Review Article

Using Wearable Technology to Evaluate Sleep and Stress for Physicians

Authors: Maxwell Harrell, BS, Dev Dayal, BS, Clay Rahaman, BS, Joe Dekle, BS, Robert Lister, BS, Adam Skelton, BS, Eugene Brabston, MD, Thomas Evely, DO, Aaron Casp, MD, Amit M. Momaya, MD

Abstract

Objectives: Physician stress and burnout are increasingly prevalent issues that often are exacerbated by chronic sleep deprivation. Poor sleep not only compromises the well-being of physicians but also can negatively affect patient care and safety. As wearable technology has become more advanced, the potential is growing to use these devices to monitor and analyze physiological metrics such as sleep and stress levels in real time. This systemic review aims to investigate the use of wearable technology to track sleep quality, stress, and burnout among physicians at various levels of training.

Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using Medline, Cochrane, and Embase to identify studies that used wearable technology to monitor sleep and stress outcomes in physicians. Inclusion criteria focused on studies that specifically measured sleep quality, stress, and burnout using wearable technology. Thirteen studies were included in this review. Data extracted from the included studies detailed study design, participant characteristics, type of wearable technology used, and measured sleep outcomes and heart rate variability (HRV) data.

Results: The data of 540 physicians were included in this study, with Emergency Medicine and Trauma Surgery representing the largest proportion of specialties assessed. Physicians not on call slept an average of 398.3 ± 49.0 minutes per night, whereas those on call slept an average of 226.0 ± 71.3 minutes per night. Physicians also spent 82.5 ± 13.4 minutes in rapid eye movement sleep per night and 41.3 ± 21.8 minutes awake in bed before falling asleep. HRV measures showed an average standard deviation of the R-R intervals across studies of 62.7 ± 28.8 milliseconds.

Conclusions: Wearable technology data indicate that physicians sleep less than the recommended amount per night and have reduced sleep quality measures. HRV data indicate increased levels of stress and burnout. The data provided by wearable technology may improve physician well-being and ultimately patient care.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Wali SO, Qutah K, Abushanab L, et al. Effect of on-call-related sleep deprivation on physicians’ mood and alertness. Ann Thorac Med. 2013;8:22–27.
 
2. Barac M, Scaletty S, Hassett LC, et al. Wearable technologies for detecting burnout and wellbeing in health care professionals: scoping review. J Med Internet Res. 2024;26:e50253.
 
3. Hassinger AB, Kwon M, Wang J, et al. Pilot study comparing sleep logs to a commercial wearable device in describing the sleep patterns of physicians-in-training. PLoS ONE. 2024; 19:e0305881.
 
4. Adler DA, Tseng VWS, Qi G, et al. Identifying mobile sensing indicators of stress-resilience. Proc ACM Interact Mob Wearable Ubiquitous Technol. 2021;5:1–32.
 
5. Rivard L, McKay B, Melanson S, et al. 208 sleep time and characteristics measured using Fitbit devices in emergency medicine residents. Ann Emerg Med. 2020;76:S80–S81.
 
6. Schubert DUC, Serfaty FM, Cunha MR, et al. Heart rate variability and perception of mental stress among medical students and residents at an emergency department. Am J Emerg Med. 2024;78:12–17.
 
7. Sagun S, DeCicco D, Badami V, et al. iSleepFirst: burnout, fatigue, and wearable-tracked sleep deprivation among residents staffing the medical intensive care unit. Sleep Breath. 2023; 27(6):2491–2497. doi:10.1007/s11325-023-02839-82.
 
8. Chowdhary A, Davis JA, Ding L, Taravati P, Feng S. Resident Sleep During Traditional Home Call Compared to Night Float. J Acad Ophthalmol. 2023;15(2):e204–e208. doi:10.1055/s0043-17755783.
 
9. Coleman JJ, Robinson CK, von Hippel W, et al. What Happens on Call Doesn’t Stay on Call. The Effects of In-house Call on Acute Care Surgeons’ Sleep and Burnout: Results of the Surgeon Performance (SuPer) Trial. Annals of Surgery. 2023;278(4):497. doi:10.1097/SLA. 00000000000059717.
 
10. Marek AP, Nygaard RM, Liang ET, et al. The association between objectively-measured activity, sleep, call responsibilities, and burnout in a resident cohort. BMC Medical Education. 2019;19(1):158. doi:10.1186/s12909-019-1592-08.
 
11. Sochacki KR, Dong D, Peterson L, McCulloch PC, Harris JD. The Measurement of Orthopaedic 8. Surgeon Burnout Using a Validated Wearable Device. Arthroscopy, Sports Medicine, and Rehabilitation. 2019;1(2):e115–e121. doi:10.1016/j.asmr.2019.09.0044.
 
