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Varma P, Postnova S, Knock S, Howard ME, Aidman E, Rajaratnam SWM, Sletten TL. SleepSync: Early Testing of a Personalised Sleep-Wake Management Smartphone Application for Improving Sleep and Cognitive Fitness in Defence Shift Workers. Clocks Sleep 2024; 6:267-280. [PMID: 38920420 PMCID: PMC11203003 DOI: 10.3390/clockssleep6020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Shift work, long work hours, and operational tasks contribute to sleep and circadian disruption in defence personnel, with profound impacts on cognition. To address this, a digital technology, the SleepSync app, was designed for use in defence. A pre-post design study was undertaken to examine whether four weeks app use improved sleep and cognitive fitness (high performance neurocognition) in a cohort of shift workers from the Royal Australian Air Force. In total, 13 of approximately 20 shift-working personnel from one base volunteered for the study. Sleep outcomes were assessed using the Insomnia Severity Index (ISI), the Patient-Reported Outcomes Measurement Information System (PROMIS), Sleep Disturbance and Sleep-Related Impairment Scales, the Glasgow Sleep Effort Scale, the Sleep Hygiene Index, and mental health was assessed using the Depression, Anxiety, and Stress Scale-21. Sustained attention was measured using the 3-min Psychomotor Vigilance Task (PVT) and controlled response using the NBack. Results showed significant improvements in insomnia (ISI scores 10.31 at baseline and 7.50 after app use), sleep-related impairments (SRI T-scores 53.03 at baseline to 46.75 post-app use), and healthy sleep practices (SHI scores 21.61 at baseline to 18.83 post-app use; all p < 0.001). Trends for improvement were recorded for depression. NBack incorrect responses reduced significantly (9.36 at baseline; reduced by -3.87 at last week of app use, p < 0.001), but no other objective measures improved. These findings suggest that SleepSync may improve sleep and positively enhance cognitive fitness but warrants further investigation in large samples. Randomised control trials with other cohorts of defence personnel are needed to confirm the utility of this intervention in defence settings.
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Affiliation(s)
- Prerna Varma
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Svetlana Postnova
- School of Physics, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Stuart Knock
- School of Physics, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Mark E. Howard
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Eugene Aidman
- Defence, Science and Technology Group, Department of Defence, Edinburgh, SA 5111, Australia;
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Shantha W. M. Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
- School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Tracey L. Sletten
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, VIC 3168, Australia
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LaGoy AD, Kubala AG, Seech TR, Jameson JT, Markwald RR, Russell DW. Steps toward developing a comprehensive fatigue monitoring and mitigation solution: perspectives from a cohort of United States Naval Surface Force officers. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae008. [PMID: 38425454 PMCID: PMC10904103 DOI: 10.1093/sleepadvances/zpae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/12/2024] [Indexed: 03/02/2024]
Abstract
Study Objectives This study analyzed fatigue and its management in US Naval Surface Force warships, focusing on understanding current practices and barriers, and examining the influence of organizational and individual factors on managing chronic fatigue. Furthermore, this study explored the impact of organizational and individual factors on fatigue management. Methods As part of a larger study, 154 naval officers (mean ± standard deviation; 31.5 ± 7.0 years; 8.8 ± 6.8 years of service; 125 male, and 29 female) completed a fatigue survey. The survey addressed (1) self-reported fatigue, (2) fatigue observed in others, (3) fatigue monitoring strategies, (4) fatigue mitigation strategies, and (5) barriers to fatigue mitigation. Logistic and ordinal regressions were performed to examine the effect of individual (i.e. sleep quality and years in military service) and organizational (i.e. ship-class) factors on fatigue outcomes. Results Fatigue was frequently experienced and observed by 23% and 54% of officers, respectively. Of note, officers often monitored fatigue reactively (i.e. 65% observed others nodding off and 55% observed behavioral impairments). Still, officers did not frequently implement fatigue mitigation strategies, citing few operationally feasible mitigation strategies (62.3%), being too busy (61.7%), and not having clear thresholds for action (48.7%). Fatigue management varies across organizational factors, which must be considered when further developing fatigue management strategies. Conclusions Fatigue remains a critical concern aboard surface force ships and it may be better addressed through development of objective sleep and fatigue monitoring tools that could inform leadership decision-making.
