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No abstract available. Article truncated at 150 words. In another move favoring business interests and against the common good, the Trump administration’s Department of Transportation announced recently that they are rescinding plans to require testing for obstructive sleep apnea (OSA) in train and commercial motor vehicle operators (1). As exemplified by its withdrawal from the Paris climate accords, this decision is another example of how the current administration disregards scientific findings and present-day events in establishing policy that will be detrimental to Americans. Let us step back for a moment and briefly review the evidence that the Trump administration has ignored. • It is well established that obstructive sleep apnea (OSA) can result in daytime sleepiness (2) and that sleepiness is detrimental to safe operation of a train or motor vehicle. • Many studies have established that persons with OSA have an increased risk of motor vehicle crashes (3). • Studies in commercial truck drivers have observed that this population has …

Accidents related to sleepiness related fatigue are an important concern in transportation related industries. This brief review outlines the public safety concerns with sleepiness related fatigue in the railroad, aviation and motor vehicle transportation fields. In addition, the common causes of sleepiness related fatigue, and impact on operators and their families are highlighted. It is suggested that in addition to greater recognition and changes in duty hour regulations, there should be a greater emphasis on the education of operators on the importance of sleep and circadian factors in causing fatigue, as well as strategies to mitigate their impact.

Sleep tracking by consumers is becoming increasingly prevalent; yet, few studies have evaluated the accuracy of such devices. We sought to evaluate the accuracy of three devices (Oura Ring Gen3, Fitbit Sense 2, and Apple Watch Series 8) compared to the gold standard sleep assessment (polysomnography (PSG)). Thirty-five participants (aged 20-50 years) without a sleep disorder were enrolled in a single-night inpatient study, during which they wore the Oura Ring, Fitbit, and Apple Watch, and were monitored with PSG. For detecting sleep vs. wake, the sensitivity was ≥95% for all devices. For discriminating between sleep stages, the sensitivity ranged from 50 to 86%, as follows: Oura ring sensitivity 76.0-79.5% and precision 77.0-79.5%; Fitbit sensitivity 61.7-78.0% and precision 72.8-73.2%; and Apple sensitivity 50.5-86.1% and precision 72.7-87.8%. The Oura ring was not different from PSG in terms of wake, light sleep, deep sleep, or REM sleep estimation. The Fitbit overestimated light (18 min; p < 0.001) sleep and underestimated deep (15 min; p < 0.001) sleep. The Apple underestimated the duration of wake (7 min; p < 0.01) and deep (43 min; p < 0.001) sleep and overestimated light (45 min; p < 0.001) sleep. In adults with healthy sleep, all the devices were similar to PSG in the estimation of sleep duration, with the devices also showing moderate to substantial agreement with PSG-derived sleep stages.

Study Objectives: Insomnia, poor sleep quality and extremes of sleep duration are associated with COVID-19 infection. This study assessed whether these factors are related to Post-Acute Sequelae of SARS-CoV-2 infection (PASC)., Methods: Cross-sectional survey of a general population of 24,803 U.S. adults to determine the association of insomnia, poor sleep quality and sleep duration with PASC. Three definitions of PASC were used based on post COVID-19 clinical features: COPE (≥3), NICE (≥1), and RECOVER (scoring algorithm)., Results: Prevalence rates of PASC were 21.9%, 38.9%, 15.5% for COPE, NICE and RECOVER PASC definitions, respectively. PASC was associated with insomnia in all 3 models after full adjustment with odds ratios (aORs) and 95% confidence intervals (CI) ranging from 1.30 (95% CI: 1.11-1.52, p≤0.05, PASC Score) to 1.52 (95% CI: 1.34-1.71, p≤0.001, (NICE). Poor sleep quality was related to PASC in all models with aORs ranging from 1.77 (95% CI: 1.60-1.97, p≤0.001, NICE) to 2.00 (95% CI: 1.77-2.26, p≤0.001, COPE). Sleep <6 hours was associated with PASC with aORs between 1.59 (95% CI: 1.40-1.80, p≤0.001, PASC Score) to 1.70 (95% CI: 1.53-1.89, p≤0.001, COPE). Sleep ≥ 9 hours was not associated with PASC in any model. Although vaccination with COVID-19 booster decreased the likelihood of developing PASC, it did not attenuate associations between insomnia, poor sleep quality and short sleep duration with PASC in any of the models., Conclusions: Insomnia, poor sleep quality and short sleep duration are cross-sectionally associated with PASC and may be potential risk factors. Further longitudinal studies should be conducted., (© 2024 American Academy of Sleep Medicine.)

The amount of time available in a day is fixed, and consequently, sleep is often sacrificed for waking activities. For college students, daily activities, comprised of scheduled classes, work, study, social, and other extracurricular events, are major contributors to insufficient and poor-quality sleep. We investigated the impact of daily schedules on sleep-wake timing in 223 undergraduate students (age: 18-27 years, 37% females) from a United States university, who were monitored for ~30 days. Sleep-wake timing and daily recorded activities (attendance at academic, studying, exercise-based, and/or extracurricular activities) were captured by a twice-daily internet-based diary. Wrist-worn actigraphy was conducted to confirm sleep-wake timing. Linear mixed models were used to quantify associations between daily schedule and sleep-wake timing at between-person and within-person levels. Later scheduled start time predicted later sleep onset (between and within: p < .001), longer sleep duration on the previous night (within: p < .001), and later wake time (between and within: p < .001). Later schedule end time predicted later sleep onset (within: p < .001) and shorter sleep duration that night (within: p < .001). For every 1 hour that activities extended beyond 10 pm, sleep onset was delayed by 15 minutes at the within-person level and 40 minutes at the between-person level, and sleep duration was shortened by 6 and 23 minutes, respectively. Increased daily documented total activity time predicted earlier wake (between and within: p < .001), later sleep onset that night (within: p < .05), and shorter sleep duration (within: p < .001). These results indicate that daily schedules are an important factor in sleep timing and duration in college students. Clinical Trial: Multi-scale Modeling of Sleep Behaviors in Social Networks; URL: https://clinicaltrials.gov/study/NCT02846077; Registration:NCT02846077., (© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society.)

