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Updated: May 26, 2026
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Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments
Published on: August 8, 2019
The relationship between shift work, sleep, and cognition in career emergency physicians
Mari S Machi1, Matthew Staum, Clifton W Callaway
1Department of Emergency Medicine, Emergency Responder Human Performance Lab, University of Pittsburgh, Pittsburgh, PA, USA.
Summary
Emergency physicians experience cognitive decline, particularly in short-term memory, after both day and overnight shifts. This study highlights the impact of shift work on physician cognition and sleep quality.
Area of Science:
- Occupational Health
- Neuroscience
- Sleep Medicine
Background:
- Emergency departments (EDs) require 24-hour physician coverage, necessitating shift work.
- Shift work can lead to circadian desynchronization and cognitive impairment in physicians.
- Understanding the impact of shift work on emergency physicians' (EPs) cognition and sleep is crucial.
Purpose of the Study:
- To measure changes in cognition and sleep disturbance in attending EPs before and after day and overnight shifts.
- To assess the effects of shift work on short-term memory, executive function, and sleep quality.
- To investigate potential neurohormonal changes associated with shift work in EPs.
Main Methods:
- Thirteen EPs underwent cognitive testing (PASAT, REMT, TMT, Stroop) before and after shifts.
- Sleep quality and fatigue were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Chalder Fatigue Questionnaire (CFQ).
- Saliva samples were collected for neurohormonal assays (cortisol, melatonin).
Main Results:
- Short-term memory declined significantly after both day and overnight shifts, as evidenced by fewer words recalled on the REMT.
- A significant increase in recall from the latter part of the memory list occurred after overnight shifts.
- EPs reported poorer sleep quality (mean PSQI = 4.8) compared to the general population, with 31% experiencing poor sleep.
- Post-shift fatigue correlated with perceived shift difficulty.
- Cortisol levels showed altered patterns after night shifts, with decreased or delayed morning peaks.
Conclusions:
- Short-term memory impairment is a consequence of both day and overnight shifts for emergency physicians.
- The study confirms a high incidence of disturbed sleep among EPs.
- These findings underscore the need for strategies to mitigate the cognitive and sleep-related effects of shift work in EDs.
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