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1. Estimated Sleep Duration Before and During the COVID-19 Pandemic in Major Metropolitan Areas on Different Continents: Observational Study of Smartphone App Data

Author

Robbins, Rebecca, Affouf, Mahmoud, Weaver, Matthew D, Czeisler, Mark É, Barger, Laura K, Quan, Stuart F, and Czeisler, Charles A

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

BackgroundAmid the COVID-19 pandemic, public health policies to curb the spread of SARS-CoV-2 and its associated disease, COVID-19, have resulted in significant alterations to daily routines (eg, work-from-home policies) that may have enabled longer sleep duration among the general population. ObjectiveWe aimed to examine changes in estimated sleep duration in 5 major metropolitan areas before and after the start of the COVID-19 pandemic. MethodsWe conducted a prospective observational study using estimated sleep duration data obtained from a smartphone app. The data were obtained from regular users of the smartphone app before and after the World Health Organization declared COVID-19 a pandemic in March 2020. We compared within-subject estimated sleep duration before and during the COVID-19 pandemic using generalized linear mixed models. ResultsAmong the 2,871,037 observations, 957,022 (33.3%) were from users in London; 549,151 (19.1%) were from users in Los Angeles; 846,527 (29.5%) were from users in New York City; 251,113 (8.7%) were from users in Seoul; and 267,224 (9.3%) were from users in Stockholm. The average age of the users in the sample was 35 years (SE 11 years). Prior to the COVID-19 pandemic, people residing in Seoul had the shortest estimated sleep duration (mean 6 hours 28 minutes, SE 11.6 minutes) and those residing in Stockholm had the longest estimated sleep duration (mean 7 hours 34 minutes, SE 9.9 minutes). The onset of the COVID-19 pandemic was associated with a 13.7 minute increase in estimated sleep duration when comparing March 2019 and March 2020 (95% CI 13.1-14.3, P

Published
2021
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4. Measurement of circulating viral antigens post-SARS-CoV-2 infection in a multicohort study

