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Sleep deprivation in PCI operators increased bleeding risk, not mortality
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Patients were at increased risk for bleeding after undergoing PCI performed by a chronically sleep-deprived operator compared with a non- or acutely sleep-deprived operator, according to recent data from the National Cardiovascular Data Registry.
However, overall procedure outcomes were similar regardless of the degree of operator sleep deprivation, the researchers wrote.
“Chronic partial sleep deprivation leads to more frequent lapses in psychomotor performance with less time-in-bed sleep opportunity,” the researchers wrote. “This scenario might occur when operators perform middle-of-the-night PCI procedures on days that are in close proximity to one another over relatively short blocks of time.”
Researchers compared in-hospital bleeding complications within 72 hours of and mortality outcomes from PCI procedures conducted by sleep-deprived vs non-sleep-deprived operators using data from the CathPCI registry. The study included 1,509,096 procedures performed between 7 a.m. and midnight from July 1, 2009, to June 30, 2012 by 5,014 operators.
Operators were considered chronically sleep-deprived if they performed two or more middle-of-the-night PCI procedures (between midnight and 6:59 a.m.) within 7 days. If operators performed a middle-of-the-night procedure and then another procedure between 7 a.m. and midnight the following day, they were considered acutely sleep-deprived.
Of all daytime procedures, 2.4% were performed by operators with some degree of sleep deprivation, with 1.3% performed by chronically sleep-deprived operators. The adjusted risk for bleeding among patients who underwent PCI procedures conducted by operators with chronic sleep deprivation was higher (OR=1.19; 95% CI, 1.05-1.34) compared with operators with acute sleep deprivation; however, the risk for mortality was not (OR=0.81; 95% CI, 0.62-1.05).
Patients who underwent PCI procedures performed by acutely sleep-deprived operators did not have a higher risk for bleeding (OR=1.03; 95% CI, 0.98-1.08) or mortality (OR=1.02; 95% CI, 0.94-1.12) compared with those who received procedures conducted by non-sleep-deprived operators, the researchers wrote.
“Our study suggests that only a small fraction of PCI procedures are performed by sleep-deprived operators,” they concluded. “The overall outcome of these patients appears similar to that in patients undergoing PCI at the hands of non-sleep-deprived operators.”
The researchers noted, however, that the data did not contain information on operator sleep status, or specify whether an operator was involved in any procedures or clinical responsibilities other than PCIs between midnight and 6:59 a.m. They also added that an operator may have been fully rested depending on the amount of sleep obtained before or after performing the middle-of-the-night procedure.
Disclosure: The researchers report no relevant financial disclosures.
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