12. Mendelsohn D, Despot I, Gooderham PA, Singhal A, Redekop GJ, Toyota BD. Impact of work hours and sleep on well-being and burnout for physicians-in-training: the Resident Activity Tracker Evaluation Study. Medical Education. 2019;53(3):306–315. doi:10.1111/ medu.137575.
 
13. Hafycz J, Morley K, Melanson S, et al. 151 analyzing sleep by shift recorded on Fitbit devices worn by emergency medicine residents. Ann Emerg Med. 2021;78:S62.
 
14. Poonja Z, O’Brien P, Cross E, et al. Sleep and exercise in emergency medicine residents: an observational pilot study exploring the utility of wearable activity monitors for monitoring wellness. Cureus. 2018;10:e2973.
 
15. Rivard L, Perez C, Morley K, Melanson S, Hafycz J, Stankewicz H. 378 Sleep Time Measured Using Fitbit Devices in Emergency Medicine Residents Based on Rotation. Annals of Emergency Medicine. 2021;78(4):S152. doi:10.1016/j.annemergmed.2021.09.3936.
 
16. Gunaga S, Park J, Obrycki B, Hashim J, Spencer R, Jarski R. 280 Tracking Physical Activity and Sleep Patterns in Emergency Medicine Residents Using Wearable Activity Monitors. Annals of Emergency Medicine. 2019;74(4):S110–S111. doi:10.1016/j.annemergmed.2019. 08.238.
 
17. Weenk M, Alken APB, Engelen LJLPG, et al. Stress measurement in surgeons and residents using a smart patch. Am J Surg. 2018;216:361–368.
 
18. National Heart, Lung, and Blood Institute. Sleep deprivation and deficiency. How much sleep is enough. https://www.nhlbi.nih.gov/health/sleep-deprivation/how-much-sleep. Published March 24, 2022. Accessed July 29, 2024.
 
19. America’s Health Rankings. Insufficient sleep in United States. https://www.americashealthrankings.org/explore/measures/sleep. Accessed September 20, 2024.
 
20. Abrams RM. Sleep deprivation. Obstet Gynecol Clin North Am. 2015;42:493–506.
 
21. Gaba DM, Howard SK. Patient safety: fatigue among clinicians and the safety of patients. N Engl J Med. 2002;347:1249–1255.
 
22. Sandoval Y, Lobo AS, Somers VK, et al. Sleep deprivation in interventional cardiology: implications for patient care and physician-health. Catheter Cardiovasc Interv. 2018;91: 905–910.
 
23. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–1848.
 
24. Majekodunmi A, Landrigan CP. The effect of physician sleep deprivation on patient safety in perinatal-neonatal medicine. Am J Perinatol. 2011;29:43–48.
 
25. Olson EJ, Drage LA, Auger RR. Sleep deprivation, physician performance, and patient safety. Chest. 2009;136:1389–1396.
 
26. Zinner MJ, Fresichlag JA. Surgeons, sleep, and patient safety. JAMA. 2013;310:1807–1808.
 
27. Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA. 2009;302:1565–1572.
 
28. Khan MA, Al-Jahdali H. The consequences of sleep deprivation on cognitive performance. Neurosciences. 2023;28:91–99.
 
29. Killgore WDS. Effects of sleep deprivation on cognition. Prog Brain Res. 2010;185:105–129.
 
30. Harris JD, Staheli G, LeClere L, et al. What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review. Clin Orthop. 2015;473: 1600–1608.
 
31. Mauser NS, Michelson JD, Gissel H, et al. Work-hour restrictions and orthopaedic resident education: a systematic review. Int Orthop. 2016;40:865–873.
 
32. Peets A, Ayas NT. Restricting resident work hours: the good, the bad, and the ugly. Crit Care Med. 2012;40:960–966.
 
33. Sephien A, Reljic T, Jordan J, et al. Resident duty hours and resident and patient outcomes: systematic review and meta-analysis. Med Educ. 2023;57:221–232.
 
34. Ohayon MM, Carskadon MA, Guilleminault C, et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004;27:1255–1273.
 
35. Palagini L, Baglioni C, Ciapparelli A, et al. REM sleep dysregulation in depression: state of the art. Sleep Med Rev. 2013;17:377–390.
 
36. Morgenthaler J, Wiesner CD, Hinze K, et al. Selective REM-sleep deprivation does not diminish emotional memory consolidation in young healthy subjects. PLoS ONE. 2014;9: e89849.
 
37. Wiesner CD, Pulst J, Krause F, et al. The effect of selective REM-sleep deprivation on the consolidation and affective evaluation of emotional memories. Neurobiol Learn Mem. 2015; 122:131–141.
 
38. Boyce R, Williams S, Adamantidis A. REM sleep and memory. Curr Opin Neurobiol. 2017; 44:167–177.
 
39. Ruiz FS, Andersen ML, Martins RC, et al. Immune alterations after selective rapid eye movement or total sleep deprivation in healthy male volunteers. Innate Immun. 2012;18: 44–54.
 