Author

Abraham, Rachael, Ager, Arijan, Aguilar, Franchesca A., Ahmadi-Izad, Ghazal, Ahmed, Dilshad R., Alvarez, Alicarmen, Anderson, Blake, Asencios, Walter D., Atha, Mary, Beaty, Casey L., Bedi, Brahmchetna, Berry, Jasmine A., Boone, Donchel, Bower, Mary, Bremner, James D., Brent, Corbin, Brown-Smith, Ke'Ara, Bull, Rachel, Bush, Patricia A., Capo, Gustavo, Carl-Igwe, Kelechi, Chitadze, Calista, Chukwumerije, Nachi, Clyburn, Erna, Collins, Shelby, Costello, Julie, Couture, Grace, Craft, Angel, Cribbs, Sushma K., Cui, Xiangqin, Dandy, Annette, Rio, Carlos del, Jasarevic, Rijalda, Detelich, Joshua F., Dixon, Cartia, Dow, Jeanne, Doyle, D'Andrea, Elchommali, Jannah, Ibeawuchi, Carmel, Elsey, Imani, Fineman, Rebecca, Francis, Anyssa G., Franks, Nicole, Gallini, Julia, Gander, Jennifer C., Gray, Natalie, Grimes, Ash, Gutter, Evan, Han, Jenny E., Hang, Tina P., Harding, Jess, Hernandez, Liliana, Hewitt, Lauren N., Holloway, Carla, Hudgins, Alex F., Huerta, Christopher, Ifejika, Cynthia, Ingram, Ketteria D., Javia, Vidhi N., Jeter, Mykayla, Johnson, Brandi, Joseph, Yasha, Juarez, Monica, Kajan, Dana, Khalil, Lana, Kirkpatrick, Caitlin M., Kleinhenz, Dean, Kolailat, Imanii, Koumanelis, Athena, Koumanelis, Alexandra, Kozoman, Rebecca, Krishnan, Shilpa, Lainez, Jordi, Lawrence, Brianna, Lee, Matthew A., Leon, Jose D., Lew, Valerie, Lewis, Kennedy C., Litvack, Matthew, Maroney, Mara, Maier, Cheryl L., Makkaoui, Nour, Marconi, Vincent C., Martin, Christopher F., Martinez, Monica, Mbogo, Loice, McCaslin, Atuarra, McIntyre, Jerrod, Moanna, Abeer, Montoya, Miranda, Morales, Elena, Moran, Caitlin A., Morgan-Billingslea, Jan, Murray, Calista, Nelson, Roslin, Neuman, Robert B., Nguyen, Tran, Ofotokun, Ighovwerha, Ojemakinde, Elizabeth I., Ojoawo, Bukkie, Osinski, Eileen, Oviedo, Sofia, Panganiban, Bernadine, Paredes-Gaitan, Yolanda, Patzer, Rachel E., Pemu, Priscilla, Prude, Michael, Rahman, Kazi, Ramakrishnan, Grace, Rebolledo, Paulina A., Roberts, Marjorie, Robinson, Keysha, Rogers, Chantrice, Rouphael, Nadine G., Searles, Charles, Shah, Anand, Segall, Marni, Shaw, Renata M., Silva, Ruvina, Simpson, Cheryl, Simpson-Derrell, Krystal, Sirajud-Deen, Talib, Smith, Veronica E., Stringer, Andre, Stroud, Jacob, Suthar, Mehul S., Sylber, Cory, Sylvera, Ashley, Tanner, Tehquin, Teunis, Larissa J., Tolbert, Maliya, Thomas, Kodasha M., Thompson, Sierra G., Titanji, Kehmia, Toy, Christopher, Traenkner, Jessica, Truong, Alex, Unterberger, Kristen, Vaccarino, Viola, Varney, Kris, Vyas, Kartavya, Vyas, Kurt, Walker, Tiffany A., Walkow, Max, Wang, Dongli, Wesley, Tamara, Wiley, Zanthia, Wimberly, Erika, Winston, Juton R., Winter, Terra J., Wongtrakool, Cherry, Aikawa, Masanori, Alba, George A., Aung, Taing N., Baden, Lindsey, Baslet, Gaston, Bassett, Ingrid V., Bennett, Lindsey, Bhattacharyya, Shamik, Blazey-Martin, Deborah, Buring, Julie, Cagnina, Rebecca E., Chen, Li Qing, Clark, Cheryl R., Cohen, Pieter, Collier, Ai-Ris, Czeisler, Charles, Duffy, Elizabeth, Estill, Peter, 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Daphne, Juskowich, Joy, Reece, Rebecca, Sarwari, Arif, Aponte-Soto, Lisa, Adams, Dara, Baker, Aileen, Barbera, Sunni, Basu, Sanjib, Bleasdale, Susan, Bolliger, Dawn, Boyd, Andrew D., Boyineni, Jerusha, Breiter, Taylor, Brown, Daniel, Buhimschi, Irina A., Carrithers, Michael D., Certa, Marta, Chalamalla, Rashmika, Chebrolu, Praneeth, Chestek, David, Chessier, Erica, Cook, Judith A., Cranford, Savannah, Curry, Hannah L., Darbar, Dawood, Dasgupta, Raktima, Blakley, Felicia Davis, DeLisa, Julie A., Del Rios, Marina, Diaz, Maya Z., Diviak, Kathleen R., Dixon, Jennifer, Donlon, Meghan F., Donohue, Sarah E., Dworkin, Mark S., Edmonds, Sherrie, Ellison, Angela, Everett, Emily, Flanigan, Clarie, Freedman, Michael B., Gale, Lisa, Gerald, Lynn B., Giles, Wayne H., Gordon, Howard S., Hafner, John, Hammad, Bayan, Hanson, Keith A., Harris, Pastor C., Hartwig, Kimberly, Hasek, Sharon, Hasse, Wendy, Hendrickson, Monica, Hobbs, Brianna, Hryniewicka, Martyna, Hammerl, Savannah, Hutton, Robert, Ibanez, Alejandra L., Illendula, Sai D., Ismail, Nahed, Jain, Akash, Jennette, Kyle J., Kadubek, Grace, Kent, Denise, Kotini-Shah, Pavitra, Kelly, Sara W., Kent, Denise A., Kim, Keri S., Kindred, Elijah, Klein, Jonathan D., Krishnan, Jerry A., Large, Lucia, Lash, James ., Lin, Janet Y., Lu, Jun, Mahamed, Abeer M., Maholovich, Phoebe, Malchenko, Sergey, Martinez, Miriam, Mauntel-Medici, Cammeo, Madineni, Abhigna, McCauley, Mark, Menchaca, Martha, Mermelstein, Robin, Moreno, David J., Morrissy, Liam, Muramatsu, Naoko, Musick, Hugh, Noland, Seth, Norwick, Lourdes, Novak, Richard M., Olds, Lela, Ortiz, Marilyn, Patel, Khushboo, Perez, Nicolas L., Pliskin, Neil H., Pope, Sam, Prabhakar, Bellur S., Prasad, Bharati, Predki, Barbara, Prendergast, Heather