PhD defense of Laura SCHMIDT on May 31, 2024

PhD defense of Laura SCHMIDT on May 31, 2024

Title: Sleep and Enhanced Performance of Health Care Professionals

Date :  May 31, 2024

Jury :
CHENNAOUI Mounir, MC, Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des Armées, 91223, Université Paris Cité 
LABORDE Sylvain, MC, Department of Performance Psychology, German Sport University Cologne 

Examinateurs : 
DUTHEIL, Frédéric, PU-PH, Physiological and Psychosocial Stress, UMR CNRS 6024, Université Clermont Auvergne 
ROLAND, Benjamin, PU-PH, PsyR2, Neurosciences de Lyon CRNL U1028 UMR5292, UCBL 1 
POIROT, Isabelle, MC, Lille Neuroscience & Cognition, INSERM U1172, Université de Lille 

Co-Directeurs de thèse:
MAZZA, Stéphanie, PU, Forgetting, Neurosciences de Lyon CRNL U1028 UMR5292, UCBL 1 
DOUPLAT, Marion, MC-PH, Research on Healthcare Performance, INSERM U1290, UCBL 1 
LILOT, Marc, MC-PH, Research on Healthcare Performance, INSERM U1290, UCBL 1 


In emergency medicine, fatigue, variable work schedules, reduced recovery times, and periodic work overload are frequently reported stress factors. While recovery time management has been extensively studied and recommendations made in high-security professional environments (aviation, navigation, transportation), research on healthcare professionals is still recent. Yet, the high incidence of burnout in this profession indicates the need for prevention actions focused on well-documented stress factors. Supporting the health of professionals enhances their ability to provide compassionate and effective patient care. In a preliminary study (Study 1), we demonstrated that sleepiness levels affected healthcare professionals' ability to recognise painful facial expressions and that work hours increased their sensitivity to pain. 

The primary objective of this thesis was to develop and evaluate an intervention aimed at better managing sleep and stress among emergency medical services professionals. We hypothesised that implementing such a program could improve their sleep and enable better stress management in their work. Our ambition being to offer a specific intervention for this population, we have sought to characterise the factors limiting their recovery time and to understand possible adaptation mechanisms. 

Thus beforehand, we aimed to quantify the constraints imposed by work schedules, we developed a metric based on emergency caregivers' shift schedules (Shift Load Index - SLI). The results showed that this index could predict scores obtained by the validated FAID Quantum tool, as well as sleepiness (Study 2) and sleep measures of healthcare personnel. Schedules with high SLI scores induced greater sleep irregularity and reduced sleep time (Study 3). 

The REST study (Recovery Optimization in Emergency Medicine Addressing Stress Adaptation Techniques) was the central focus of this thesis. Fifty-nine physicians and nurses from two emergency departments participated in a cluster-randomized controlled trial to evaluate the effectiveness of our intervention. Wake/rest rhythms were recorded by actigraphy for three weeks before the intervention and one week after. Participants' cardiac activity was also recorded during work hours one week before and one week after the intervention. The intervention included a 3-hour workshop in groups of four caregivers and individual follow-up for two weeks. The intervention was built on principles of cognitive-behavioural therapy for insomnia and included mental imagery and cardio-feedback techniques. During the workshop, caregivers analysed their wake/sleep rhythms using their actigraphy results. 

The intervention significantly increased caregivers' sleep time (+15 minutes/night) (Study 4) and improved heart rate variability during work hours by 9% for the intervention group. This improvement was even more pronounced for caregivers with moderate burnout on the Maslach scale (Study 5). 

This thesis highlights the feasibility and effectiveness of a program designed to improve sleep and stress management of healthcare professionals. These results encourage broader implementation of training and education for staff on shift work demands. Based on the developed tools, the final step of this work will be to help develop a holistic approach to caregiver well-being, at both individual and organisational levels. 


Keywords: Shift Work; Public Health; Shift adaptation; Emergency Department; Critical Care; Sleep deprivation; Circadian Misalignment 

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