Cross-sectional studies suggest that obstructive sleep apnea (OSA) is a potential risk factor for incident COVID-19 infection, but longitudinal studies are lacking. In this study, two surveys from a large general population cohort, the COVID-19 Outbreak Public Evaluation (COPE) Initiative, undertaken 147 ± 58 days apart were analyzed to determine whether the pre-existing OSA was a risk factor for the incidence of COVID-19. Of the 24,803 respondents completing the initial survey, 14,950 were negative for COVID-19; data from the follow-up survey were available for 2,325 respondents. Those with incident COVID-19 infection had a slightly higher prevalence of OSA (14.3 vs. 11.5%, p=0.068). Stratification by treatment status revealed that those untreated for their OSA were at greater risk for developing COVID-19 infection (OSA Untreated, 14.2 vs. 7.4%, p≤0.05). In a logistic regression model adjusted for comorbidities, demographic and socioeconomic factors and the interaction between vaccination status and OSA, incident COVID-19 infection was 2.15 times more likely in those with untreated OSA (aOR: 2.15, 95% CI: 1.18-3.92, p≤0.05). Stratification by treatment status revealed only untreated OSA participants were at greater risk for COVID-19 (aOR: 3.21, 95% CI: 1.25-8.23, p≤0.05). The evidence from this study confirms untreated OSA as a risk factor for acquiring COVID-19 infection and highlights the importance of actively treating and managing OSA as a preventative mechanism against COVID-19 disease., Competing Interests: MDW reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, and Delta Airlines; as well as consulting fees from the Fred Hutchinson Cancer Center and the University of Pittsburgh. LKB reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots; as well as honorariums from the National Institutes of Occupational Safety and Health, University of Arizona and University of British Columbia. MÉC reported personal fees from Vanda Pharmaceuticals Inc., research grants or gifts to Monash University from WHOOP, Inc., Hopelab, Inc., CDC Foundation, and the Centers for Disease Control and Prevention. SMWR reported receiving grants and personal fees from Cooperative Research Centre for Alertness, Safety, and Productivity, receiving grants and institutional consultancy fees from Teva Pharma Australia and institutional consultancy fees from Vanda Pharmaceuticals, Circadian Therapeutics, BHP Billiton, and Herbert Smith Freehills. SFQ has served as a consultant for Teledoc, Bryte Foundation, Jazz Pharmaceuticals, Summus, Apnimed, and Whispersom. RR reports personal fees from SleepCycle AB; Rituals Cosmetics BV; Sonesta Hotels International, LLC; Ouraring Ltd; AdventHealth; and With Deep, LLC. CAC serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc. and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc, Philips Respironics, Inc., Optum, and ResMed, Inc.; research support to Brigham and Women’s Hospital from Axome Therapeutics, Inc., Dayzz Ltd., Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc., Takeda Pharmaceutical Co., LTD, Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc., Teva Pharmaceuticals Industries, Ltd., and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc; personal consulting fees from Axome, Inc., Bryte Foundation, With Deep, Inc. and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Wellbeing, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd. and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the UK Biotechnology and Biological Sciences Research Council. CAC has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc.; C&J Energy Services; Dallas Police Association; Delta Airlines/Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc./Motor Coach Industries/FirstGroup America; PAR Electrical Contractors, Inc.; Puget Sound Pilots; and the San Francisco Sheriff’s Department; Schlumberger Technology Corp.; Union Pacific Railroad; United Parcel Service; Vanda Pharmaceuticals. CAC has received travel support from the Stanley Ho Medical Development Foundation for travel to Macao and Hong Kong; equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc.; and institutional educational gifts to Brigham and Women’s Hospital from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc., Harmony Biosciences LLC, Eisai Co., LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp., Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, Stuart F. and Diana L. Quan Charitable Fund. Dr Czeisler’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of interest policies. No other disclosures were reported.

Adaptation of the circadian clock to the environment is essential for optimal health, well-being, and performance. Animal models demonstrate that a high-fat diet impairs circadian adaptation to advances of the light-dark cycle; it is unknown whether this occurs in humans. Utilizing a natural experiment that occurs when humans must advance their behaviors to an earlier hour for daylight saving time (DST), we measured the influence of diet on sleep/wake timing relative to dim-light melatonin onset time. Students with a lower-fat diet rapidly altered their sleep-wake timing to match the imposed time change, whereas those with a high-fat diet were slower to adapt to the time change. Moreover, a faster shift in timing after DST was associated with higher general health, lower body mass index, and higher grade point average. These data suggest that diet may influence the speed of sleep and circadian adaptation, which could have implications for health and performance., Competing Interests: A.W.M. reports consulting for Pure Somni Corporation. A.S. has received travel reimbursement or honorarium payments from Leuven Mindgate, American Epilepsy Society, IEEE, and Apple. A.S. has also received research support from Microsoft, Sony Corporation, NEC Corporation, Pola Chemicals, and Meta and consulting fees from Gideon Health and Suntory Global Innovation Center. L.K.B. has received consulting funds from Boston’s Children’s Hospital, University of Helsinki, AAA Foundation, University of Arizona, and University of British Columbia. A.J.K.P. has received research funding from Versalux and Delos; he is co-founder and co-director of Circadian Health Innovations PTY LTD. C.A.C. reports grants and contracts to Brigham and Women’s Hospital from Axsome Therapeutics, CDC Foundation, City of San Francisco, Dayzz Live Well, Delta Airlines, Jazz Pharmaceuticals PLC Inc, Puget Sound Pilots, and Regeneron Pharmaceuticals/Sanofi during the conduct of the study; reports personal fees from Axsome Therapeutics, Associated Professional Sleep Societies, Bryte Foundation, Clement Law Firm, Institute of Digital Media and Child Development, Klarman Family Foundation, Law Offices of James L Mitchell, Law Office of Yolanda Huang, Massachusetts Medical Society, National Council for Mental Wellbeing, National Sleep Foundation, Puget Sound Pilots, Rabb and Rabb LLC, Segal Law Firm, Shaked Law Firm, P.A., Simpson & Simpson, Tencent Holdings Ltd, Teva Pharma Australia, The Armstrong Firm, PLLC, Vanda Pharmaceuticals Inc, With Deep, Inc., and Zehl Law Firm during the conduct of the study; reports research/education support to Brigham and Women’s Hospital from Abbaszadeh Foundation, Alexandra Drane, Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, Casey Feldman Foundation, Cephalon, DR Capital, Eisai Co., LTD, f.lux Software, LLC, Idorsia Pharmaceuticals LTD, Mary Ann & Stanley Snider via Combined Jewish Philanthropies, Harmony Biosciences LLC, Jazz Pharmaceuticals PLC, Inc, Johnson & Johnson, NeuroCare, Inc., Optum, Peter Brown and Margaret Hamburg, Philips Respironics Inc, Regional Home Care, ResMed Foundation, San Francisco Bar Pilots, Sleep Number Corp., Stuart F. and Diana L. Quan Charitable Fund, Summus, Inc., Takeda Pharmaceutical Co., LTD, Teva Pharmaceuticals Industries Ltd, ResMed, Sanofi, Philips, Vanda Pharmaceuticals, and Whoop, Inc. during the conduct of the study; and is the incumbent of an endowed professorship provided to Harvard University by Cephalon Inc. during the conduct of the study; report serving as an expert witness in legal cases, including those involving Advanced Power Technologies, Aegis Chemical Solutions LLC, Amtrak, Bombardier, Inc., Casper Sleep Inc, C&J Energy Services, Delta Airlines/Comair, Enterprise Rent-A-Car, FedEx, Greyhound Lines, Inc., Puget Sound Pilots, Steel Warehouse, FedEx, Greyhound Lines, Product & Logistics Services LLC, San Francisco Sheriff’s Department, Schlumberger Technology Corp., Union Pacific Railroad, UPS, and Vanda Pharmaceuticals during the conduct of the study; reports having an equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc. during the conduct of the study; and reports receiving royalties from McGraw Hill, Massachusetts Medical Society, and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices during the conduct of the study. C.A.C.: interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. E.B.K.: consulting: American Academy of Sleep Medicine Foundation, Circadian Therapeutics, National Sleep Foundation, Sleep Research Society Foundation, and Yale University Press. Travel support: European Biological Rhythms Society, EPFL Pavilions, Santa Fe Institute, Sleep Research Society, and World Sleep Society. Other: unpaid scientific board member of Chronsulting; partner is founder, director, and chief scientific officer of Chronsulting., (© 2024 The Author(s).)

