睡眠剥夺、决策疲劳与医学培训中的临床表现：神经生理监测的叙事综述与展望
Sleep Deprivation, Decision Fatigue, and Clinical Performance in Medical Training: A Narrative Review and Perspective on Neurophysiological Monitoring.
摘要(中文译文)
睡眠剥夺与决策疲劳是日间临床表现的重要但常被低估的决定因素。在医学培训环境中，这些状态依赖性因素可能损害注意力、执行控制和决策能力，从而使对清醒状态下所观察到能力的解读变得复杂。本叙述性综述与观点文章综合了睡眠科学、神经生理学、心理学和医学教育的证据，探讨睡眠不足与决策疲劳如何塑造临床表现，以及无创监测方法如何有助于将这种变异性置于具体情境中加以理解。文中关注脑电图（EEG）和功能性近红外光谱（fNIRS）作为候选研究工具，用于表征疲劳相关的认知负荷与警觉性变化。所综述的文献支持睡眠不足、疲劳与神经认知功能受损之间的强关联，但在医学培训中使用实时神经生理监测进行可操作的准备度评估仍处于概念阶段，尚需实证验证。我们提出CBME-BCI-Fatigue框架，作为一个产生假设的观点模型，用于将生理状态信息与基于能力的评估相结合，同时强调与构念效度、增量价值、个体变异性、可行性和治理相关的局限性。该框架可为未来在睡眠易受影响的临床培训环境中开展基于模拟的低风险研究提供参考，涉及疲劳感知反馈和学习者支持。
Abstract
Sleep deprivation and decision fatigue are important but often under-recognized determinants of daytime clinical performance. In medical training environments, these state-dependent factors may impair attention, executive control, and decision-making, complicating the interpretation of observed competence during wakefulness. This narrative review and perspective synthesizes evidence from sleep science, neurophysiology, psychology, and medical education to examine how sleep loss and decision fatigue shape clinical performance and how non-invasive monitoring approaches may help contextualize this variability. Attention is given to electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) as candidate research tools for characterizing fatigue-related changes in cognitive workload and vigilance. The reviewed literature supports strong links between sleep loss, fatigue, and impaired neurocognitive functioning, but the use of real-time neurophysiological monitoring for actionable readiness assessment in medical training remains conceptual and requires empirical validation. We propose the CBME-BCI-Fatigue framework as a hypothesis-generating perspective model for integrating physiological state information with competency-based assessment, while emphasizing limitations related to construct validity, incremental value, individual variability, feasibility, and governance. This framework may inform future simulation-based and low-stakes research on fatigue-aware feedback and learner support in sleep-vulnerable clinical training environments.
如何引用
AMA
Kun Li, Zhuojun Shen, Hui Lu, Xueling Fang. Sleep Deprivation, Decision Fatigue, and Clinical Performance in Medical Training: A Narrative Review and Perspective on Neurophysiological Monitoring.. Journal of visualized experiments : JoVE. 2026; doi:10.3791/71627.
APA
Kun Li, Zhuojun Shen, Hui Lu, Xueling Fang (2026). Sleep Deprivation, Decision Fatigue, and Clinical Performance in Medical Training: A Narrative Review and Perspective on Neurophysiological Monitoring.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/71627
GB/T 7714
Kun Li, Zhuojun Shen, Hui Lu, Xueling Fang. Sleep Deprivation, Decision Fatigue, and Clinical Performance in Medical Training: A Narrative Review and Perspective on Neurophysiological Monitoring.[J]. Journal of visualized experiments : JoVE, 2026 doi:10.3791/71627.
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