A randomized control trial to test performance enhancements following a powernap in a critical care simulation after a 24-hour shift

Position du problème et objectif(s) de l’étude

Sleep deprivation is highly prevalent among anesthesia residents and impairs both technical and non-technical skills. The effectiveness of recovery strategies, such as napping remains underexplored. This study evaluated the impact of a powernap on performance during a simulated critical clinical care scenario involving bounded rationality decision making in sleep-deprived residents.

Matériel et méthodes

The protocol was preregistered on November 16, 2022 on clinicaltrial.gov (NCT05619081) after the IRB was obtained from the Comité d'Ethique pour la Recherche en Anesthésie-Réanimation in June 2022 (00010254 - 2022 - 085). A prospective randomized controlled trial was conducted with anesthesia and intensive care residents, each tested twice: once rested at baseline and once partially sleep-deprived after a 24-hour shift. In the shift condition, participants were randomly assigned to either a NAP group (30-minute nap opportunity) or a NO-NAP group (calm activity). The simulation scenarios were designed to induce stress through distractors, limited resources, diagnostic uncertainty, and minimal facilitation. Both the simulation team and performance assessors were blinded to the intervention. The primary endpoint was simulated clinical performance (combining both technical and non-technical skills), assessed using standardized grids. Secondary endpoints included technical skills (comprising initial cardiac arrest management and post-cardiac arrest reasoning), non-technical skills (Ottawa Global Rating Scale), and vigilance (Sustained Attention to Response Task). Repeated measures ANOVA and Pearson correlations were conducted with a significance level set at p < 0.05.

Résultats & Discussion

Of the 35 randomized residents, 27 were included in the analysis. A significant condition-by-group interaction was found when controlling for partial sleep deprivation (F(1, 24) = 5.69, p = 0.025), with the NAP group showing a 10% improvement in simulated clinical performance compared to the NO-NAP group. Non-technical skills exhibited the greatest improvement (F(1, 24) = 6.67, p = 0.016), while no significant interaction was observed for technical skills (F(1, 24) = 1.22, p = 0.281). Technical skills were, however, the most sensitive to varying amounts of sleep deprivation (r = 0.43, p = 0.024) and nap duration (post-cardiac arrest reasoning: r = 0.52, p = 0.041). Furthermore, the NAP group exhibited faster reaction times and greater accuracy in the cognitive vigilance task.

Conclusion

Clinical performance is highly dependent on sleep, and power naps can significantly mitigate the negative effects of sleep deprivation. The degree of sleep loss, the opportunity to nap, and nap duration each influence technical and non-technical performance in distinct ways. Furthermore, simulated scenarios with limited resources offer significant training potential.

Auteurs

Laura SCHMIDT (1), Florian GENTY (2) , Thomas DELAIRE (2), Berenice VALERO (3), Sacha MAIRET (1), Marion DOUPLAT (4), Sophie SCHLATTER (1), Thomas RIMMELE (2), Stéphanie MAZZA (5), Marc LILOT (6) - (1)Research On Healthcare Performance Laboratory, Inserm U1290, Université Claude Bernard, Lyon, France, (2)Hospices Civils De Lyon, Departments Of Anesthesia And Intensive Care, Lyon, France, (3)Human Science Department, Centre Léon Bérard, Lyon, France, (4)Hospices Civils De Lyon, Service D'accueil Des Urgences, Hôpital Lyon Sud, Lyon, France, (5)Forgetting Team, Centre De Recherche En Neurosciences De Lyon Crnl U1028 Umr5292, Lyon, France, (6)Hospices Civils De Lyon, Département D’anesthésie-Réanimation, Hôpital Louis Pradel, Lyon, France

Orateur(s)

Florian GENTY (Lyon)