Author Contributions: Dr Ayas 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: Ayas, Barger, Cade, Hashimoto, Czeisler.
Acquisition of data: Ayas, Barger, Cade, Hashimoto, Cronin.
Analysis and interpretation of data: Ayas, Hashimoto, Rosner, Speizer, Czeisler.
Drafting of the manuscript: Ayas.
Critical revision of the manuscript for important intellectual content: Barger, Cade, Hashimoto, Rosner, Cronin, Speizer, Czeisler.
Statistical analysis: Ayas, Rosner, Cronin.
Obtained funding: Barger, Czeisler.
Administrative, technical, or material support: Barger, Cade, Hashimoto, Speizer, 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 speakers 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. Dr Hashimoto reports that he is a paid employee of Partners Healthcare System and has received income from the Harvard Law School and the Massachusetts Department of Industrial Accidents. Drs Ayas, Barger, Cronin, Czeisler, Hashimoto, Rosner, and Speizer 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 Accreditation Council of Graduate Medical Education; Cephalon, Inc; MPM Capital; Philips Lighting; Sanofi-Aventis; Takeda; 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.
Funding/Support: This study was supported by grants from the National Institute for Occupational Safety and Health within the Centers for Disease Control and Prevention (1 R01 OH07567) and by the Agency for Healthcare Research and Quality (R01 HS12032), Brigham and Women’s Hospital and Division of Sleep Medicine, Harvard Medical School. Dr Cronin was the recipient of an AHRQ National Research Service Award (NRSA; F32 HS14130), and Drs Cronin and Barger were the recipients of National Heart, Lung, and Blood Institute fellowships in the program of training in Sleep, Circadian and Respiratory Neurobiology at Brigham and Women's Hospital (NHLBI; T32 HL079010). Dr Czeisler is supported by NASA Cooperative Agreement NCC 9-58 with the National Space Biomedical Research Institute and by the Air Force Office of Scientific Research. Dr Ayas is supported by a New Investigator Award from the Canadian Institutes of Health Research/British Columbia Lung Association, a Michael Smith Foundation Scholar Award, and a Departmental Scholar Award from the University of British Columbia.
Role of the Sponsor: The funding sources 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 would like to 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; DeWitt C. Baldwin, MD, and Steven R. Daugherty, PhD, for serving as paid consultants to assist in designing the questionnaires; Tim Ayas, MD, and Sharlene Hudson, MD, for questionnaire review; Steven W. Lockley, PhD, for assistance with study design; Christopher P. Landrigan, MD, MPH, for helpful comments on the manuscript; and Joseph B. Martin, MD, PhD, Anthony Whittemore, MD, and Gary Gottlieb, MD, for their support and encouragement of this work. We are also appreciative of Cherelyn Were and Mohammed Rasheed, employees at Pearson NCS (company contracted to administer the Web-based survey instrument), for their commitment to this project.