Sleep Deprivation, Performance
Conditions
Brief summary
While the negative impact of sleep deprivation on cognitive processing and the partial reversal of this phenomenon by caffeine are well known, the types of cognitive processing previously studied have been limited to simple, straight-forward laboratory tasks. It is unclear how sleep deprivation and caffeine affect performance on operationally relevant complex cognitive tasks, like those encountered by working professionals such as doctors. This study aims to uncover how sleep deprivation and caffeine impact two types of clinical reasoning processes encountered by physicians on a daily basis. Previous work from members of our team investigated diagnostic reasoning in medical professionals and discovered that brain activation in executive processing areas was modulated by self-reported sleepiness and burnout and level of expertise (Durning, Costanzo, et al., 2013; Durning et al., 2014, 2015). The current study aims to expand upon those findings by also investigating a potentially more complex type of clinical reasoning, i.e. therapeutic reasoning, and directly manipulating sleep and caffeine use in a controlled sleep laboratory. Medical students, residents, and board-certified physicians will undergo thirty-seven hours of sleep deprivation and ten hours of sleep recovery in the sleep laboratory. During two FMRI scan sessions we will present high-quality validated multiple-choice questions on common patient situations in internal medicine to participants to explore brain activity during therapeutic reasoning compared with diagnostic reasoning. One FMRI scan will occur following a night of sleep deprivation, and another scan will occur following a night of recovery sleep. Additionally, half of the participants will receive caffeine gum during the sleep deprivation period, while the other half will receive placebo gum. This design will allow us to study the effect of sleep deprivation and caffeine on the neural correlates of diagnostic and therapeutic reasoning and performance in general.
Interventions
DIETARY_SUPPLEMENTMilitary Energy Gum
Caffeine (1, 3, 7-trimethylxanthine) is a central nervous system stimulant that is found naturally in some foods and beverages such as coffee and tea. For this study, caffeine will be administered in the form of gum pellets (Military Energy chewing gum). Each pellet contains 100 mg of caffeine.
DIETARY_SUPPLEMENTPlacebo Gum
Pellet form placebo gum
Sponsors
Walter Reed Army Institute of Research (WRAIR)
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
BASIC_SCIENCE
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
1. Novice group --National Capital Area Interns and Medical Students (3rd and 4th year only) 2. Intermediate group - National Capital Area PGY-2 and 3 residents in internal medicine 3. Expert group-Board certified internists from National Capital Area
Exclusion criteria
Related to Sleep Research Center. The following
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Psychomotor Vigilance Task | 5 days | Computer Based response time measurement |
| Clinical Reasoning Questions | 5 days | Answer clinical board questions |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Structural Brain Scan-functional MRI | 5 days | Measurement of structural brain topography to localize areas of functional activation using a functional MRI scan |
| Actigraphy | 5 days | Wrist movement and activity monitoring |
| Polysomnography | 5 days | Measurement of brain activity |
Countries
United States
Outcome results
None listed