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Affiliation(s)
- Alice D LaGoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA, USA
| | - Andrew G Kubala
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA, USA
| | - Todd R Seech
- Commander, Naval Surface Force, U.S. Pacific Fleet, Coronado, CA, USA
| | - Jason T Jameson
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
- Military and Veterans Health Solutions, Leidos, Inc., San Diego, CA, USA
| | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, San Diego, CA, USA
| | - Dale W Russell
- Commander, Naval Surface Force, U.S. Pacific Fleet, Coronado, CA, USA
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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LaGoy AD, Kubala AG, Deering S, Germain A, Markwald RR. Dawn of a New Dawn: Advances in Sleep Health to Optimize Performance. Sleep Med Clin 2023; 18:361-371. [PMID: 37532375 DOI: 10.1016/j.jsmc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Optimal sleep health is a critical component to high-level performance. In populations such as the military, public service (eg, firefighters), and health care, achieving optimal sleep health is difficult and subsequently deficiencies in sleep health may lead to performance decrements. However, advances in sleep monitoring technologies and mitigation strategies for poor sleep health show promise for further ecological scientific investigation within these populations. The current review briefly outlines the relationship between sleep health and performance as well as current advances in behavioral and technological approaches to improving sleep health for performance.
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Affiliation(s)
- Alice D LaGoy
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA; Leidos, Inc., San Diego, CA, USA
| | - Andrew G Kubala
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA; Leidos, Inc., San Diego, CA, USA
| | - Sean Deering
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA; Leidos, Inc., San Diego, CA, USA
| | | | - Rachel R Markwald
- Sleep, Tactical Efficiency, and Endurance Laboratory, Warfighter Performance Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, USA.
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Varma P, Postnova S, Phillips AJK, Knock S, Howard ME, Rajaratnam SMW, Sletten TL. Pilot feasibility testing of biomathematical model recommendations for personalising sleep timing in shift workers. J Sleep Res 2023:e14026. [PMID: 37632717 DOI: 10.1111/jsr.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023]
Abstract
Sleep disturbances and circadian disruption play a central role in adverse health, safety, and performance outcomes in shift workers. While biomathematical models of sleep and alertness can be used to personalise interventions for shift workers, their practical implementation is undertested. This study tested the feasibility of implementing two biomathematical models-the Phillips-Robinson Model and the Model for Arousal Dynamics-in 28 shift-working nurses, 14 in each group. The study examined the overlap and adherence between model recommendations and sleep behaviours, and changes in sleep following the implementation of recommendations. For both groups combined, the mean (SD) percentage overlap between when a model recommended an individual to sleep and when sleep was obtained was 73.62% (10.24%). Adherence between model recommendations and sleep onset and offset times was significantly higher with the Model of Arousal Dynamics compared to the Phillips-Robinson Model. For the Phillips-Robinson model, 27% of sleep onset and 35% of sleep offset times were within ± 30 min of model recommendations. For the Model of Arousal Dynamics, 49% of sleep onset, and 35% of sleep offset times were within ± 30 min of model recommendations. Compared to pre-study, significant improvements were observed post-study for sleep disturbance (Phillips-Robinson Model), and insomnia severity and sleep-related impairments (Model of Arousal Dynamics). Participants reported that using a digital, automated format for the delivery of sleep recommendations would enable greater uptake. These findings provide a positive proof-of-concept for using biomathematical models to recommend sleep in operational contexts.
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Affiliation(s)
- Prerna Varma
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
| | | | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
| | - Stuart Knock
- School of Physics, The University of Sydney, Camperdown, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Australia
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Allison P, Tiesman HM, Wong IS, Bernzweig D, James L, James SM, Navarro KM, Patterson PD. Working hours, sleep, and fatigue in the public safety sector: A scoping review of the research. Am J Ind Med 2022; 65:878-897. [PMID: 35711032 PMCID: PMC9851314 DOI: 10.1002/ajim.23407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The public safety sector includes law enforcement officers (LEO), corrections officers (CO), firefighter service (FF), wildland firefighting (WFF), and emergency medical services (EMS), as defined in the National Occupational Research Agenda (NORA) of the National Institute for Occupational Safety and Health (NIOSH). Across these occupations, shiftwork, long-duration shifts, and excessive overtime are common. Our objective was to identify research gaps related to working hours, sleep, and fatigue among these workers. METHODS We used a scoping review study design that included searches of MEDLINE, Embase, CAB Abstracts, Global Health, PsychInfo, CINAHL, Scopus, Academic Search Complete, Agricultural and Environmental Science Collection, ProQuest Central, Cochrane Library, Safety Lit, Homeland Security Digital Library, and Sociological Abstracts using a range of occupational search terms and terms related to working hours, sleep, and fatigue. RESULTS Out of 3415 articles returned from our database search, 202 met all inclusion criteria. Six common outcomes related to working hours, sleep, and fatigue emerged: sleep, fatigue, work performance, injury, psychosocial stress, and chronic disease. Nearly two-thirds (59%, n = 120) of the studies were observational, of which 64% (n = 77) were cross sectional and 9% were (n = 11) longitudinal; 14% (n = 30) of the studies were reviews; and 19% (n = 39) were experimental or quasi-experimental studies. Only 25 of the 202 articles described mitigation strategies or interventions. FFs, LEOs, EMS, and WFFs were the most studied, followed by COs. CONCLUSIONS In general, more longitudinal and experimental studies are needed to enrich the knowledge base on the consequences of long working hours, poor sleep, and fatigue in the public safety sector. Few experimental studies have tested novel approaches to fatigue mitigation in diverse sectors of public safety. This gap in research limits the decisions that may be made by employers to address fatigue as a threat to public-safety worker health and safety.