M., Quigley, John G., Ramchandran, Ramaswamy, Ramirez, Ana, Rappe, Sarah, Rehman, Jalees, Rolon, Cesar, Rowley, Matthew, Rudraraju, Gowrisree, Rutherfoord, Melissa, Sader, Samer B., Sculley, Jennifer A., Smith-Mack, Jerisha, Swearingen, Peyton, Stewart de Ramirez, Sarah A., Sudhindra, Praveen, Sun, Jun, Tartt, Nancy, Terlinde, Tracy, Thompson, Tiffany, Vanden Hoek, Terry L., Kelly, Sara Warfield, Villanueva, Laura, Welter, Hannah, Woolley, Brittany, Yazici, Cemal, Charney, Alexander W., Kovatch, Patricia, Merad, Miriam, Nadkarni, Girish N., Wisnivesky, Juan P., Aberg, Judith A., Ascolillo, Steven, Assenso, Esther, Bagiella, Emilia, Bartram, Logan, Becker, Jacqueline, Beckmann, Noam D., Bendl, Ashley, Chen, Benjamin K., Civil, Alyssa, Dhar, Kaberi, Evo-Ortega, Lorraine, Fierer, Daniel, Gallagher, Emily J., Garcia-Sastre, Adolfo, Gnjatic, Sacha, Guliyeva, Sabina, Harvey-Ingram, Lori, Herrera-Moreno, Julia, Hill, Matthew, Horowitz, Carol R., Jackson, Rachel, Kastrat, Din, Lala-Trindade, Anu, Lin, Jenny, Macaluso, Nick, Marcon, Kathryn, Meyer, Dara, Morinigo, Janice, Natelson, Benjamin H., Nussenzweig, Maya, Padua, Tiffani, Putrino, David, Quazi, Nawreen, Ramos, Michelle, Richardson, Lynne, Russo, Scott, Seifert, Alan C., Serri, Abdullah, Walker, Jordan, Yee, Michell, Adolphi, Natalie L., Alekhina, Natalya, Archuleta, David A., Barlocker, Jackson, Bateman, Lucinda, Bradfute, Steven B., Brito, Rebecca, Bryan, Tanner W., Buck, Kaitlin E., Davis, Debra, Deakyne Davies, Sara J., Decker, Lauren A., Elifritz, Jamie, Erlandson, Kristine M., Facelli, Julio C., Fudge, Harrison Z., Tran, Huong, Pitch, Chloe, Feuerriegel, Elen M., Ford, Isaac, Friedman, Naomi P., Garcia-Soberanez, Noella D., Gardner, Edward M., Stringham, Caitlyn, Ling, Leah, Gebremariam, Tewodros H., Gentry, Frederick D., Gouripeddi, Ramkiran, Graham, Paige, Gronert, Eve G., Harkins, Michelle S., Hawkins, Kellie L., Hess, Rachel, Johnny, Jace D., Johnson, Brandon M., Jolley, Sarah E., Lloyd, Jennifer, Ludwig, Katelyn R., Martinez, Noah I., McCandless, Sean A., Montoya, Lorenzo A., Oakes, Judy L., Parada, Alisha N., Quinn, Davin K., Raissy, Hengameh, Ramos, Alfredo, Reid, Kayleigh M., Reusch, Jane E., Sheehan, Elyce B., Sokol, Ron J., Treacher, Irena S., Trinity, Joel D., Truong, Dongngan T., West, Shelby C., Molden, Joie, Sharareh, Nasser, Weaver, Lisa J., Spivak, Adam M., Brown, Jeanette P., Shah, Kevin S., Pace, Laura A., Scholand, Mary Beth, Velinder, Matt, Cortez, Melissa, Morimoto, Sarah Shizuko, Vernon, Suzanne D., Lu, Yue, Owen, Megan, Hermansen, Jessica A., Lindsay, Ashton M., Donohue, Dagny K., Garg, Lohit, Wodushek, Thomas, Higgins, Janine, Lockie, Tim, Brightman, Marisa, Thurman, Brook, Powell, Jenny M., Freston, Dylan C., Medina, Juliemar C., Aguirre, Bailee, Anderson, Jeff, Bair, Tami, Bosh, Lindsay, Evans, Lorlie, Garrett, Chase, Harris, Dixie, Herrera, Katherine, Horne, Benjamin D., Juan, James, Knight, Stacey, Knowlton, Kirk, Leither, Lindsay, Maestas, Heather, May, Heidi T., Najarian, Gabriel, Woller, Scott C., Zubal, Shyanne, Jensen, McKenna M., Webb, Tiaura, Iverson, Leslie, Ayache, Mirna, Baloi, Alexis, Barnboym, Emma, Boldt, Nicholas, Bukulmez, Hulya, Chesnick, Hailey, Conrad, Ann, Consolo, Mary, Curtis, Lynette, D’anza, Brian, DiFrancesco, Kathryn, Edminston, Marissa, Eteshola, Ebenezer, Gallagher, Michelle, Gibson, Kelly S., Gordesky, Larraine, Greenwood, Carla, Haghiac, Maricela, Harris, Paul, Hernandez, Carla, Iqbal, Shirin, Kaelber, David C., Kaufman, Elizabeth S., Kennedy, Olivia, Labbato, Danielle, Lengu, Ketrin, Levert, Antonio, Levin, Jennifer, Lowenthal, Rebecca, Mackin, Bridget, Malakooti, Shahdi K., McComsey, Grace A., Minium, Judy, Mouchati, Christian, Oleson, Christine, Pearman, Ann, Hershey, Morgan, Rivera, Amanda, Rodgers, Michael, Rodgers, Theresa, Roy, Arnab, Russ, Kris, Scott, Sarah, Sheth, Niyati, Singer, Nora G., Smith, Beth, Smith, Cheryl, Stancin, Terry, Temple, Daniel, Tribout, Megan, Weinberger, Elisheva, Zhang, David, Zisis, Sokratis N., Atieh, Ornina, Yendewa, George, Baissary, Jhony, Pettinato, KImberly, Lim, Joaquin, Jacob, Joshua, Adams, Cara, Tejani, Viral, Algren, Heather A., Alicic, Radica, Baxter, Joni, Brennan, Conor, Caudill, Antonina, Chen, Peter, Chopra, 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Italia, Infante, Edgar, Johnson, Hillary, Jones, Johnnie, Kellogg, Dean L., Kraig, Ellen, Longoria, Lisa, Nambiar, Anoop M., Okafor, Emeka, Paredes, Claudia C., Patterson, Thomas F., Patterson, Jan E., Pinones, Alexis, Potter, Jennifer S., Reeves, W.B., Saade, George R., Salehi, Marzieh, Scholler, Irma, Seshadri, Sudha, Shah, Dimpy P., Shah, Pankil, Sharma, Kumar, Sharma, Kavita, Soileau, Bridgette, Solis, Pamela, Stoebner, Carmen, Sullivan, Michael, Taylor, Barbara