Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study

Abstract

Long duty hours (DH) impair sleep and negatively affect residents' health and medical safety. This cross-sectional study investigated the association among residents' DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.

Figure 1

Sleep-related variables categorized by weekly duty hours. The categories of weekly duty hours were as follows: Category 1 (C1, < 50 h), Category 2 (C2, ≥ 50 and < 60 h), Category 3 (C3, ≥ 60 and < 70 h), Category 4 (C4, ≥ 70 and < 80 h), Category 5 (C5, ≥ 80 and < 90 h), Category 6 (C6, ≥ 90 and < 100 h), and Category 7 (C7, ≥ 100 h). *On the Athens Insomnia Scale, insomnia severity is classified as follows: 0–5 points, “absence”; 6–9 points, “mild”; 10–15 points, “moderate”; and 16–24 points, “severe”.

Figure 2

Results of structural equation modeling among the association between weekly duty hours, sleep-related variables, depressive symptoms, and severe medical error. Insomnia symptoms and sleep duration are considered as covariates. The values shown are standardized profit regression coefficients. Solid lines indicate statistical significance (p < 0.05), while dashed lines represent relationships that are not statistically significant. Our model was well fitted to our data (root mean square error of approximation [RMSEA]: 0.048; comparative fit index [CFI]: 0.99; Tucker-Lewis index [TLI]: 0.93).