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Affiliation(s)
- Penelope Allison
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Hope M. Tiesman
- Division of Safety Research, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Imelda S. Wong
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - David Bernzweig
- Ohio Association of Professional Fire Fighters, Columbus, Ohio, USA
| | - Lois James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Stephen M. James
- Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
| | - Kathleen M. Navarro
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - P. Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Devine JK, Garcia CR, Simoes AS, Guelere MR, de Godoy B, Silva DS, Pacheco PC, Choynowski J, Hursh SR. Predictive Biomathematical Modeling Compared to Objective Sleep During COVID-19 Humanitarian Flights. Aerosp Med Hum Perform 2022; 93:4-12. [PMID: 35063050 DOI: 10.3357/amhp.5909.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Biomathematical modeling software like the Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model and Fatigue Avoidance Scheduling Tool (FAST) help carriers predict fatigue risk for planned rosters. The ability of a biomathematical model to accurately estimate fatigue risk during unprecedented operations, such as COVID-19 humanitarian ultra-long-range flights, is unknown. Azul Cargo Express organized and conducted five separate humanitarian missions to China between May and July 2020. Prior to conducting the missions, a sleep-prediction algorithm (AutoSleep) within SAFTE-FAST was used to predict in-flight sleep duration and pilot effectiveness. Here we compare AutoSleep predictions against pilots' sleep diary and a sleep-tracking actigraphy device (Zulu watch, Institutes for Behavior Resources) from Azul's COVID-19 humanitarian missions.METHODS: Pilots wore Zulu watches throughout the mission period and reported sleep duration for their in-flight rest periods using a sleep diary. Agreement between AutoSleep, diary, and Zulu watch measures was compared using intraclass correlation coefficients (ICC). Goodness-of-fit between predicted effectiveness distribution between scenarios was evaluated using the R² statistic.RESULTS: A total of 20 (N = 20) pilots flying across 5 humanitarian missions provided sleep diary and actigraphy data. ICC and R² values were >0.90, indicating excellent agreement between sleep measures and predicted effectiveness distribution, respectively.DISCUSSION: Biomathematical predictions of in-flight sleep during unprecedented humanitarian missions were in agreement with actual sleep patterns during flights. These findings indicate that biomathematical models may retain accuracy even under extreme circumstances. Pilots may overestimate the amount of sleep that they receive during extreme flight-duty periods, which could constitute a fatigue risk.Devine JK, Garcia CR, Simoes AS, Guelere MR, de Godoy B, Silva DS, Pacheco PC, Choynowski J, Hursh SR. Predictive biomathematical modeling compared to objective sleep during COVID-19 humanitarian flights. Aerosp Med Hum Perform. 2022; 93(1):4-12.
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Knock SA, Magee M, Stone JE, Ganesan S, Mulhall MD, Lockley SW, Howard ME, Rajaratnam SMW, Sletten TL, Postnova S. Prediction of shiftworker alertness, sleep, and circadian phase using a model of arousal dynamics constrained by shift schedules and light exposure. Sleep 2021; 44:zsab146. [PMID: 34111278 PMCID: PMC8598188 DOI: 10.1093/sleep/zsab146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES The study aimed to, for the first time, (1) compare sleep, circadian phase, and alertness of intensive care unit (ICU) nurses working rotating shifts with those predicted by a model of arousal dynamics; and (2) investigate how different environmental constraints affect predictions and agreement with data. METHODS The model was used to simulate individual sleep-wake cycles, urinary 6-sulphatoxymelatonin (aMT6s) profiles, subjective sleepiness on the Karolinska Sleepiness Scale (KSS), and performance on a Psychomotor Vigilance Task (PVT) of 21 ICU nurses working day, evening, and night shifts. Combinations of individual shift schedules, forced wake time before/after work and lighting, were used as inputs to the model. Predictions were compared to empirical data. Simulations with self-reported sleep as an input were performed for comparison. RESULTS All input constraints produced similar prediction for KSS, with 56%-60% of KSS scores predicted within ±1 on a day and 48%-52% on a night shift. Accurate prediction of an individual's circadian phase required individualized light input. Combinations including light information predicted aMT6s acrophase within ±1 h of the study data for 65% and 35%-47% of nurses on diurnal and nocturnal schedules. Minute-by-minute sleep-wake state overlap between the model and the data was between 81 ± 6% and 87 ± 5% depending on choice of input constraint. CONCLUSIONS The use of individualized environmental constraints in the model of arousal dynamics allowed for accurate prediction of alertness, circadian phase, and sleep for more than half of the nurses. Individual differences in physiological parameters will need to be accounted for in the future to further improve predictions.