S., Tragus, Robin, Tsevat, Joel, Verduzco-Gutierrez, Monica, Ahuja, Neera, Blish, Catherine A., Blomkalns, Andra L., Bonilla, Hector, Brotherton, Richard, Clinton, Kimberly, Dingankar, Vaidehi, Geng, Linda N., Go, Minjoung, Haddad, Francois, Jagannathan, Prasanna, Jamero, Christopher, Jee, Kathryn, Jia, Xiaolin K., Khurana, Naresh, Kumar, Andre, Maldonado, Yvonne, Miglis, Mitchell G., O'Conor, Ellen, Olszewski, Kelly, Pathak, Divya, Quintero, Orlando, Scott, Jake, Singh, Upinder, Urdaneta, Alfredo E., Utz, Paul J., Varkey, 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Tatapudi, Vasishta, Thawani, Sujata, Thomas, Mary, Thorpe, Lorna, Tom, MeeLee, Treiha, Ethan, Troxel, Andrea, Truong, Jennifer, Udosen, Mmekom, Valencia, Carlos, Velazquez-Perez, Jessica, Vernetti, Patricio M., Vidal, Crystal, Viswanathan, Anand, Willerford, Amy, Williams, Natasha, Wong, Crystal, Wood, Marion J., Wuller, Shannon, Yin, Shonna H., Young, Chloe, Zaretsky, Jonah, Zavlunova, Susanna, Ahirwar, Shreya, Ahmed, Shifa, Ainsworth, Layne L., Atchley-Challenner, Rachel, Avilach, Paul, Balan, Trisha T., Benik, Nicholas, Benoit, Barbara, Bind, Marie-Abèle C., Bonaventura, William J., Boutin, Natalie, Brion, Beverly, Cagan, Andrew, Cai, Tianrun, Cao, Tingyi, Castro, Victor M., Cerretani, Xander R., Chan, James G., Cheng, David, Chibnik, Lori B., Ciriello, Mark, Costenbader, Karen, Dimitrov, Dimitar S., Estiri, Hossein, Fayad, Maria, Feldman, Candace H., Foulkes, Andrea, Gainer, Vivian, Ghosh, Bhaswati, Gollub, Randy, Guan, Zoe, Harris, Alan, Helmer, Karl, Hendrix, Andrew, Holzbach, Ana, Huang, Weixing, Karlson, Elizabeth W., Kaufman, Daniel, Keogh, Diane, Kerr, James D., Klann, Jeffrey G., Krishnamoorthy, Aparna, Lasky-Su, Jessica A., Liao, Katherine P., MacFadden, Doug, Maram, Anupama, Martel, Megan W., Mendis, Michael, Metta, Reeta, Monteiro, Jonathan, Morales, Eduardo, Morse, Richard E., Murphy, Shawn, Nazaire, Marc-Danie, Neils, Gregory, Nguyen, Amber N., Norman, James, Paik, Henry H., Pant, Deepti, Park, HeeKyong, Rabideau, Dustin J., Reeder, Harrison T., Rossi-Roh, Kathleen, Santacroce, Leah M., Schlepphorst, Katherine, Schulte, Carolin, Selvaggi, Caitlin A., Shinnick, Daniel J., Simons, William, Simpson, Lynn A., St. Jean Flanders, Mary L., Strasser, Zachary, Thakrar, Mansi R., Thaweethai, Tanayott, Thorn, Madeleine, Trewett, Philip, Van Fleet, Dustin, Wagholikar, Kavishwar B., Wang, Taowei D., Wattanasin, Nich, Weber, Griffin, Williams, Michael A., Zhang, Ren Zhe, Cicek, Mine, Chang, Nancy, Wirkus, Samantha, Zahnle, Nicole, Flotte, Thomas J., Frisch, Erika, Boysen, Erik M., Welch, Gary, Akintonwa, Teresa, Blancero, Frank, Brown, Heather-Elizabeth, Carmilani, Megan, Cerda, Marta, Clash, Victor H., Copeland, Debra, Hall, Yvonka, kevin kondo, Lerma, Lydia, Lindsay, Jacqui, Marti, Heather, Maughan, Christine, Minor, Tony, Taylor, Brittany, Vincent, Hyatt, Zissis, Mike, Anderson, Brett, Bardhan, Sujata, Castro-Baucom, Leah, Chisolm, Deena, Corchado, Claudia, Damian, April Joy, Daniel, Casey, DasGupta, Soham, Dehority, Walter, Feldman, Candace, Fessel, Josh, Rosas, Lisa Goldman, Horowitz, Carol, Khullar, Dhruv, Lopez, Keila, McDonald Pinkett, Shelly, Myaskovsky, Larissa, Regino, Lidia, St John Thomas, Gelise, Stewart de Ramirez, Sarah, Vangeepuram, Nita, Walden, Anita, Williams, Neely, Yin, Shonna, Burton, Phoebe, Catallozzi, Marina, Clark, Cheryl, Dworetzky, Beth, Edwards, Belinda, Ferrer, Robert L., Judd, Suzanne, Rothman, Russell, Wagner, Laura, Wallace, Ann, Adams, Sonseeahray (Ray), Aragon, Leyna, Bander, Bryan, Bishof, Karyn, Brooks, Gail, Carignan, Etienne, Coombs, Krista, Davis, Hannah, Blakley, Felicia D., Diggs, Marissa, Brown, Heather E., Favors, Umar, Fields, Whitney, Fisher, Liza, Fitzgerald, Megan, Gaffney, Alicia, Witvliet, Margot Gage, Garcia, Roberto, Gustafson, Tyler, Guthe, Nick, Holmes, Verna, Hornig, Mady, Hornig, Maxwell, Jefferson, Wendy, Kochis, Nancy, Kondo, Kevin, Lam, Julie, Lawrence, Fadwa, Letts, Rebecca, Lewis, Juan, Lopez, Silcia, Martinez, Thomas, McCorkell, Lisa, McGrath, Rebecca, Minor, Thomas T., Moore, Charita, Nguyen, Kian, Nichols, Lauren, O'Brien, Lisa, Olson, Holly, Peddie, Aimee, Perlowski, Alice, Lorenzo, Elizabeth P., Prentiss, Lisa, Raytselis, Nadia, Rochez, Nitza, Rockwell, Megan, Rutter, Jacqueline, Seibert, Elle, Sekar, Anisha, Smith, Chimere, Stiles, Lauren, Taylor, Emily, Thompson, Julie, Trapp, Stephen, Valdiva, Stephen, Wilensky, Rochelle, Williams, Melissa, Dawson, Kay W., Wylam, Andrew, Swank, Zoe, Borberg, Ella, Chen, Yulu, Senussi, Yasmeen, Chalise, Sujata, Manickas-Hill, Zachary, Yu, Xu G., Li, Jonathan Z., Alter, Galit, Kelly, J. Daniel, Goldberg, Sarah A., Talla, Aarthi, Li, Xiaojun, Skene, Peter, Bumol, Thomas F., Torgerson, Troy R., Czartoski, Julie L., McElrath, M. Juliana, and Walt, David R.

