The night float paradigm to decrease sleep deprivation: good solution or a new problem?

Abstract

In the late 1980s physician residency training programs developed the night float rotation, characterized by a sequence of 5 - 15 days of night work without any daytime duties, thereby involving an abrupt reversal of the wake-sleep schedule. We examined the effect of the night float rotation on sleep, mood and performance of pediatric residents. Residents completed sleep diaries daily, and tests of mood (Profile of Mood States) and attention (Conner's Continuous Performance Test) three times a week during the two-week night float rotation, and during equivalent blocks of time of their daytime rotations. Results show that, despite having ample opportunity to sleep during the day, while on night float rotation residents slept less than during the nights of their normal daytime rotations, 6.3 h ± 2.5 h and 7.2 h ± 1.7 h, respectively, p < 0.0001. Also, during night float compared to daytime rotations residents had increased fatigue-inertia scores, 8.7 ± 4.1 and 4.8 ± 2.4, respectively, p < 0.0001, and decreased vigor-activity scores 10.7 ± 5.4 and 14.8 ± 5.3, respectively, p = 0.02. The scores for attention were not significantly different between night float and daytime rotations. The correlation coefficients of fatigue with measures of attention were not statistically significant for daytime rotations. However, for night float fatigue correlated with omission errors, r = 0.51, p = 0.001 and with attentiveness r = −0.36, p = 0.03. Training programs that adopt the night float rotation must be aware of potential deleterious effects of the night float rotation as they may lead to serious consequences on residents' performance and patients' safety.