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Affiliation(s)
- Stuart A Knock
- School of Physics, the University of Sydney, Camperdown, NSW, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
| | - Michelle Magee
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Julia E Stone
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Saranea Ganesan
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Megan D Mulhall
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Steven W Lockley
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark E Howard
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Shantha M W Rajaratnam
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Tracey L Sletten
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Svetlana Postnova
- School of Physics, the University of Sydney, Camperdown, NSW, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Sydney Nano, the University of Sydney, Camperdown, NSW, Australia
- Woolcock Institute of Medical Research, Glebe, NSW, Australia
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Schwartz LP, Devine JK, Hursh SR, Davis JE, Smith M, Boyle L, Fitzgibbons SC. Addressing fatigue in medical residents with biomathematical fatigue modeling. J Occup Health 2021; 63:e12267. [PMID: 34390073 PMCID: PMC8363908 DOI: 10.1002/1348-9585.12267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/27/2023] Open
Abstract
Fatigue in resident physicians has been identified as a factor that contributes to burnout and a decline in overall wellbeing. Fatigue risk exists because of poor sleep habits and demanding work schedules that have only increased due to the COVID‐19 pandemic. At this time, it is important not to lose sight of how fatigue can impact residents and how fatigue risk can be mitigated. While fatigue mitigation is currently addressed by duty hour restrictions and education about fatigue, Fatigue Risk Management Systems (FRMSs) offer a more comprehensive strategy for addressing these issues. An important component of FRMS in other shiftwork industries, such as aviation and trucking, is the use of biomathematical models to prospectively identify fatigue risk in work schedules. Such an approach incorporates decades of knowledge of sleep and circadian rhythm research into shift schedules, taking into account not just duty hour restrictions but the temporal placement of work schedules. Recent research has shown that biomathematical models of fatigue can be adapted to a resident physician population and can help address fatigue risk. Such models do not require subject matter experts and can be applied in graduate medical education program shift scheduling. It is important for graduate medical education program providers to consider these alternative methods of fatigue mitigation. These tools can help reduce fatigue risk and may improve wellness as they allow for a more precise fatigue management strategy without reducing overall work hours.
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Affiliation(s)
| | | | - Steven R Hursh
- Institutes for Behavior Resources, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan E Davis
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, USA
| | - Mark Smith
- MedStar Institute for Innovation, Washington, DC, USA
| | - Lisa Boyle
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shimae C Fitzgibbons
- Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Wilson MK, Ballard T, Strickland L, Amy Boeing A, Cham B, Griffin MA, Jorritsma K. Understanding fatigue in a naval submarine: Applying biomathematical models and workload measurement in an intensive longitudinal design. APPLIED ERGONOMICS 2021; 94:103412. [PMID: 33740741 DOI: 10.1016/j.apergo.2021.103412] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
Fatigue is a critically important aspect of crew endurance in submarine operations, with continuously high fatigue being associated with increased risk of human error and long-term negative health ramifications. Submarines pose several unique challenges to fatigue mitigation, including requirements for continuous manning for long durations, a lack of access to critical environmental zeitgebers (stimuli pertinent to circadian physiology; e.g., natural sunlight), and work, rest and sleep occurring within an encapsulated environment. In this paper, we examine the factors that underlie fatigue in such a context with the aim of evaluating the predictive utility of a biomathematical model (BMM) of fatigue. Three experience sampling studies were conducted with submarine crews using a participant-led measurement protocol that included assessments of subjective sleepiness, workload (NASA-Task Load Index [TLX] and a bespoke underload-overload scale), and sleep. As expected, results indicated that predicting KSS with a BMM approach outperformed more conventional linear modelling approaches (e.g., time-of-day, sleep duration, time awake). Both the homeostatic and circadian components of the BMM were significantly associated with KSS and used as controls in the workload models. We found increased NASA-TLX workload was significantly associated with increased average KSS ratings at the between-person level. However, counter to expectations, the two workload measures were not found to have significant linear or quadratic relationship with fatigue at the within-person level. An important outcome of the research is that applied fatigue researchers should be extremely cautious applying conventional linear predictors when predicting fatigue. Practical implications for the submarine and related extreme work context are discussed. Important avenues for continued research are outlined, including directly estimating BMM parameters.
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Affiliation(s)
- Micah K Wilson
- Future of Work Institute, Curtin University, Perth, Australia.
| | | | - Luke Strickland
- Future of Work Institute, Curtin University, Perth, Australia
| | | | - Belinda Cham
- Future of Work Institute, Curtin University, Perth, Australia
| | - Mark A Griffin
- Future of Work Institute, Curtin University, Perth, Australia
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