Published
2024
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14. Desynchronizing the sleep­­–wake cycle from circadian timing to assess their separate contributions to physiology and behaviour and to estimate intrinsic circadian period

Author

Wang, Wei, Yuan, Robin K., Mitchell, Jude F., Zitting, Kirsi-Marja, St. Hilaire, Melissa A., Wyatt, James K., Scheer, Frank A. J. L., Wright, Jr, Kenneth P., Brown, Emery N., Ronda, Joseph M., Klerman, Elizabeth B., Duffy, Jeanne F., Dijk, Derk-Jan, and Czeisler, Charles A.

Published
2023
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16. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts

Author

Landrigan, Christopher P, Rahman, Shadab A, Sullivan, Jason P, Vittinghoff, Eric, Barger, Laura K, Sanderson, Amy L, Wright, Kenneth P, O'Brien, Conor S, Qadri, Salim, St Hilaire, Melissa A, Halbower, Ann C, Segar, Jeffrey L, McGuire, John K, Vitiello, Michael V, de la Iglesia, Horacio O, Poynter, Sue E, Yu, Pearl L, Zee, Phyllis C, Lockley, Steven W, Stone, Katie L, and Czeisler, Charles A

Subjects
Clinical Trials and Supportive Activities, Patient Safety, Clinical Research, Prevention, Cross-Over Studies, Humans, Intensive Care Units, Pediatric, Internship and Residency, Medical Errors, Personnel Staffing and Scheduling, Psychomotor Performance, Sleep, Time Factors, Work Schedule Tolerance, Workload, ROSTERS Study Group, Medical and Health Sciences, General & Internal Medicine
Abstract

