Author Contributions: Dr Landrigan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Landrigan, Barger, Cade, Ayas, Czeisler.
Acquisition of data: Landrigan, Barger, Cade.
Analysis and interpretation of data: Landrigan, Barger, Czeisler.
Drafting of the manuscript: Landrigan.
Critical revision of the manuscript for important intellectual content: Landrigan, Barger, Cade, Ayas, Czeisler.
Statistical analysis: Landrigan, Barger, Cade.
Obtained funding: Landrigan, Barger, Ayas, Czeisler.
Administrative, technical, or material support: Barger, Cade, Ayas, Czeisler.
Study supervision: Barger, Czeisler.
Financial Disclosures: Dr Ayas reports that he has received a research grant from Respironics Inc and a consulting fee from Unilever and lecture fees from the American Academy of Sleep Medicine and the National Sleep Foundation. Dr Barger reports receiving a speaker’s fee from HCPRO for a national audio conference on “Resident Fatigue: Identify and Manage Your Risk.” Mr Cade reports serving as a paid consultant for Vanda Pharmaceuticals. Drs Barger, Ayas, and Czeisler, and Mr Cade report that they are or were paid employees of the Brigham and Women's Hospital (a subsidiary of Partners HealthCare System Inc), which employs interns and residents. Dr Czeisler has received consulting fees from or served as a paid member of scientific advisory boards for: Accelerator Corp; Actelion Inc; American Physiological Society; Aventis; Avera Pharmaceuticals Inc; Cephalon Inc; Coca-Cola Co; Hypnion Inc; NASA Jet Propulsion Laboratory, California Institute of Technology; National Center for Sleep Disorders Research, National Heart, Lung and Blood Institute; Oxford Biosignals; Pfizer Inc; Morgan Stanley; Sleep Multimedia Inc; Sleep Research Society (for which Dr Czeisler served as president); Respironics Inc; Takeda Pharmaceuticals Inc; Unilever; Vanda Pharmaceuticals Inc and Warburg-Pincus. He owns an equity interest in Hypnion Inc and Vanda Pharmaceuticals Inc. He has received lecture fees from the ACGME, Cephalon Inc, MPM Capital, Philips Lighting, Sanofi-Aventis, Takada, and multiple academic institutions and organizations. Dr Czeisler holds a number of process patents in the field of sleep/circadian rhythms (eg, photic resetting of the human circadian pacemaker), all of which are assigned to the Brigham and Women's Hospital per institutional policy. He has also received research prizes with monetary awards from the American Academy of Sleep Medicine; American Clinical and Climatological Association; Association for Patient-Oriented Research; National Institute for Occupational Safety and Health and National Sleep Foundation; clinical trial research contracts from Cephalon Inc and Pfizer Inc; an investigator-initiated research grant from Cephalon Inc; and unrestricted research and education funds from Cephalon Inc, Philips Lighting, and the Brigham and Women's Hospital. Dr Czeisler is the incumbent of an endowed professorship provided to Harvard University by Cephalon Inc. Since 1985, Dr Czeisler has served as an expert witness on various legal cases related to sleep and/or circadian rhythms. Dr Czeisler has never served as an expert witness for a commercial research sponsor. Dr Landrigan is a paid employee of Brigham and Women's Hospital and Children's Hospital Boston, both of which employ interns and residents. He has served as a paid consultant to the District Health Boards of New Zealand, performing an assessment of current working conditions for junior physicians in New Zealand, and providing recommendations on how to improve the safety of scheduling practices. Dr Landrigan has received research prizes with monetary awards from the National Sleep Foundation, the Sleep Research Society, the Society of Hospital Medicine, and the Mount Sinai School of Medicine. Dr Landrigan has received honoraria for delivering lectures on sleep and safety for multiple academic institutions and organizations.
Funding/Support: This study was supported by grants from the National Institute for Occupational Safety and Health within the US Centers for Disease Control (1 R01 OH07567), which provided a Certificate of Confidentiality for data protection; the Agency for Healthcare Research and Quality (RO1 HS12032), affording data confidentiality protection by federal statute (Public Health Service Act; 42 U.S.C.), Brigham and Women's Hospital, and Division of Sleep Medicine, Harvard Medical School. Dr Landrigan is the recipient of an Agency for Healthcare Research and Quality career development award (K08 HS13333), and Dr Barger was the recipient of a National Heart, Lung and Blood Institute fellowship in the program of training in Sleep, Circadian and Respiratory Neurobiology at Brigham and Women's Hospital (NHLBI; T32 HL079010). Dr Czeisler is supported in part by the Air Force Office of Scientific Research and by the National Space Biomedical Research Institute through the National Aeronautics and Space Administration (NCC9-58).
Role of the Sponsor: Sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
Acknowledgment: We thank the National Residency Matching Program and the Association of American Medical Colleges, especially Jordan J. Cohen, MD, Paul Jolly, PhD, and the Division of Medical School Services and Studies, for their assistance with recruitment. Our thanks to DeWitt C. Baldwin, MD, and Steven R. Daugherty, PhD, for their help in designing the questionnaires (compensated as consultants for their assistance in questionnaire design); Tim Ayas, MD, and Sharlene Hudson, MD, for questionnaire review; Steven W. Lockley, PhD, for his assistance with data interpretation; Cherelyn Werre and Mohammed Rasheed at Pearson Assessments (Web hosting company contracted to administer the survey) and Joseph B. Martin, MD, PhD, Gary L. Gottlieb, MD, MBA, and Anthony D. Whittemore, MD, for their support and encouragement.