Clinical Performance in Critical Care Simulation Under Sleep Deprivation: Effects of Power Napping in the R-NAP Randomized Controlled Trial

BACKGROUND: Sleep deprivation is common among anesthesia residents and impairs both technical and non-technical skills such as leadership. Napping is recommended in fatigue management across healthcare and other safety-sensitive sectors, yet its effectiveness for healthcare providers remains underexplored. This study evaluated whether a 30-min nap opportunity improved simulated crisis performance after a 24-h shift. METHODS: Residents were tested twice: once rested and once using a 24-h shift to induce partial sleep deprivation. Between sessions, they were trained in fatigue management. In the sleep-deprived condition, they were randomized to a nap opportunity or a control condition. Actigraphy objectively assessed sleep and nap duration. The primary endpoint was overall simulated clinical performance (0-200; combined technical and non-technical scores). Secondary endpoints were technical and non-technical subscales. Group effects were primarily tested using intention-to-treat regression models adjusted for rested performance, prior sleep, and critical care experience. RESULTS: Thirty-five residents were enrolled (nap opportunity n = 19, control n = 16). In the primary analysis sample (n = 27), clinical performance was 14.8 points higher following the nap opportunity compared with controls (95% confidence interval: 2.8-26.9; p =.018), corresponding to a 7.4% improvement. Technical skills did not differ significantly between groups, although more sleep was associated with better technical performance. Non-technical skills were higher in the nap opportunity condition (+11.0 points; 95% confidence interval: 2.2-19.8; p =.016), including significant effects of leadership and resource utilization. Exploratory analyses suggested associations between longer nap duration and multiple performance domains, strongest for technical skills (p =.010). CONCLUSIONS: Napping appears to enhance clinical performance, while the nap opportunity, nap duration, and prior sleep deprivation each influenced technical and non-technical performance in distinct ways. These findings support integrating napping and recovery into medical education and scheduling.