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Over the past decade, a series of studies have found that physicians-in-training who work extended shifts (>16 hours) are at increased risk of experiencing motor vehicle crashes, needlestick injuries, and medical errors. In response to public concerns and a request from Congress, the Institute of Medicine (IOM) conducted an inquiry into the issue and concluded in 2009 that resident physicians should not work for more than 16 consecutive hours without sleep. They further recommended that the Centers for Medicare & Medicaid Services (CMS) and the Joint Commission work with the Accreditation Council for Graduate Medical Education (ACGME) to ensure effective enforcement of new work hour standards.
The IOM's concerns with enforcement stem from well-documented non-compliance with the ACGME's 2003 work hour rules, and the ACGME's history of non-enforcement. In a nationwide cohort study, 84% of interns were found to violate the ACGME's 2003 standards in the year following their introduction.
This chapter summarizes trait-like (phenotypic) individual differences in neurobehavioral vulnerability to sleep deprivation, and current promising efforts to identify objective and biological markers of such differences. Sleep loss has increasingly become a major public health concern as population studies worldwide have found reduced sleep duration associated with increased risks of obesity, morbidity, and mortality. Available data suggest that common genetic variations (polymorphisms) involved in sleep-wake, circadian, and cognitive regulation may underlie symptomatic aspects of these large interindividual differences in neurobehavioral vulnerability to sleep deprivation in healthy adults. The impairing effects of sleep loss on neurobehavioral functions are the most well-established and conspicuous consequences of sleep deprivation. They include fatigue and sleepiness and unstable wakefulness; deficits in attention, working memory and executive functions; reduced mood-affect regulation; and increased accidents and injuries. Identifying who is likely to suffer neurobehavioral impairments would improve prevention of sleep deprivation and mitigation of its behavioral morbidity.