To the Editor. —
In the recent article entitled "Sleep Deprivation and Resident Performance,"1 the authors conclude that sleep deprivation associated with an every-other-night on-call schedule does not adversely affect patient care. However, the evidence presented in their article does not support that conclusion.
In making the critical decision to define sleep deprivation by a cutoff point of less than 4 hours' uninterrupted sleep, the authors stated that this is what appears to be the minimum requirement for a beneficial effect on cognitive performance in studies of nonphysicians. If the thrust of their article is that sleep deprivation does not affect cognitive and motor performance of residents, the logical conclusion must be either that the authors' original definition of sleep deprivation is flawed or that physicians are somehow physiologically different from other human beings.
Also, the use of the residents as their own controls is extremely questionable in a
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