The impact of remote working on sleep quality in otolaryngology

Background: Shift work can lead to sleep deprivation and circadian misalignment. Sleep disturbances have implications for patient care, clinician well-being, and overall healthcare performance. In the United Kingdom, otolaryngology operates a non-resident on-call structure at registrar and consultant levels, necessitating availability for remote consultation and potential on-site attendance overnight. Objectives: Whilst resident on-call rotas have been shown to have a detrimental effect on sleep quality, the impact of non-resident on calls remains under investigated. This study aims to assess the impact of non-resident on-call structures on sleep quality using smart phone sleep-tracking. Materials and Methods: Three consultants and three registrars monitored their sleep quality using the mobile phone application ‘Sleep cycle’ over a ten week on call cycle at a district general hospital. Data was collected prospectively and results analysed anonymously. Results: Sleep length was longest during off days (when clinicians had no clinical commitments the following day). The average sleep length for consultants was 7.07 h versus 6.97 h for registrars. There were variations in sleep quality across different work and on-call scenarios. For consultants, the highest average sleep quality was during on-call hours (80.00%). Sleep quality was lowest when a consultant was called for advice after 22:00h (54.00%), however, this increased to 73.00% when a consultant was required on site after 22:00 h. For registrars, average sleep quality was highest during off days at 83.00%. When registrars were contacted for advice overnight, average sleep quality was 68.67% and was lowest when registrars were called on-site after 22:00h (57%). Conclusion: Sleep length and quality are negatively affected by non-resident on-calls when clinicians are contacted after 22:00h. There is no measurable impact on sleep quality when clinicians are not disturbed whilst on-call remotely. NHS trusts should monitor the wellbeing of their doctors and consider the implications of overnight commitments when structuring elective rotas.