BackgroundThe effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial.MethodsWe conducted a multicenter, cluster-randomized, crossover trial comparing two schedules for pediatric resident physicians during their intensive care unit (ICU) rotations: extended-duration work schedules that included shifts of 24 hours or more (control schedules) and schedules that eliminated extended shifts and cycled resident physicians through day and night shifts of 16 hours or less (intervention schedules). The primary outcome was serious medical errors made by resident physicians, assessed by intensive surveillance, including direct observation and chart review.ResultsThe characteristics of ICU patients during the two work schedules were similar, but resident physician workload, described as the mean (±SD) number of ICU patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2). Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P

Published
2020

17. Design and recruitment of the randomized order safety trial evaluating resident-physician schedules (ROSTERS) study

Author

Blackwell, Terri, Kriesel, Dana R, Vittinghoff, Eric, O'Brien, Conor S, Sullivan, Jason P, Viyaran, Natalie C, Rahman, Shadab A, Lockley, Steven W, Barger, Laura K, Halbower, Ann C, Poynter, Sue E, Wright, Kenneth P, Yu, Pearl L, Zee, Phyllis C, Landrigan, Christopher P, Czeisler, Charles A, Stone, Katie L, and Group, for the ROSTERS Study

Subjects
Health Services and Systems, Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Trials and Supportive Activities, Prevention, Clinical Research, Patient Safety, Adult, Cross-Over Studies, Female, Health Services Research, Humans, Internship and Residency, Male, Medical Errors, Outcome Assessment, Health Care, Personnel Staffing and Scheduling, Work Performance, Work Schedule Tolerance, Randomized, Sleep, Work hours, Medical errors, Pediatric intensive care unit, Patient safety, ROSTERS Study Group, Medical and Health Sciences, General Clinical Medicine, Public Health, Biomedical and clinical sciences, Health sciences
Abstract

IntroductionWhile the Accreditation Council for Graduate Medical Education limited first year resident-physicians to 16 consecutive work hours from 2011 to 2017, resident-physicians in their second year or higher were permitted to work up to 28 h consecutively. This paper describes the Randomized Order Safety Trial Evaluating Resident-physician Schedules (ROSTERS) study, a clustered-randomized crossover clinical trial designed to evaluate the effectiveness of eliminating traditional shifts of 24 h or longer for second year or higher resident-physicians in pediatric intensive care units (PICUs).MethodsROSTERS was a multi-center non-blinded trial in 6 PICUs at US academic medical centers. The primary aim was to compare patient safety between the extended duration work roster (EDWR), which included shifts ≥24 h, and a rapidly cycling work roster (RCWR), where shifts were limited to a maximum of 16 h. Information on potential medical errors was gathered and used for classification by centrally trained physician reviewers who were blinded to the study arm. Secondary aims were to assess the relationship of the study arm to resident-physician sleep duration, work hours and neurobehavioral performance.ResultsThe study involved 6577 patients with a total of 38,821 patient days (n = 18,749 EDWR, n = 20,072 RCWR). There were 413 resident-physician rotations included in the study (n = 203 EDWR, n = 210 RCWR). Resident-physician questionnaire data were over 95% complete.ConclusionsResults from data collected in the ROSTERS study will be evaluated for the impact of resident-physician schedule roster on patient safety outcomes in PICUs, and will allow for examination of a number of secondary outcome measures. ClinicalTrials.gov Identifier: NCT02134847.

Published
2019

18. Sleep disorders, depression and anxiety are associated with adverse safety outcomes in healthcare workers: A prospective cohort study

Author

Weaver, Matthew D, Vetter, Céline, Rajaratnam, Shantha MW, O’Brien, Conor S, Qadri, Salim, Benca, Ruth M, Rogers, Ann E, Leary, Eileen B, Walsh, James K, Czeisler, Charles A, and Barger, Laura K

Subjects
Biomedical and Clinical Sciences, Prevention, Behavioral and Social Science, Patient Safety, Sleep Research, Mental Health, Brain Disorders, Clinical Research, Health Services, Depression, Mental health, Good Health and Well Being, Accidents, Traffic, Adult, Anxiety, Cohort Studies, Female, Health Personnel, Humans, Male, Middle Aged, Prospective Studies, Shift Work Schedule, Sleep Wake Disorders, Surveys and Questionnaires, mental health, occupational safety, sleep-wake disorders, Medical and Health Sciences, Psychology and Cognitive Sciences, Neurology & Neurosurgery, Biomedical and clinical sciences, Psychology
Abstract

The objective of the study was to determine if sleep disorder, depression or anxiety screening status was associated with safety outcomes in a diverse population of hospital workers. A sample of shift workers at four hospitals participated in a prospective cohort study. Participants were screened for five sleep disorders, depression and anxiety at baseline, then completed prospective monthly surveys for the next 6 months to capture motor vehicle crashes, near-miss crashes, occupational exposures and medical errors. We tested the associations between sleep disorders, depression and anxiety and adverse safety outcomes using incidence rate ratios adjusted for potentially confounding factors in a multivariable negative binomial regression model. Of the 416 hospital workers who participated, two in five (40.9%) screened positive for a sleep disorder and 21.6% screened positive for depression or anxiety. After multivariable adjustment, screening positive for a sleep disorder was associated with 83% increased incidence of adverse safety outcomes. Screening positive for depression or anxiety increased the risk by 63%. Sleep disorders and mood disorders were independently associated with adverse outcomes and contributed additively to risk. Our findings suggest that screening for sleep disorders and mental health screening can help identify individuals who are vulnerable to adverse safety outcomes. Future research should evaluate sleep and mental health screening, evaluation and treatment programmes that may improve safety.

