Sleep Deprivation and Performance of Residents

To the Editor.—  In their article entitled "Sleep Deprivation and Resident Performance," Deaconson et al¹ state, "The strength of our study is its design." They could not be more wrong; the study's design is so flawed that their results and conclusions must be questioned.The subjects were surgical residents working every other night on call. The residents served as their own controls: the study compared them when sleep deprived—after a night on call—with when rested—after a night off. The authors assumed that residents who slept the previous night were rested, but this is hardly a safe assumption.The effects of acute sleep deprivation last far longer than 24 hours.² Many residents describe difficulty concentrating "the day after the day after" a night on call—precisely when the rested controls were tested. The authors fail to consider that the control group may also have been sleep deprived, both acutely, as