Key Points

Question  Is sleep-related impairment associated with burnout, professional fulfillment, and self-reported clinically significant medical error in physicians?

Findings  In this cross-sectional study of 11 395 physicians, sleep-related impairment had statistically significant correlations with burnout and professional fulfillment. In a model adjusting for gender, training status, practice specialty, and burnout, moderate, high, and very high sleep-related impairment were associated with 53%, 96%, and 97% greater odds of self-reported clinically significant medical error, respectively, compared with low sleep-related impairment.

Meaning  These findings suggest that interventions to mitigate sleep-related impairment in physicians are warranted.

Abstract

Importance  Sleep-related impairment in physicians is an occupational hazard associated with long and sometimes unpredictable work hours and may contribute to burnout and self-reported clinically significant medical error.

Objective  To assess the associations between sleep-related impairment and occupational wellness indicators in physicians practicing at academic-affiliated medical centers and the association of sleep-related impairment with self-reported clinically significant medical errors, before and after adjusting for burnout.

Design, Setting, and Participants  This cross-sectional study used physician wellness survey data collected from 11 academic-affiliated medical centers between November 2016 and October 2018. Analysis was completed in January 2020. A total of 19 384 attending physicians and 7257 house staff physicians at participating institutions were invited to complete a wellness survey. The sample of responders was used for this study.

Exposures  Sleep-related impairment.

Main Outcomes and Measures  Association between sleep-related impairment and occupational wellness indicators (ie, work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment) was hypothesized before data collection. Assessment of the associations of sleep-related impairment and burnout with self-reported clinically significant medical errors (ie, error within the last year resulting in patient harm) was planned after data collection.

Results  Of all physicians invited to participate in the survey, 7700 of 19 384 attending physicians (40%) and 3695 of 7257 house staff physicians (51%) completed sleep-related impairment items, including 5279 women (46%), 5187 men (46%), and 929 (8%) who self-identified as other gender or elected not to answer. Because of institutional variation in survey domain inclusion, self-reported medical error responses from 7538 physicians were available for analyses. Spearman correlations of sleep-related impairment with interpersonal disengagement (r = 0.51; P < .001), work exhaustion (r = 0.58; P < .001), and overall burnout (r = 0.59; P < .001) were large. Sleep-related impairment correlation with professional fulfillment (r = −0.40; P < .001) was moderate. In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleep-related impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53% (odds ratio, 1.53; 95% CI, 1.12-2.09), 96% (odds ratio, 1.96; 95% CI, 1.46-2.63), and 97% (odds ratio, 1.97; 95% CI, 1.45-2.69), respectively.

Conclusions and Relevance  In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Interventions to mitigate sleep-related impairment in physicians are warranted.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773777

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Majid Bagheri Hosseinabadi, Narges Khanjani, Mohammad Hossein Ebrahimi, Seyed Habib Mousavi, Fereshteh Nazarkhani

First published: 25 July 2020

https://doi.org/10.1002/1348-9585.12136

Abstract

Objectives

This study was designed to investigate the possible effect of exposure to extremely low frequency electromagnetic fields (ELF‐EMFs) on occupational burnout syndrome and the severity of depression experienced among thermal power plant workers and the role of oxidative stress.

Methods

In this cross‐sectional study, 115 power plant workers and 124 administrative personnel of a hospital were enrolled as exposed and unexposed groups, respectively, based on inclusion and exclusion criteria. Levels of oxidative stress biomarkers, including malondialdehyde (MDA), superoxide dismutase (SOD), catalase (Cat), and total antioxidant capacity were measured in serum samples. Exposure to electric and magnetic fields was measured using the IEEE Std C95.3.1 standard at each workstation. The burnout syndrome and the severity of depression were assessed using the Maslach Burnout and Beck Depression Inventory.

Results

The levels of MDA and SOD were significantly lower in the exposed group than the unexposed group. The exposed group reported a higher prevalence of burnout syndrome and higher depression severity. Multiple linear regression showed that work experience, MDA level, and levels of exposure to magnetic fields are the most important predictor variables for burnout syndrome and severity of depression. In addition, a decrease in the level of Cat was significantly associated with increased burnout syndrome.

Conclusion

The thermal power plant workers exposed to ELF‐EMFs are at risk of burnout syndrome and depression. These effects may be caused directly by exposure to magnetic fields or indirectly due to increased oxidative stress indices.

Excerpt

The International Agency for Cancer Research has classified these fields as possibly carcinogenic to humans. The results of this study showed a significant relation between occupational exposure to magnetic fields, occupational burnout syndrome and depression severity. Moreover it was showed that levels of some indicators of oxidative stress had increased in the exposed group which may be the possible mechanism for the effects of exposure to ELF‐EMFs on burnout and depression. We showed in previous studies that exposure to these fields disturbs the antioxidant system balance, and leads to increased levels of malondialdehyde, catalase, and superoxide dismutase, which is also associated with poor sleep quality, stress, anxiety, and depression.18

In explaining the relation between exposure to magnetic fields and occupational burnout syndrome, some researchers think that exogenous stresses cause oxidative cellular stress, the formation of reactive oxygen species, reactive nitrogen species, and reactive products. These factors also cause mitochondrial metabolic dysfunction, which results in the lack of adenosine triphosphate (ATP) followed by a decrease in the cells function. This decrease in ATP levels is a detrimental factor in the occurrence of burnout syndrome. As a result, weak ambient magnetic fields (such as fields produced by transformers found in devices) and various radio frequency resonances, can increase the prevalence of burnout syndrome by increasing levels of free radicals and reactive products.46

This study had some strengths and weakness. One of the strengths was that the direct and indirect effects of exposure to magnetic fields were evaluated. Furthermore, we quantified exposure to electric and magnetic fields by measuring them in different workstations during normal work shifts. However, this cross‐sectional study cannot prove causality and was conducted on only one power plant, that makes it difficult to generalize the results to all thermal power plants. We had difficulty in shift classification because workers were working in three rotating shifts (morning, evening, and night) and the unexposed group were working in two shifts (morning and evening). Thus, we could not differentiate the effect of each shift on depression and burnout syndrome.52 We tried to find a control group with very similar work conditions that probably had the same level of workload, similar life style and diet. But we cannot be sure that their conditions were completely similar.

https://onlinelibrary.wiley.com/doi/full/10.1002/1348-9585.12136?fbclid=IwAR3eGwtPE2C3jON_rdzatLFiAAD_GXmWlTprREIlm9cJxA8nvctD1Ce7ejU

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