Objective: This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods: This study used a cross-sectional survey of 19,821 U.S. adults. Results: COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration, and comorbidities, morning chronotype was associated with a higher (adjusted odds ratio [aOR]: 1.15, 95% CI: 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion: Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection., Competing Interests: Conflicts of interest: Dr. Matthew D. Weaver reported consulting fees from Fred Hutchinson Cancer Center, the National Sleep Foundation, and the University of Pittsburgh., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Background: Obstructive sleep apnea is associated with COVID-19 infection. Less clear is whether obstructive sleep apnea is a risk factor for the development of post-acute sequelae of SARS-CoV-2 infection (PASC)., Study Design: Cross-sectional survey of a general population of 24,803 US adults to determine the association of obstructive sleep apnea with PASC., Results: COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence of persistent (>3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models, obstructive sleep apnea was associated with all putative PASC-related symptoms with the highest adjusted odds ratios being fever (2.053) and nervous/anxious (1.939). In 4 logistic regression models of overall PASC derived from elastic net regression, obstructive sleep apnea was associated with PASC (range of adjusted odds ratios: 1.934-2.071); this association was mitigated in those with treated obstructive sleep apnea. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%., Conclusion: In a general population sample, obstructive sleep apnea is associated with the development of PASC-related symptoms and a global definition of PASC. Treated obstructive sleep apnea mitigates the latter risk. The presence of 3 or more PASC symptoms may be useful in identifying cases and for future research., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objectives: We previously reported that during a 45-day simulated space mission, a dynamic lighting schedule (DLS) improved circadian phase alignment and performance assessed once on selected days. This study aimed to evaluate how DLS affected performance on a 5-minute psychomotor vigilance task (PVT) administered multiple times per day on selected days., Methods: Sixteen crewmembers (37.4 ± 6.7 years; 5F) underwent six cycles of 2 × 8-hour/night followed by 5 × 5-hour/night sleep opportunities. During the DLS ( n  = 8), daytime white light exposure was blue-enriched (~6000 K; Level 1: 1079, Level 2: 76 melanopic equivalent daytime illuminance (melEDI) lux) and blue-depleted (~3000-4000 K; L1: 21, L2: 2 melEDI lux) 3 hours before bed. In the standard lighting schedule (SLS; n  = 8), lighting remained constant (~4500K; L1: 284, L2 62 melEDI lux). Effects of lighting condition (DLS/SLS), sleep condition (5/8 hours), time into mission, and their interactions, and time awake on PVT performance were analyzed using generalized linear mixed models., Results: The DLS was associated with fewer attentional lapses (reaction time [RT] > 500 milliseconds) compared to SLS. Lapses, mean RT, and 10% fastest/slowest RTs were worse following 5 compared to 8 hours of sleep but not between lighting conditions. There was an effect of time into mission on RTs, likely due to sleep loss. Overall performance differed by time of day, with longer RTs at the beginning and end of the day. There were more lapses and slower RTs in the afternoon in the SLS compared to the DLS condition., Conclusions: Future missions should incorporate DLS to enhance circadian alignment and performance. This paper is part of the Sleep and Circadian Rhythms: Management of Fatigue in Occupational Settings Collection., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

Study Objectives: To explore the feasibility, effectiveness, and acceptability of an afternoon-evening sleep schedule in older (age 50-65 years) nightshift workers., Methods: We used a three-part strategy: a screening survey to identify individuals who said they could adopt an 8-hour afternoon-evening sleep schedule; a field study where daily diary and actigraphy data were collected during a baseline week and intervention week, with randomization to self-selected sleep, 8-hour afternoon-evening time in bed (TIB), or 8-hour self-selected TIB; and follow-up focus groups to understand the acceptability of the intervention., Results: Gender ( p  < 0.001), Hispanic ethnicity ( p  = 0.023), the care of children ( p  = 0.014), and chronotype ( p  = 0.012), predicted the reported ability to spend 8 hours in bed in the afternoon-evening. Participants assigned to the 8-hour self-selected and 8-hour afternoon-evening groups significantly increased their TIB and sleep duration compared to baseline ( p  < 0.05), while the control group did not. Although spending 8 hours in bed was feasible for the participants during the study, focus group discussions indicated participants would not continue an 8-hour TIB schedule after the study due to family responsibilities and other activities of daily living., Conclusions: Spending 8 hours in bed between successive night shifts, initiated at both a self-selected time and in the afternoon-evening, increased the sleep duration of older shiftworkers, but most would not continue such a schedule on their own. Additional research is needed to find countermeasures for the reduced sleep duration experienced by most shiftworkers that are not only effective, but also compatible with shiftworkers' lifestyles., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

