A pilot study exploring the relationship between internists' self-reported sleepiness, performance on multiple-choice...

Area of Science:

• Neuroscience
• Medical Education
• Sleep Medicine

Background:

• Previous research on resident fatigue and performance yielded inconsistent findings.
• Daytime sleepiness and its impact on attending physicians' performance remain under-explored.
• The prefrontal cortex (PFC) role in fatigue-related cognitive impairment is an emerging area of investigation.

Purpose of the Study:

• To investigate the relationship between sleepiness, cognitive performance, and prefrontal cortex (PFC) activity in attending physicians.
• To test the hypothesis that higher sleepiness scores correlate negatively with multiple-choice question (MCQ) performance and PFC activity.

Main Methods:

• Board-certified physicians completed the Epworth Sleepiness Scale (ESS) to assess sleepiness.
• Participants answered MCQs from licensing examinations while undergoing functional Magnetic Resonance Imaging (fMRI).
• fMRI measured medial PFC (mPFC) activity during cognitive tasks.

Main Results:

• Seventeen physicians completed the study, with an average MCQ score of 18.5/32.
• A negative correlation (-0.30) was observed between ESS scores and MCQ performance.
• Higher ESS scores were associated with significant negative changes in mPFC activity.

Conclusions:

• Attending physicians reporting greater sleepiness demonstrated poorer performance on licensing examination questions.
• The study cohort exhibited normal to mild sleepiness scores.
• Findings suggest that increased sleepiness negatively impacts mPFC activity, consistent with PFC's role in cognitive function and fatigue.