Published
2018

23. Accuracy of Three Commercial Wearable Devices for Sleep Tracking in Healthy Adults.

Author

Robbins, Rebecca, Weaver, Matthew D., Sullivan, Jason P., Quan, Stuart F., Gilmore, Katherine, Shaw, Samantha, Benz, Abigail, Qadri, Salim, Barger, Laura K., Czeisler, Charles A., and Duffy, Jeanne F.

Subjects
SLEEP duration, APPLE Watch, SLEEP stages, SLEEP disorders, SLEEP
Abstract

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. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Association of Chronotype and Shiftwork with COVID-19 Infection

Author

Quan, Stuart F., primary, Weaver, Matthew D., additional, Czeisler, Mark É., additional, Barger, Laura K., additional, Booker, Lauren A., additional, Howard, Mark E., additional, Jackson, Melinda L., additional, Lane, Rashon I., additional, McDonald, Christine F., additional, Ridgers, Anna, additional, Robbins, Rebecca, additional, Varma, Prerna, additional, Rajaratnam, Shantha M.W., additional, and Czeisler, Charles A., additional

Published
2024
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35. List of contributors

Author

Adams, Elizabeth, primary, Bai, Liu, additional, Bakour, Chighaf, additional, Birkland, Thomas A., additional, Buran, Meghan N., additional, Buxton, Orfeu Marcello, additional, Buysse, Daniel J., additional, Czeisler, Charles A., additional, Dautovich, Natalie D., additional, Donskoy, Innessa, additional, Dzierzewski, Joseph M., additional, Fu, Ying-Hui, additional, Gentry, Nicholas, additional, Hale, Lauren, additional, Hall, Martica H., additional, Jackson, Chandra L., additional, Johnson, Dayna A., additional, Knutson, Kristen L., additional, Leser, Kendall A., additional, Lubas, Margaret M., additional, MacPherson, Ashley, additional, Mukundan, Tanvi, additional, Nieto, F. Javier, additional, Petersen, Donna J., additional, Ptacek, Louis, additional, Samet, Jonathan M., additional, Sheldon, Stephen H., additional, Shochat, Tamar, additional, Simonelli, Guido, additional, Szklo-Coxe, Mariana, additional, Teti, Douglas Michael, additional, Trosman, Irina, additional, and Wallace, Meredith L., additional

Published
2022
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38. The Effect of a Dynamic Lighting Schedule on Neurobehavioral Performance During a 45-Day Simulated Space Mission

Author

Grant, Leilah, Kent, Brianne, Rahman, Shadab, St Hilaire, Melissa, Kirkley, Crystal, Gregory, Kevin, Clark, Toni, Hanifin, John, Barger, Laura, Czeisler, Charles, Brainard, George, Lockley, Steven, Flynn-Evans, Erin, Grant, Leilah, Kent, Brianne, Rahman, Shadab, St Hilaire, Melissa, Kirkley, Crystal, Gregory, Kevin, Clark, Toni, Hanifin, John, Barger, Laura, Czeisler, Charles, Brainard, George, Lockley, Steven, and Flynn-Evans, Erin

Abstract

Study Objective: 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. 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 t

Published
2024

39. Time of Day and Sleep Deprivation Effects on Risky Decision Making.

Author

Ruiz-Herrera, Noelia, Friedman, Mia, St. Hilaire, Melissa A., Arrona-Palacios, Arturo, Czeisler, Charles A., and Duffy, Jeanne F.

Subjects
SLEEP deprivation, DECISION making, TASK performance, MONETARY incentives, CIRCADIAN rhythms, PUNISHMENT
Abstract

Previous research has revealed that daily variations in human neurobehavioral functions are driven in part by the endogenous circadian system. The objective of this study was to explore whether there exists a circadian influence on performance regarding a risky decision-making task and to determine whether the performance changes with sleep deprivation (SD). Thirteen participants underwent a 39 h constant routine (CR) protocol, during which they remained awake in constant conditions and performed the BART (balloon analogue risk task) every two hours. The mean pumps (gains) (p < 0.001) and balloons popped (losses) (p = 0.003) exhibited variation during the CR. The reaction time (RT) also showed significant variation across the CR (p < 0.001), with slower mean RTs in the morning hours following SD. A greater risk propensity was observed around midday before SD and a lower risk propensity after 29.5 h of being awake. The sensitivity to punishment varied during the CR, but did not follow a predictable trend. Further research using real monetary incentives and neurophysiological measures is warranted to elucidate these findings. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes

