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Impact of fatigue and insufficient sleep on physician and patient outcomes: a systematic review
  1. Michelle Gates1,
  2. Aireen Wingert1,
  3. Robin Featherstone1,
  4. Charles Samuels2,
  5. Christopher Simon3,
  6. Michele P Dyson1
  1. 1 Alberta Research Centre for Health Evidence (ARCHE), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Centre for Sleep and Human Performance, Calgary, Alberta, Canada
  3. 3 Canadian Medical Association, Ottawa, Ontario, Canada
  1. Correspondence to Dr Michele P Dyson; mdyson{at}


Objectives For physicians in independent practice, we synthesised evidence on the (1) impacts of insufficient sleep and fatigue on health and performance, and patient safety and (2) effectiveness of interventions targeting insufficient sleep and fatigue.

Design We systematically reviewed online literature. After piloting, one reviewer selected studies by title and abstract; full texts were then reviewed in duplicate. One reviewer extracted data; another verified a random 10% sample. Two reviewers assessed risk of bias. We pooled findings via meta-analysis when appropriate or narratively.

Data sources We searched Medline, Embase, PsycINFO, CINAHL and PubMed for published studies in April 2016; Medline was updated in November 2017. We searched Embase for conference proceedings, and hand-searched meeting abstracts, association and foundation websites.

Eligibility criteria for selecting studies English or French language primary research studies published from 2000 to 2017 examining the effect of fatigue-related or sleep-related exposures or interventions on any outcome among physicians in independent practice and their patients.

Results Of 16 154 records identified, we included 47 quantitative studies of variable quality. 28 studies showed associations between fatigue or insufficient sleep and physician health and well-being outcomes. 21 studies showed no association with surgical performance, and mixed findings for psychomotor performance, work performance and medical errors. We pooled data from six cohort studies for patient outcomes. For sleep deprived versus non-sleep deprived surgeons, we found no difference in patient mortality (n=60 436, relative risk (RR) 0.98, 95% CI 0.84 to 1.15, I2=0% (p=0.87)) nor postoperative complications (n=60 201, RR 0.99, 95% CI 0.95 to 1.03, I2=0% (p=0.45)). The findings for intraoperative complications and length of stay were considerably heterogeneous.

Conclusions Fatigue and insufficient sleep may be associated with negative physician health outcomes. Current evidence is inadequate to inform practice recommendations.

  • risk management
  • sleep medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors All authors contributed to the conception and design of the project. MG and AW contributed to the acquisition, analysis and interpretation of the data, and drafted the manuscript. RF contributed to acquisition of data. CSa, CSi and MPD contributed to interpretation of data and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript as submitted.

  • Funding This research was supported by the Canadian Medical Association.

  • Competing interests CSi is employed by the Canadian Medical Association, who provided financial support for the research.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data pertaining to this systematic review are available from the corresponding author on reasonable request.

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