Objectives: Mathematical models of human neurobehavioral performance that include the effects of acute and chronic sleep restriction can be key tools in assessment and comparison of work schedules, allowing quantitative predictions of performance when empirical assessment is impractical., Methods: Using such a model, we tested the hypothesis that resident physicians working an extended duration work roster, including 24-28 hours of continuous duty and up to 88 hours per week averaged over 4weeks, would have worse predicted performance than resident physicians working a rapidly cycling work roster intervention designed to reduce the duration of extended shifts. The performance metric used was attentional failures (ie, Psychomotor Vigilance Task lapses). Model input was 169 actual work and sleep schedules. Outcomes were predicted hours per week during work hours spent at moderate (equivalent to 16-20 hours of continuous wakefulness) or high (equivalent to ≥20 hours of continuous wakefulness) performance impairment., Results: The model predicted that resident physicians working an extended duration work roster would spend significantly more time at moderate impairment (p = .02, effect size=0.2) than those working a rapidly cycling work roster; this difference was most pronounced during the circadian night (p < .001). On both schedules, performance was predicted to decline from weeks 1 + 2 to weeks 3 + 4 (p < .001), but the rate of decline was significantly greater on extended duration work roster (p < .01). Predicted performance impairment was inversely related to prior sleep duration (p < .001)., Conclusions: These findings demonstrate the utility of a mathematical model to evaluate the predicted performance profile of schedules for resident physicians and others who experience chronic sleep restriction and circadian misalignment., Competing Interests: Declaration of conflict of interest Dr. Phillips has received research funding from Versalux and Delos, and he is co-founder and co-director of Circadian Health Innovations PTY LTD. He also holds a patent (US20150080756A1) for estimating arousal states from ambulatory recordings by using sleep and wake models. Dr. St Hilaire has received grant/research support from NIH, NASA, and Merrimack College. Dr. Barger reports honorariums from AAA Foundation, University of Arizona and University of British Columbia. Mr. O’Brien has no COI to report from the past 3 years. Dr. Rahman holds patents for (1) Method and device for preventing alterations in circadian rhythm (U.S. patent application Ser. No. 10/525,958), and (2) Methods and devices for improving sleep performance in subject exposed to light at night (U.S. Application No. 61/810,985); owns equity in Melcort Inc; has provided paid consulting services to Sultan & Knight Limited, Bambu Vault LLC, Lucidity Lighting Inc; and has received honoraria as an invited speaker and travel funds from Starry Skies Lake Superior, University of Minnesota Medical School, PennWell Corp, and Seoul Semiconductor Co Ltd, FALK FOUNDATION E.V.; and has received grant/research support from Seoul Semiconductor Co Ltd, Biological Innovation and Optimization Systems, LLC, Merck & Co, Inc, Pfizer Inc, Vanda Pharmaceuticals Inc, Lighting Science Group, NIH, and NASA. These interests were reviewed and managed by Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Landrigan holds equity in and has consulted with the I-PASS Patient Safety Institute, which seeks to train institutions in best handoff practices and aid in their implementation. In addition, Dr. Landrigan has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety, and has served as an expert witness in cases regarding patient safety and sleep deprivation. Dr. Lockley reports consulting fees from the Hintsa Performance AG, Stantec and View Inc, and has consulting contracts with Absolute Rest, Akili Interactive, Apex 2100 Ltd, Ashurst Risk Advisory, Consumer Sleep Solutions, KBR Wyle Services, Light Cognitive; Lighting Science Group Corporation/HealthE; and Mental Workout/Timeshifter. He has received honoraria and travel or accommodation expenses from Bloxhub, Clifton College, Danish Centre for Lighting, and University of Toronto; and travel or accommodation expenses (no honoraria) from Wiley; and royalties from Monash University and Oxford University Press. He holds equity in iSleep pty. He has received an unrestricted equipment gift and investigator-initiated grant from F. Lux Software LLC, and a Clinical Research Support Agreement and Clinical Trial Agreement with Vanda Pharmaceuticals Inc. He is an unpaid Board Member of the Midwest Lighting Institute (non-profit). He was a Program Leader for the CRC for Alertness, Safety and Productivity, Australia, through an adjunct professor position at Monash University (2015-2019). He is part-time adjunct professor at the University of Surrey, UK. He holds several pending patents (US2019366032A1; USD943612S1; US2021162164A1, US20220151552A1). He has served as a paid expert in legal proceedings related to light, sleep, and health. His interests are reviewed and managed by Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Czeisler reports that he serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc, Philips Respironics, Inc, Optum, and ResMed, Inc; research support to Brigham and Women’s Hospital from Axsome Therapeutics, Inc, Dayzz Ltd, Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc, Takeda Pharmaceutical Co, LTD, Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc, Teva Pharmaceuticals Industries, Ltd, and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc; personal consulting fees from Axsome Therapeutics, Bryte Foundation, With Deep, Inc and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Wellbeing, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the UK Biotechnology and Biological Sciences Research Council. CAC has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc; C&J Energy Services; Dallas Police Association; Delta Airlines/Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc/Motor Coach Industries/FirstGroup America; PAR Electrical Contractors, Inc; Puget Sound Pilots; the San Francisco Sheriff’s Department; Schlumberger Technology Corp; Union Pacific Railroad; United Parcel Service; and Vanda Pharmaceuticals. CAC has received travel support from Merck, Sharpe and Dohme for travel to Japan and Australia; equity interest in Vanda Pharmaceuticals, With Deep, Inc, WHOOP, Inc, and Signos, Inc; and institutional educational gifts to Brigham and Women’s Hospital from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc, Harmony Biosciences LLC, Eisai Co, LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp, Apnimed, Inc, Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, Stuart F. and Diana L. Quan Charitable Fund. Dr. Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. Dr. Klerman reports consulting for the American Academy of Sleep Medicine Foundation, Circadian Therapeutics, National Sleep Foundation, Puerto Rico Science, Technology, and Research Trust, Pfizer Pharmaceuticals, Sanofi-Genzyme, Sleep Research Society Foundation, and Yale University Press; travel support from the DGSM (Germany Sleep Society), EPFL Pavilions, European Biological Rhythms Society, Gordon Research Conference, Santa Fe Research Institute, Sleep Research Society, and World Conference of Chronobiology; and being on the Scientific Advisory Board (unpaid) for Chronsulting. Other: Partner is founder, director, and chief scientific officer of Chronsulting., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: We sought to characterize sleep and mental health, and their relationship, among unpaid caregivers., Methods: During March through August 2022, four waves of cross-sectional surveys were administered to US adults using demographic quota sampling and weighting to improve representativeness of the US adult population., Results: Among 19,767 respondents, 6260 (31.7%) identified as serving one or more unpaid caregiving roles. Compared to people without caregiving roles, caregivers more commonly reported sleep duration outside the healthy range (7-9 hours), insomnia symptoms, diagnosed sleep disorders, and more commonly screened positive for anxiety, depression, and burnout symptoms. Multivariable analyses adjusted for demographics characteristics revealed unpaid caregivers had several-fold elevated odds of adverse mental health symptoms; associations were attenuated but remained significant after adjusting for impaired and nonoptimal sleep., Conclusions: Both sleep and mental health challenges are disproportionately experienced by and commonly co-occur among unpaid caregivers, especially those who care for both children and adults. These populations, which serve critical societal roles, may benefit from enhanced support services to address sleep and mental health., Competing Interests: Declaration of conflicts of interest MÉC reported institutional gifts or grants from the US Centers for Disease Control and Prevention, WHOOP, Inc and HopeLab Foundation and consulting fees from Vanda Pharmaceuticals, Inc and Nychthemeron, LLC. MDW reported institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots; as well as consulting fees from the Fred Hutchinson Cancer Center and the University of Pittsburgh. RR reported consulting fees from Savoir Beds Ltd, Sonesta Hotels International, Castle Hot Springs, Oura Ring Ltd, and One Care Media. SFQ has served as a consultant for Best Doctors, Bryte Foundation, Jazz Pharmaceuticals, and Whispersom. LKB reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots; as well as honorariums from the National Institutes of Occupational Safety and Health, University of Arizona and University of British Columbia. CAC reported receiving grants to support The COVID-19 Outbreak Public Evaluation (COPE) Initiative and grants from Brigham and Women's Physician's Organization during the conduct of the study; being a paid consultant to or speaker for Ganésco, Institute of Digital Media and Child Development, Klarman Family Foundation, M. Davis and Co, Physician's Seal, Samsung Group, State of Washington Board of Pilotage Commissioners, Tencent Holdings, Teva Pharma Australia, and Vanda Pharmaceuticals, in which Dr Czeisler holds an equity interest; receiving travel support from Aspen Brain Institute, Bloomage International Investment Group, UK Biotechnology and Biological Sciences Research Council, Bouley Botanical, Dr Stanley Ho Medical Development Foundation, Illuminating Engineering Society, National Safety Council, Tencent Holdings, and The Wonderful Co; receiving institutional research and/or education support from Cephalon, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Harmony Biosciences, Jazz Pharmaceuticals PLC, Johnson and Johnson, Neurocare, Peter Brown and Margaret