Author

Burks, Stephen V, Anderson, Jon E, Bombyk, Matthew, Haider, Rebecca, Ganzhorn, Derek, Jiao, Xueyang, Lewis, Connor, Lexvold, Andrew, Liu, Hong, Ning, Jiachen, Toll, Alice, Hickman, Jeffrey S, Mabry, Erin, Berger, Mark, Malhotra, Atul, Czeisler, Charles A, and Kales, Stefanos N

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Prevention, Clinical Research, Sleep Research, Lung, Good Health and Well Being, Accidents, Traffic, Adult, Automobile Driving, Female, Humans, Male, Mandatory Programs, Mass Screening, Middle Aged, Motor Vehicles, Occupational Health Services, Patient Compliance, Polysomnography, Retrospective Studies, Risk Factors, Sleep Apnea, Obstructive, Young Adult, APAP, commercial motor vehicle operator, CPAP, motor carrier, obstructive sleep apnea, OSA, preventable crash, PSG, screening, truckload, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Neurology & Neurosurgery, Biological sciences, Biomedical and clinical sciences, Psychology
Abstract

Study objectivesTo evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes.MethodsData are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: "Full Adherence" (n = 682), "Partial Adherence" (n = 571), or "No Adherence" (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed.ResultsAfter the matching date, "No Adherence" cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of "Full Adherence" cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles).ConclusionsNontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private.CommentaryA commentary on this article appears in this issue on page 961.

Published
2016

44. Circadian protein expression patterns in healthy young adults

Author

Specht, Adrien, primary, Kolosov, German, additional, Cederberg, Katie L.J., additional, Bueno, Flavia, additional, Arrona-Palacios, Arturo, additional, Pardilla-Delgado, Enmanuelle, additional, Ruiz-Herrera, Noelia, additional, Zitting, Kirsi-Marja, additional, Kramer, Achim, additional, Zeitzer, Jamie M., additional, Czeisler, Charles A., additional, Duffy, Jeanne F., additional, and Mignot, Emmanuel, additional

Published
2023
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45. Impact of Sleep and Circadian Disruption on Energy Balance and Diabetes: A Summary of Workshop Discussions

Author

Arble, Deanna M, Bass, Joseph, Behn, Cecilia Diniz, Butler, Matthew P, Challet, Etienne, Czeisler, Charles, Depner, Christopher M, Elmquist, Joel, Franken, Paul, Grandner, Michael A, Hanlon, Erin C, Keene, Alex C, Joyner, Michael J, Karatsoreos, Ilia, Kern, Philip A, Klein, Samuel, Morris, Christopher J, Pack, Allan I, Panda, Satchidananda, Ptacek, Louis J, Punjabi, Naresh M, Sassone-Corsi, Paolo, Scheer, Frank A, Saxena, Richa, Seaquest, Elizabeth R, Thimgan, Matthew S, Van Cauter, Eve, and Wright, Kenneth P

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Obesity, Nutrition, Lung, Neurosciences, Diabetes, Sleep Research, Metabolic and endocrine, Age of Onset, Animals, Circadian Rhythm, Diabetes Mellitus, Endophenotypes, Energy Metabolism, Fasting, Food Deprivation, Glucose, Homeostasis, Humans, Insulin, Metabolic Syndrome, Mice, Sleep, Sleep Apnea, Obstructive, Sleep Disorders, Circadian Rhythm, Time Factors, circadian disruption, circadian rhythm, diabetes, insulin resistance, metabolism, obesity, short sleep, sleep apnea, sleep disorders, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Neurology & Neurosurgery, Biological sciences, Biomedical and clinical sciences, Psychology
Abstract

A workshop was held at the National Institute for Diabetes and Digestive and Kidney Diseases with a focus on the impact of sleep and circadian disruption on energy balance and diabetes. The workshop identified a number of key principles for research in this area and a number of specific opportunities. Studies in this area would be facilitated by active collaboration between investigators in sleep/circadian research and investigators in metabolism/diabetes. There is a need to translate the elegant findings from basic research into improving the metabolic health of the American public. There is also a need for investigators studying the impact of sleep/circadian disruption in humans to move beyond measurements of insulin and glucose and conduct more in-depth phenotyping. There is also a need for the assessments of sleep and circadian rhythms as well as assessments for sleep-disordered breathing to be incorporated into all ongoing cohort studies related to diabetes risk. Studies in humans need to complement the elegant short-term laboratory-based human studies of simulated short sleep and shift work etc. with studies in subjects in the general population with these disorders. It is conceivable that chronic adaptations occur, and if so, the mechanisms by which they occur needs to be identified and understood. Particular areas of opportunity that are ready for translation are studies to address whether CPAP treatment of patients with pre-diabetes and obstructive sleep apnea (OSA) prevents or delays the onset of diabetes and whether temporal restricted feeding has the same impact on obesity rates in humans as it does in mice.

Published
2015

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