Sleep Deprivation and Performance of Residents

Abstract

To the Editor.— Deaconson et al 1 show only that chronically sleep-deprived residents do no worse on cognitive tests when they are also acutely sleep-deprived. One must question what this proves. The study does not discover whether sleep deprivation impairs performance—to investigate this possibility, those who are sleep deprived should be compared with those who are not. But the authors admit that they did not use [prolonged-rest] controls, as these are inappropriate to the realities of the clinical on-call schedules of residents. In other words, they did not address whether a reduction in call would be beneficial to patients. If they had wanted to ask this question, they would have had to compare the performance of residents working every other night with those working less often. They also discount previous studies that showed impairment because those studies did not offer incentives to their subjects, even as they admit that their