Hamburg, Philips Respironics, Regeneron Pharmaceuticals, Regional Home Care, Teva Pharmaceuticals Industries, Sanofi S.A., Optum, ResMed, San Francisco Bar Pilots, Schneider National, Serta, Simmons Betting, Sysco, Vanda Pharmaceuticals; being or having been an expert witness in legal cases, including those involving Advanced Power Technologies; Aegis Chemical Solutions; Amtrak; Casper Sleep; C and J Energy Services; Complete General Construction; Dallas Police Association; Enterprise Rent-A-Car; Steel Warehouse Co; FedEx; Greyhound Lines; Palomar Health District; PAR Electrical, Product, and Logistics Services; Puckett Emergency Medical Services; South Carolina Central Railroad Co; Union Pacific Railroad; UPS; and Vanda Pharmaceuticals; serving as the incumbent of an endowed professorship provided to Harvard University by Cephalon; and receiving royalties from McGraw Hill and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices. Dr Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of-interest policies. Dr Rajaratnam reported receiving institutional consulting fees from CRC for Alertness, Safety, and Productivity; Teva Pharmaceuticals; Vanda Pharmaceuticals; Circadian Therapeutics; BHP Billiton; and Herbert Smith Freehills; receiving grants from Teva Pharmaceuticals and Vanda Pharmaceuticals; and serving as chair for the Sleep Health Foundation outside the submitted work. Dr Howard reports receiving institutional consulting fees from Teva Pharmaceuticals, Biogen and Sanofi; and equipment to support research from Optalert and Philips Respironics outside the submitted work. No other potential conflicts of interest were reported., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to characterize public awareness and opinion regarding resident physician work hours in the United States., Methods: We conducted a nationally representative cross-sectional survey among adults in the United States. Demographic quota-based sampling was conducted by Qualtrics to match 2020 United States Census estimates of age, sex, race, and ethnicity. Descriptive statistics are presented. Hypothesis testing was conducted to identify characteristics associated with agreement with current resident physician work-hour policies., Results: 4763 adults in the United States participated in the study. 97.1% of the public believes that resident physicians should not work 24-hour shifts and 95.6% believe the current 80 hours resident work week is too long. 66.4% of the participants reported that the maximum shift duration should be 12 consecutive hours or fewer, including 22.9% who recommended a maximum shift length of 8 hours. Similarly, 66.4% reported that maximum weekly work hours should be 59 or fewer, including 24.9% who recommended a maximum of 40 weekly work hours., Conclusions: Nearly all US adults disagree with current work-hour policies for resident physicians. Public opinion supports limiting shifts to no more than 12 consecutive hours and weekly work to no more than 60 hours, which is in sharp contrast to current regulations that permit of 28 hours shifts and 80 hours of work per week., Competing Interests: Declaration of Competing Interest The survey was partially supported through funding to our institution from the Centers for Disease Control and Prevention. MDW reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots; as well as consulting fees from the Fred Hutchinson Cancer Center and the University of Pittsburgh. LKB reports institutional support from the US Centers for Disease Control and Prevention, National Institutes of Occupational Safety and Health, Delta Airlines, and the Puget Sound Pilots; as well as honorariums from the National Institutes of Occupational Safety and Health, University of Arizona, and University of British Columbia. CPL reports personal fees and other from I-PASS Patient Safety Institute, personal fees from the Missouri Hospital Association and Executive Speakers Bureau, outside the submitted work; and In addition, Dr Landrigan has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety, and has served as an expert witness in cases regarding patient safety and sleep deprivation. Dr Robbins reports personal fees from Savoir Beds Ltd, Oura Ring Inc, Sonesta Hotels International, Castle Hot Springs, With Deep LLC, and One Care Media. Dr Quan has served as a consultant for Best Doctors, Bryte Foundation, Jazz Pharmaceuticals, and Whispersom. CAC serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc, Philips Respironics, Inc, Optum, and ResMed, Inc; research support to Brigham and Women’s Hospital from Axome Therapeutics, Inc, Dayzz Ltd, Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc, Takeda Pharmaceutical Co, LTD, Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc, Teva Pharmaceuticals Industries, Ltd, and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc; personal consulting fees from Axome, Inc, Bryte Foundation, With Deep, Inc and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Well-being, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the UK Biotechnology and Biological Sciences Research Council. CAC has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc; C&J Energy Services; Dallas Police Association; Delta Airlines and Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc and Motor Coach Industries and FirstGroup America; PAR Electrical Contractors, Inc; Puget Sound Pilots; and the San Francisco Sheriff’s Department; Schlumberger Technology Corp; Union Pacific Railroad; United Parcel Service; Vanda Pharmaceuticals. CAC has received travel support from the Stanley Ho Medical Development Foundation for travel to Macao and Hong Kong; equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc; and institutional educational gifts to Brigham and Women’s Hospital from Johnson and Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc, Harmony Biosciences LLC, Eisai Co, LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp, Apnimed, Inc, Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, Stuart F., and Diana L. Quan Charitable Fund. Dr Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of interest policies., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: The aim of this observational study was to examine sleep obtained between consecutive night shifts from shift workers in their natural environment. The goal was to identify the various sleep strategies and the timing, duration, regularity, and quality of sleep associated with the strategies., Methods: Participants (N = 33, 23 women, aged 40 ± 15years) reported their sleep information in daily diaries over 2weeks while working at least one series of consecutive night shifts. Sleep timing, duration, quality, and regularity were calculated for each sleep episode between consecutive night shifts., Results: Based on the reported sleep behavior, shift workers were categorized as either morning, delayed, split- or mixed sleepers. We found significant differences between the groups in timing of sleep, feeling refreshed, and regularity of sleep between consecutive night shifts, whereas duration and subjective soundness of sleep did not show significant differences., Conclusions: In this sample, four sleep strategies were observed between consecutive night shifts in actual shift workers. These observations may help design future interventions to improve sleep that are individualized to the worker., Competing Interests: Declaration of conflicts of interest The authors have no conflicts of interest to disclose. All authors have approved the final article., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Resident physician work hour limits continue to be controversial. Numerous trials have come to conflicting conclusions about the impact on patient safety of eliminating extended duration work shifts. We conducted meta-analyses to evaluate the impact of work hour policies and work schedules on patient safety. After identifying 8,362 potentially relevant studies and reviewing 688 full-text articles, 132 studies were retained and graded on quality of evidence. Of these, 68 studies provided enough information for consideration in meta-analyses. We found that patient safety improved following implementation of the Accreditation Council for Graduate Medical Education's 2003 and 2011 resident physicians work hour guidelines. Limiting all resident physicians to 80-hour work weeks and 28-hour shifts in 2003 was associated with an 11% reduction in mortality (p < 0.001). Limited shift durations and shorter work weeks were also associated with improved patient safety in clinical trials and observational studies not specifically tied to policy changes. Given the preponderance of evidence showing that patient and physician safety is negatively affected by long work hours, efforts to improve physician schedules should be prioritized. Policies that enable extended-duration shifts and long work weeks should be reexamined. Further research should expand beyond resident physicians to additional study populations, including attending physicians and other health care workers., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Nurses are at a high risk for short sleep duration and poor sleep quality due to irregular work schedules and high occupational stress. Considering the effect of nurses' sleep on the safety and health of themselves and their patients, it is important to promote healthy sleep for nurses. We sought to synthesize the published experimental and quasi-experimental studies that address interventions to improve sleep in nurses. A systematic search was conducted for studies published in English up until May 15, 2023, using the databases PubMed, CINAHL, Academic Search Ultimate, and PsycINFO. In total, 38 articles were included, covering 22 experimental and 16 quasi-experimental studies with sample sizes ranging from 9 to 207. Studies were assessed using the Cochrane Risk of Bias tool and considered as low to medium quality. Thirty-six of the 38 studies reported positive findings for at least one sleep outcome. Intervention types included aroma therapy, dietary supplements, cognitive behavioral therapy, light therapy, mind-body therapy, sleep education, exercise, napping, shift schedule modification, and multicomponent intervention, all of which showed moderate effectiveness in promoting sleep outcomes of nurses. Comparing and contrasting studies on specific interventions for improving sleep in nurses is sparse and often equivocal. With the variations of research methodology and outcome measures, it is difficult to make a conclusion about each intervention's effectiveness on specific sleep outcomes. Additional high-quality research, including randomized controlled trials, is needed to evaluate strategies for improving sleep in this unique, safety-sensitive occupational group., (© 2023 Wiley Periodicals LLC.)

