature of sleep loss-induced cognitive deficits, neurophysiologic basis of these deficits, relative efficacy and limitations of various interventions (including non-pharmacological), and implications for applying these interventions in operational environments (commercial and military). Readers of this volume will gain a working knowledge of: • Mechanisms contributing to sleep loss-induced cognitive deficits • Differential effects of stimulant compounds on various aspects of cognition • Considerations (such as abuse liability) when applying stimulant interventions in operational settings • Current state and future directions for including stimulants in comprehensive fatigue-management strategies. This text is key reading for researchers and trainees in sleep and psychopharmacology.
Sleep deprivation. --- Sleep deprivation --- Stimulants. --- Cognition. --- Psychological aspects.
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Electroencephalography --- Sleep --- Sleep Deprivation --- physiology
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Sleep deprivation. --- Deprivation, Sleep --- Stress (Physiology)
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Sleep --- Sleep deprivation --- Naps (Sleep) --- Stages
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Sleep Deprivation --- Depressive Disorder --- Clomipramine --- therapeutic use
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Epilepsy --- Sleep deprivation --- Sleep --- Congresses --- Congresses --- Congresses
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