40. Xu Y, Qu B, Liu F, et al. Sleep deprivation and heart rate variability in healthy volunteers: effects of REM and SWS sleep deprivation. Comput Math Methods Med. 2023;2023: 7121295.
 
41. Iskander A, Jairam T, Wang C, et al. Normal multiple sleep latency test values in adults: a systematic review and meta-analysis. Sleep Med. 2023;109:143–148.
 
42. Thomas D, Anderson MW. Assessment, methodology, training, and policies of sleep. In: Kushida CA, ed., Encyclopedia of Sleep. 1st ed. New York: Elsevier/Academic Press; 2013.
 
43. Omichi C, Kadotani H, Sumi Y, et al. Prolonged sleep latency and reduced REM latency are associated with depressive symptoms in a Japanese working population. Int J Environ Res Public Health. 2022;19:2112.
 
44. Zhong X, Gou F, Jiao H, et al. Association between night sleep latency and hypertension: a cross-sectional study. Medicine (Baltimore). 2022;101:e31250.
 
45. American Psychiatric Association. Sleep-wake disorders. In: Diagnostic and Statistical Manual of Mental Disorders., Fifth Edition. Washington DC: American Psychiatric Association Publishing; 2022.
 
46. Immanuel S, Teferra MN, Baumert M, et al. Heart rate variability for evaluating psychological stress changes in healthy adults: a scoping review. Neuropsychobiology. 2023;82:187–202.
 
47. Lennartsson AK, Jonsdottir I, Sjörs A. Low heart rate variability in patients with clinical burnout. Int J Psychophysiol. 2016;110:171–178.
 
48. Tiwari R, Kumar R, Malik S, et al. Analysis of heart rate variability and implication of different factors on heart rate variability. Curr Cardiol Rev. 2021;17:e160721189770.
 
49. Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health. 2017;5:258.
 
50. Aubert AE, Seps B, Beckers F. Heart rate variability in athletes. Sports Med. 2003;33: 889–919.
 
51. Alkhamees AA, Aljohani MS, Kalani S, et al. Physician’s burnout during the COVID-19 pandemic: a systematic review and meta-analysis. Int J Environ Res Public Health. 2023;20:4598.
 
52. Lazarides AL, Belay ES, Anastasio AT, et al. Physician burnout and professional satisfaction in orthopedic surgeons during the COVID-19 pandemic. Work Read Mass. 2021;69:15–22.
 
53. Melnikow J, Padovani A, Miller M. Frontline physician burnout during the COVID-19 pandemic: national survey findings. BMC Health Serv Res. 2022;22:365.
 
54. Shopen N, Schneider A, Aviv Mordechai R, et al. Emergency medicine physician burnout before and during the COVID-19 pandemic. Isr J Health Policy Res. 2022;11:30.
 
55. Zhang S, Ramalingam ND, Chandran C. Unmasking resident physician burnout during the COVID-19 era. Perm J. 2023;27:179–183.
 
56. Kobayashi H, Park BJ, Miyazaki Y. Normative references of heart rate variability and salivary alpha-amylase in a healthy young male population. J Physiol Anthropol. 2012;31:9.
 
57. Brinth LS, Jørgensen T, Mehlsen J, et al. Normative values of short-term heart rate variability in a cross-sectional study of a Danish population. The DanFunD study. Scand J Public Health. 2024;52:48–57.
 
58. Nunan D, Sandercock GRH, Brodie DA. A quantitative systematic review of normal values for short-term heart rate variability in healthy adults. Pacing Clin Electrophysiol. 2010;33: 1407–1417.
 
59. Kleiger RE, Miller JP, Bigger JT, et al. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59:256–262.
 
60. Nayyar S, Hasan MA, Roberts-Thomson KC, et al. Effect of loss of heart rate variability on T-wave heterogeneity and QT variability in heart failure patients: implications in ventricular arrhythmogenesis. Cardiovasc Eng Technol. 2017;8:219–228.
 
61. Senthinathan A, Mainwaring LM, Hutchison M. Heart rate variability of athletes across concussion recovery milestones: a preliminary study. Clin J Sport Med. 2017;27:288–295.
 
62. Musa SM, Adam I, Lutfi MF. Heart rate variability and autonomic modulations in preeclampsia. PloS ONE. 2016;11:e0152704.
 
63. Lutfi MF. Patterns of heart rate variability and cardiac autonomic modulations in controlled and uncontrolled asthmatic patients. BMC Pulm Med. 2015;15:119.
 
64. Zhang L, Zhou J, Ke L, et al. Role of heart rate variability in predicting the severity of severe acute pancreatitis. Dig Dis Sci. 2014;59:2557–2564.
 
65. Danzig R, Wang M, Shah A, et al. The wrist is not the brain: estimation of sleep by clinical and consumer wearable actigraphy devices is impacted by multiple patient- and device-specific factors. J Sleep Res. 2020;29:e12926.