Background: Medical comorbidities increase the risk of severe acute COVID-19 illness. Although sleep problems are common after COVID-19 infection, it is unclear whether insomnia, poor sleep quality, and extremely long or short sleep increase risk of developing COVID-19 infection or hospitalization., Methods: The study used a cross-sectional survey of a diverse sample of 19,926 US adults., Results: COVID-19 infection and hospitalization prevalence rates were 40.1% and 2.9%, respectively. Insomnia and poor sleep quality were reported in 19.8% and 40.1%, respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but excluding participants who reported COVID-19-associated sleep problems, poor sleep quality, but not insomnia, was associated with COVID-19 infection (adjusted odds ratio [aOR] 1.16; 95% CI, 1.07-1.26) and COVID-19 hospitalization (aOR 1.50; 95% CI, 1.18-1.91). In comparison with habitual sleep duration of 7-8 hours, sleep durations <7 hours (aOR 1.14; 95% CI, 1.06-1.23) and sleep duration of 12 hours (aOR 1.61; 95% CI, 1.12-2.31) were associated with increased odds of COVID-19 infection. Overall, the relationship between COVID-19 infection and hours of sleep followed a quadratic (U-shaped) pattern. No association between sleep duration and COVID-19 hospitalization was observed., Conclusion: In a general population sample, poor sleep quality and extremes of sleep duration are associated with greater odds of having had a COVID-19 infection; poor sleep quality was associated with an increased requirement of hospitalization for severe COVID-19 illness. These observations suggest that inclusion of healthy sleep practices in public health messaging may reduce the impact of the COVID-19 pandemic., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Study Objectives: Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination?, Methods: This was a cross-sectional survey of a diverse sample of 15,057 US adults., Results: COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized., Conclusions: In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization., Citation: Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med . 2023;19(7):1303-1311., (© 2023 American Academy of Sleep Medicine.)

