Need for naps?
The researchers then analyzed analgesic prescription patterns drawn from three datasets of discharge notes of patients presenting to the emergency department with pain complaints (n = 13,482) at two branches of Hadassah-Hebrew University Medical Center and the University of Missouri Health Center.
The researchers collected data, including discharge time, medications patients were prescribed upon discharge, and patients’ subjective pain rating on a scale of 0-10 on a visual analogue scale (VAS).
Although patients’ VAS scores did not differ with respect to time or shift, patients were discharged with significantly less prescribed analgesics during the night shift in comparison with the day shift.
No similar differences in prescriptions between night shifts and day shifts were found for nonanalgesic medications, such as for diabetes or blood pressure. This suggests “the effect was specific to pain,” Dr. Gileles-Hillel said.
The pattern remained significant after controlling for potential confounders, including patient and physician variables and emergency department characteristics.
In addition, patients seen during night shifts received fewer analgesics, particularly opioids, than recommended by the World Health Organization for pain management.
“The first study enabled us to measure empathy for pain directly and examine our hypothesis in a controlled environment, while the second enabled us to test the implications by examining real-life pain management decisions,” Dr. Gileles-Hillel said.
“Physicians need to be aware of this,” he noted. “I try to be aware when I’m taking calls [at night] that I’m less empathetic to others and I might be more brief or angry with others.”
On a “house management level, perhaps institutions should try to schedule naps either before or during overnight call. A nap might give a boost and reboot not only to cognitive but also to emotional resources,” Dr. Gileles-Hillel added.
Compromised safety
In a comment, Eti Ben Simon, PhD, a postdoctoral fellow at the Center for Human Sleep Science, University of California, Berkeley, called the study “an important contribution to a growing list of studies that reveal how long night shifts reduce overall safety” for both patients and clinicians.
“It’s time to abandon the notion that the human brain can function as normal after being deprived of sleep for 24 hours,” said Dr. Ben Simon, who was not involved with the research.
“This is especially true in medicine, where we trust others to take care of us and feel our pain. These functions are simply not possible without adequate sleep,” she added.
Also commenting, Kannan Ramar, MD, president of the American Academy of Sleep Medicine, suggested that being cognizant of these findings “may help providers to mitigate this bias” of underprescribing pain medications when treating their patients.
Dr. Ramar, who is also a critical care specialist, pulmonologist, and sleep medicine specialist at Mayo Clinic, Rochester, Minn., was not involved with the research.
He noted that “further studies that systematically evaluate this further in a prospective and blinded way will be important.”
The research was supported in part by grants from the Israel Science Foundation, Joy Ventures, the Recanati Fund at the Jerusalem School of Business at the Hebrew University, and a fellowship from the Azrieli Foundation and received grant support to various investigators from the NIH, the Leda J. Sears Foundation, and the University of Missouri. The investigators, Ramar, and Ben Simon have reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.