Padrão de sono e tomada de decisão em médicos de unidades móveis de atenção às urgências submetidos a esquemas de turnos

Abstract

The change in sleep-wake patterns, one of the consequences of shift work and night shifts, causes many biopsychosocial changes that interfere on the health-disease processes of workers. One of the impacts caused by these changes is observed in decision-making, one of the components of executive functioning. In the context of emergency care in health work, decision making becomes one of the most important elements, because although most decisions can be resolved with a prepared team, the unpredictability scenario and the severity of interventions exposes the medical team to a constant stress, which can impair activities such as plan appropriate responses. This study aimed to assess the relationship between sleep and decision making in 26 medical technicians of the emergency care units undergoing shifts schemes and to translate and adapt to Portuguese decision-making hypothetical scenarios based on Policy-Capturing Technique. To sleep evaluation, we used the Pittsburgh Sleep Quality Index (PSQI), the Sleep Habits Questionnaire, the Epworth Sleepiness Scale and Chronotype Identification Questionnaire Horne-Ostberg. To evaluate the decision-making, was used the Iowa Gambling Task (IGT) and hypothetical scenarios created according to the Policy-Capturing Technique, which were translated into Portuguese and adapted according to the needs of our sample. For inclusion / exclusion criteria, the participants answered the Chalder Fatigue Scale, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI) and the Inventory of Stress Symptoms for adults of Lipp (ISSL). Participants were divided into day shift (N = 6) and alternating shift (N = 20). The results showed a good sleep quality for physicians of the day shift and poor sleep quality for the alternating shift. A good quality sleep and less somnolence were correlated with better performance in decision-making. An assessment was made in order to verify the relationship between the two decision-making protocols and the results showed a correlation between them, indicating worse decision-making evaluated by IGT related to losses in decision making evaluated by the scenarios. It was found impaired decision making when measured along the shift. It is concluded that the scheme of alternating shift work can be detrimental to the sleep quality of doctors and a good sleep quality can contribute to a better performance in decision-making.