Study Objectives: Sleep deficiency can adversely affect the performance of resident physicians, resulting in greater medical errors. However, the impact of sleep deficiency on surgical outcomes, particularly among attending surgeons, is less clear., Methods: Sixty attending surgeons from academic and community departments of surgery or obstetrics and gynecology were studied prospectively using direct observation and self-report to explore the effect of sleep deprivation on patient safety, operating room communication, medical errors, and adverse events while operating under 2 conditions, post-call (defined as > 2 hours of nighttime clinical duties) and non-post-call., Results: Each surgeon contributed up to 5 surgical procedures post-call and non-post-call, yielding 362 cases total (150 post-call and 210 non-post-call). Most common were caesarian section and herniorrhaphy. Hours of sleep on the night before the operative procedure were significantly less post-call (4.98 ± 1.41) vs non-post-call (6.68 ± 0.88, P < .01). Errors were infrequent and not related to hours of sleep or post-call status. However, Non-Technical Skills for Surgeons ratings demonstrated poorer performance while post-call for situational awareness, decision-making, and communication/teamwork. Fewer hours of sleep also were related to lower ratings for situational awareness and decision-making. Decreased self-reported alertness was observed to be associated with increased procedure time., Conclusions: Sleep deficiency in attending surgeons was not associated with greater errors during procedures performed during the next day. However, procedure time was increased, suggesting that surgeons were able to compensate for sleep loss by working more slowly. Ratings on nontechnical surgical skills were adversely affected by sleep deficiency., Citation: Quan SF, Landrigan CP, Barger LK, et al. Impact of sleep deficiency on surgical performance: a prospective assessment. J Clin Sleep Med . 2023;19(4):673-683., (© 2023 American Academy of Sleep Medicine.)

Objective: To determine whether long weekly work hours and shifts of extended duration (≥24 hours) are associated with adverse patient and physician safety outcomes in more senior resident physicians (postgraduate year 2 and above; PGY2+)., Design: Nationwide, prospective cohort study., Setting: United States, conducted over eight academic years (2002-07, 2014-17)., Participants: 4826 PGY2+ resident physicians who completed 38 702 monthly web based reports of their work hours and patient and resident safety outcomes., Main Outcome Measures: Patient safety outcomes included medical errors, preventable adverse events, and fatal preventable adverse events. Resident physician health and safety outcomes included motor vehicle crashes, near miss crashes, occupational exposures to potentially contaminated blood or other bodily fluids, percutaneous injuries, and attentional failures. Data were analysed with mixed effects regression models that accounted for dependence of repeated measures and controlled for potential confounders., Results: Working more than 48 hours per week was associated with an increased risk of self-reported medical errors, preventable adverse events, and fatal preventable adverse events as well as near miss crashes, occupational exposures, percutaneous injuries, and attentional failures (all P<0.001). Working between 60 and 70 hours per week was associated with a more than twice the risk of a medical error (odds ratio 2.36, 95% confidence interval 2.01 to 2.78) and almost three times the risk of preventable adverse events (2.93, 2.04 to 4.23) and fatal preventable adverse events (2.75, 1.23 to 6.12). Working one or more shifts of extended duration in a month while averaging no more than 80 weekly work hours was associated with an 84% increased risk of medical errors (1.84, 1.66 to 2.03), a 51% increased risk of preventable adverse events (1.51, 1.20 to 1.90), and an 85% increased risk of fatal preventable adverse events (1.85, 1.05 to 3.26). Similarly, working one or more shifts of extended duration in a month while averaging no more than 80 weekly work hours also increased the risk of near miss crashes (1.47, 1.32 to 1.63) and occupational exposures (1.17, 1.02 to 1.33)., Conclusions: These results indicate that exceeding 48 weekly work hours or working shifts of extended duration endangers even experienced (ie, PGY2+) resident physicians and their patients. These data suggest that regulatory bodies in the US and elsewhere should consider lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from National Institute for Occupational Safety & Health (NIOSH) within the US Centers for Disease Control and the Agency for Healthcare Research and Quality for the submitted work. LKB reports support from NIOSH, National Heart, Lung, and Blood Institute (NHLBI), Puget Sound Pilots and Delta Airlines, through Brigham and Women’s Hospital and Brigham and Women’s Physician Organization and personal fees from Boston Children’s Hospital, University of Helsinki, and the AAA Foundation. MDW reports grant support from NIOSH, NHLBI, and US CDC, as well as consulting fees from the Fred Hutchinson Cancer Center, National Sleep Foundation, and University of Pittsburgh for activities outside the submitted work. JPS and SQ report no competing interests. CPL reports personal fees and other from I-PASS Patient Safety Institute, personal fees from Missouri Hospital Association/Executive Speakers Bureau, outside the submitted work; CPL has also received monetary awards, honorariums, and travel reimbursement from multiple academic and professional organisations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety, and has served as an expert witness in cases regarding patient safety and sleep deprivation. CAC reports grant support from NIOSH within the US CDC, Agency for HealthCare Research and Quality, and NHLBI. CAC serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon in 2004, which provided institutional support for this work. He has received additional support from Delta Airlines, Jazz Pharmaceuticals, Axome Therapeutics, Philips Respironics Puget Sound Pilots, Regeneron Pharmaceuticals and Sanofi SA, ResMed, Teva Pharmaceuticals Industries, and Vanda Pharmaceuticals. CAC receives royalty payments from Phillips Respironices on sales of the Actiwatch-2 and Actiwatch-Spectrum devices. He has received personal consultancy fees from With Deep and Vanda Pharmaceuticals. CAC has received honorariums from the Associated Professional Sleep Societies, Massachusetts Medical Society, and National Sleep Foundation and travel fees from Stanley Ho Medical Development Foundation and Associated Professional Sleep Societies. CAC has equity interest in Vanda Pharmaceuticals, With Deep, and Signos. CAC is an advisory board member for UK Biotechnology and Biological Sciences Research Council, Institute of Digital Media and Child Development and Klarman Family Foundation. CAC has received educational or research gifts (to Brigham and Women’s Hospital) from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital Management, Harmony Biosciences, Vanda Pharmaceuticals, Eisai, Jazz Pharmaceuticals, Idorsia Pharmaceuticals, Sleep Number, Apnimed, Avadel Pharmaceuticals, Axome Therapeutics, Bryte Foundation, f.lux Software, Stuart F and Diana L Quan Charitable Fund, Casey Feldman Foundation, Roman Catholic Archdiocese of Boston, Summus, Takeda Pharmaceutical, Philips Respironics, Abbaszadeh Foundation, Sharon and John Loeb, CDC Foundation, US CDC, and ResMed. CAC’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of-interest policies., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Later circadian timing of energy intake is associated with higher body fat percentage. Current methods for obtaining accurate circadian timing are labor- and cost-intensive, limiting practical application of this relationship. This study investigated whether the timing of energy intake relative to a mathematically modeled circadian time, derived from easily collected ambulatory data, would differ between participants with a lean or overweight/obesity body fat percentage., Methods: Participants (N = 87) wore a light- and activity-measuring device (actigraph) throughout a cross-sectional 30-day study. For 7 consecutive days within these 30 days, participants used a time-stamped-picture phone application to record energy intake. Body fat percentage was recorded. Circadian time was defined using melatonin onset from in-laboratory collected repeat saliva sampling or using light and activity or activity data alone entered into a mathematical model., Results: Participants with overweight/obesity body fat percentages ate 50% of their daily calories significantly closer to model-predicted melatonin onset from light and activity data (0.61 hours closer) or activity data alone (0.86 hours closer; both log-rank p < 0.05)., Conclusions: Use of mathematically modeled circadian timing resulted in similar relationships between the timing of energy intake and body composition as that observed using in-laboratory collected metrics. These findings may facilitate use of circadian timing in time-based interventions., (© 2022 The Obesity Society.)

