Sleep deprived doctors find potential cure

A preliminary study published recently in Annals of Surgery suggests that modafinil, an analeptic drug, can help sleep-deprived doctors to improve their cognitive process, but not their clinical psychomotor performance.

Cognitive processes – mental tasks – are critical for various aspects of the medical profession, such as making the right decision under time pressure. Clinical psychomotor skills are involved with the surgical skills and other procedural tasks.

The nature of the medical profession is inherently unpredictable, demanding and inflexible; doctors often find themselves deprived of sleep because of the extended working hours demanded of them.

The link between fatigue and impaired working performance is well established. Therefore, doctors who have been working for long periods without sleep pose a safety risk to both themselves and their patients because they are more likely to commit medical errors and make poor judgments than if they were well rested.

Hence, this study was designed to find out whether certain drugs can be used to resolve the problems of fatigued and sleep-deprived doctors.

The study, carried out as a randomised controlled trial, looked at the effects of Modafinil on the performance of 39 healthy male doctors who have been deprived of sleep for one night. 20 of the doctors were given Modafinil while the other 19 were givena placebo.

A series of tests were then carried out to assess the cognitive processes of the doctors and their clinical psychomotor skills. Interestingly, those that were given the modafinil drugs performed better in the psychological tests than the placebo group. The modafinil group also behaved less-impulsively in the decision-making tests; showed a better result in the working memory and planning tests; and were more responsive to changing demands. This indicates that they had greater mental flexibility.

On the other hand, the placebo group was expected to perform sub-optimally in the surgical motor skill tasks under conditions of fatigue as a previous study found that thesetasks are susceptible to the effects of fatigue. It is worth noting, however, that the modafinil group performed the same as the placebo group in this task showing that modafinil administration did not improve psychomotor performance. It is thought that little demand is placed on higher-cognitive centres to carry out the surgical skills. Therefore an improved cognitive process has no advantage for doctors performing surgical tasks.

The researchers stress that until further investigations are done that the use of pharmacological enhancement in the workplace cannot be recommended. A larger sample size, long term study and different characteristics of the sample have yet to be done to confirm the findings of the study.

The investigation only involves the effects of one dose of modafinil over a short period of time. In addition, the participants were only young doctors and no older participants were included. Therefore, before a sound conclusion about the benefits of modafinil to the sleep-deprived doctors can be drawn, further researches are needed. There are also challenging ethical considerations that have to be taken into account very carefully.

Until then, perhaps, a good quality sleep is the best solution.