Background: The services of Healthcare and Social Assistance (HCSA) workers are needed by society around the clock. As a result, these workers are exposed to shift work and long work hours. The combination of demanding work schedules and other hazards in the HCSA work environment increases the health and safety risks to these workers, as well as to their patients/clients and the public., Methods: This paper has three aims: (1) provide an overview of the burden of shift work, long hours, and related sleep and fatigue problems in this sector; (2) suggest research priorities that would improve these; and (3) discuss potential positive impacts of addressing these research priorities for the health and safety of workers and the public. The authors used a modified Delphi approach to anonymously rank-order priorities for improving HCSA worker health and safety and public safety. Input was also obtained from attendees at the 2019 National Institute for Occupational Safety and Health (NIOSH) Work Hours, Sleep, and Fatigue Forum., Results: The highest rated research priorities were developing better designs for work schedules, and improving the HCSA culture and leadership approaches to shift work and long work hours. Additional priorities are identified., Conclusion: Research in these priority areas has the potential to benefit HCSA workers as well as their patients/clients, employers, and society., (© 2022 Wiley Periodicals LLC.)

Spaceflight exposes crewmembers to circadian misalignment and sleep loss, which impair cognition and increase the risk of errors and accidents. We compared the effects of an experimental dynamic lighting schedule (DLS) with a standard static lighting schedule (SLS) on circadian phase, self-reported sleep and cognition during a 45-day simulated space mission. Sixteen participants (mean age [±SD] 37.4 ± 6.7 years; 5 F; n = 8/lighting condition) were studied in four-person teams at the NASA Human Exploration Research Analog. Participants were scheduled to sleep 8 h/night on two weekend nights, 5 h/night on five weekday nights, repeated for six 7-day cycles, with scheduled waketime fixed at 7:00 a.m. Compared to the SLS where illuminance and spectrum remained constant during wake (~4000K), DLS increased the illuminance and short-wavelength (blue) content of white light (~6000K) approximately threefold in the main workspace (Level 1), until 3 h before bedtime when illuminance was reduced by ~96% and the blue content also reduced throughout (~4000K × 2 h, ~3000K × 1 h) until bedtime. The average (±SE) urinary 6-sulphatoxymelatonin (aMT6s) acrophase time was significantly later in the SLS (6.22 ± 0.34 h) compared to the DLS (4.76 ± 0.53 h) and more variable in SLS compared to DLS (37.2 ± 3.6 min vs. 28.2 ± 2.4 min, respectively, p = .04). Compared to DLS, self-reported sleep was more frequently misaligned relative to circadian phase in SLS RR: 6.75, 95% CI 1.55-29.36, p = .01), but neither self-reported sleep duration nor latency to sleep was different between lighting conditions. Accuracy in the abstract matching and matrix reasoning tests were significantly better in DLS compared to SLS (false discovery rate-adjusted p ≤ .04). Overall, DLS alleviated the drift in circadian phase typically observed in space analog studies and reduced the prevalence of self-reported sleep episodes occurring at an adverse circadian phase. Our results support incorporating DLS in future missions, which may facilitate appropriate circadian alignment and reduce the risk of sleep disruption., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: We evaluated an online Sleep Health and Wellness (SHAW) programme paired with dayzz, a personalised sleep training programme deployed via smartphone application (dayzz app) that promotes healthy sleep and treatment for sleep disorders, among employees at a large healthcare organisation., Design: Open-label, randomised, parallel-group controlled trial., Setting: A healthcare employer in the USA., Participants: 1355 daytime workers., Intervention: Participants were randomised to intervention (n=794) or control (n=561) on consent. Intervention participants received the SHAW educational programme at baseline plus access to the personalised dayzz app for up to 9 months. The control condition received the intervention at month 10., Primary and Secondary Outcome Measures: Our primary outcome measures were sleep-related behavioural changes (eg, consistent sleep schedule); sleep behaviour tracked on an electronic sleep diary and sleep quality. Our secondary outcome measures included employee absenteeism, performance and productivity; stress, mood, alertness and energy; and adverse health and safety outcomes (eg, accidents)., Results: At follow-up, employees in the intervention condition were more likely to report increased sleep duration on work (7.20 vs 6.99, p=0.01) and on free (8.26 vs 8.04, p=0.03) nights. At follow-up, the prevalence of poor sleep quality was lower in the intervention (n=160 of 321, 50%) compared with control (n=184 of 327, 56%) (p=0.04). The mean total dollars lost per person per month due to reduced workplace performance (presenteeism) was less in the intervention condition (US$1090 vs US$1321, p=0.001). Employees in the intervention reported fewer mental health visits (RR 0.72, 95% CI 0.56 to 0.94, p=0.01) and lower healthcare utilisation over the study interval (RR 0.81, 95% CI 0.67 to 0.98, p=0.03). We did not observe differences in stress (4.7 (95% CI 4.6 to 4.8) vs 4.7 (95% CI 4.6 to 4.8)), mood (4.5 (95% CI 4.4 to 4.6) vs 4.6 (95% CI 4.5 to 4.7)), alertness (4.9 (95% CI 4.8 to 5.0) vs 5.0 (95% CI 4.9 to 5.1)) or adverse health and safety outcomes (motor vehicle crashes: OR 0.82 (95% CI 0.34 to 1.9); near-miss crashes: OR=0.89 (95% CI 0.5 to 1.5) and injuries: 0.9 (95% CI 0.6 to 1.3)); energy was higher at follow-up in the intervention group (4.3 vs 4.5; p=0.03)., Conclusions: Results from this trial demonstrate that a SHAW programme followed by access to the digital dayzz app can be beneficial to both the employee and employer., Trial Registration Number: NCT04224285., Competing Interests: Competing interests: MC-Z and LG are employees at dayzz Live Well. MDW reports consulting fees from the National Sleep Foundation and the University of Pittsburgh. LKB reports consulting fees from the University of Helsinki, the AAA Foundation, Puget Sound Pilots, and Boston Children’s Hospital. RR reports consulting fees from SleepCycle AB; Rituals Cosmetics BV; Denihan Hospitality Group; AdventHealth; and With Deep. SFQ has served as a consultant for Best Doctors, the Bryte Foundation, Jazz Pharmaceuticals, and Whispersom. CAC reports grants and contracts to BWH from Dayzz Live Well, Delta Airlines, Jazz Pharma, Puget Sound Pilots, Regeneron Pharmaceuticals/Sanofi; is/was paid consultant/speaker for Inselspital Bern, Institute of Digital Media and Child Development, Klarman Family Foundation, M.D and Co, National Council for Mental Wellbeing, National Sleep Foundation, Physician's Seal, SRS Foundation, State of Washington Board of Pilotage Commissioners, Tencent, Teva Pharma Australia, With Deep, and Vanda Pharmaceuticals, in which CAC holds an equity interest; received travel support from Aspen Brain Institute, Bloomage International Investment Group, Dr. SH Medical Development Foundation, German National Academy of Sciences, Ludwig-Maximilians-Universität München, National Highway Transportation Safety Administration, National Safety Council, National Sleep Foundation, Salk Institute for Biological Studies/Foundation Ipsen, Society for Research on Biological Rhythms, Stanford Medical School Alumni Association, Tencent Holdings, and Vanda Pharmaceuticals; receives research/education gifts through BWH from Arbor Pharmaceuticals, Avadel Pharmaceuticals, Bryte, Alexandra Drane, Cephalon, DR Capital Ltd, Eisai, Harmony Biosciences, Jazz Pharmaceuticals, Johnson & Johnson, Mary Ann & Stanley Snider via Combined Jewish Philanthropies, NeuroCare, Optum, Philips Respironics, Regeneron, Regional Home Care, ResMed, Resnick Foundation (The Wonderful Company), San Francisco Bar Pilots, Sanofi SA, Schneider, Simmons, Sleep Cycle AB. Sleep Number, Sysco, Teva Pharmaceuticals, Vanda Pharmaceuticals; is/was an expert witness in legal cases, including those involving Advanced Power Technologies, Aegis Chemical Solutions, Amtrak; Casper Sleep Inc, C&J Energy Services, Catapult Energy Services Group, Covenant Testing Technologies, Dallas Police Association, Enterprise Rent-A-Car, Espinal Trucking/Eagle Transport Group/Steel Warehouse Inc, FedEx, Greyhound, Pomerado Hospital/Palomar Health District, PAR Electrical Contractors, Product and Logistics Services/Schlumberger Technology, Puckett EMS, Puget Sound Pilots, Union Pacific Railroad, UPS and Vanda Pharmaceuticals; serves as the incumbent of an endowed professorship given to Harvard by Cephalon; and receives royalties from McGraw Hill and Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices. CAC’s interests were reviewed and are managed by the Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict-of-interest policies., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The Antarctic environment presents an extreme variation in the natural light-dark cycle which can cause variability in the alignment of the circadian pacemaker with the timing of sleep, causing sleep disruption, and impaired mood and performance. This study assessed the incidence of circadian misalignment and the consequences for sleep, cognition, and psychological health in 51 over-wintering Antarctic expeditioners (45.6 ± 11.9 years) who completed daily sleep diaries, and monthly performance tests and psychological health questionnaires for 6 months. Circadian phase was assessed via monthly 48-h urine collections to assess the 6-sulphatoxymelatonin (aMT6s) rhythm. Although the average individual sleep duration was 7.2 ± 0.8 h, there was substantial sleep deficiency with 41.4% of sleep episodes <7 h and 19.1% <6 h. Circadian phase was highly variable and 34/50 expeditioners had sleep episodes that occurred at an abnormal circadian phase (acrophase outside of the sleep episode), accounting for 18.8% (295/1565) of sleep episodes. Expeditioners slept significantly less when misaligned (6.1 ± 1.3 h), compared with when aligned (7.3 ± 1.0 h; p < .0001). Performance and mood were worse when awake closer to the aMT6s peak and with increased time awake (all p < .0005). This research highlights the high incidence of circadian misalignment in Antarctic over-wintering expeditioners. Similar incidence has been observed in long-duration space flight, reinforcing the fidelity of Antarctica as a space analog. Circadian misalignment has considerable safety implications, and potentially longer term health risks for other circadian-controlled physiological systems. This increased risk highlights the need for preventative interventions, such as proactively planned lighting solutions, to ensure circadian alignment during long-duration Antarctic and space missions., (© 2022 The Authors. Journal of Pineal Research published by John Wiley & Sons Ltd.)

Circadian adaptation to shifted sleep/wake schedules may be facilitated by optimizing the timing, intensity and spectral characteristics of light exposure, which is the principal time cue for mammalian circadian pacemaker, and possibly by strategically timing nonphotic time cues such as exercise. Therefore, circadian phase resetting by light and exercise was assessed in 44 healthy participants (22 females, mean age [±SD] 36.2 ± 9.2 years), who completed 8-day inpatient experiments simulating night shiftwork, which included either an 8 h advance or 8 h delay in sleep/wake schedules. In the advance protocol (n = 18), schedules were shifted either gradually (1.6 h/day across 5 days) or abruptly (slam shift, 8 h in 1 day and maintained across 5 days). Both advance protocols included a dynamic lighting schedule (DLS) with 6.5 h exposure of blue-enriched white light (704 melanopic equivalent daylight illuminance [melEDI] lux) during the day and dimmer blue-depleted light (26 melEDI lux) for 2 h immediately before sleep on the shifted schedule. In the delay protocol (n = 26), schedules were only abruptly delayed but included four different lighting conditions: (1) 8 h continuous room-light control; (2) 8 h continuous blue-enriched light; (3) intermittent (7 × 15 min pulses/8 h) blue-enriched light; (4) 8 h continuous blue-enriched light plus moderate intensity exercise. In the room-light control, participants received dimmer white light for 30 min before bedtime, whereas in the other three delay protocols participants received dimmer blue-depleted light for 30 min before bedtime. Both the slam and gradual advance protocols induced similar shifts in circadian phase (3.28 h ± 0.37 vs. 2.88 h ± 0.31, respectively, p = .43) estimated by the change in the timing of timing of dim light melatonin onset. In the delay protocol, the continuous 8 h blue-enriched exposure induced significantly larger shifts than the room light control (-6.59 h ± 0.43 vs. -4.74 h ± 0.62, respectively, p = .02). The intermittent exposure induced ~60% of the shift (-3.90 h ± 0.62) compared with 8 h blue-enriched continuous light with only 25% of the exposure duration. The addition of exercise to the 8 h continuous blue-enriched light did not result in significantly larger phase shifts (-6.59 h ± 0.43 vs. -6.41 h ± 0.69, p = .80). Collectively, our results demonstrate that, when attempting to adapt to an 8 h overnight work shift, delay shifts are more successful, particularly when accompanied by a DLS with high-melanopic irradiance light stimulus during wake., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)