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Sleep Matters Initiative

Improved Sleep Leads to a Healthier Life

Sleep Matters Initiative Research Publications

Sleep and Circadian Principles Impact

Health and Well-Being

Weaver MD, Quan SF, Barger LK, O’Brien CS, Czeisler CA. Whitcomb E. Calculating the Cost of Poor Sleep. This paper details the methodology underlying the National Safety Council Fatigue Cost Calculator: Real Costs of Fatigue in the Workforce.

VoPham T*, Weaver MD*, Vetter C, Hart JE, Tamimi RM, Laden F, Bertrand KA. Circadian misalignment and hepatocellular carcinoma incidence in the United States. Cancer Epidemiology, Biomarkers, and Prevention. 2018. Epub 2018 Apr 11. doi:10.1158/1055-9965.EPI-17-1052. *co-first-author

Phillips AJK, Clerx WM, O'Brien CS, Sano A, Barger LK, Picard RW, Lockley SW, Klerman EB, Czeisler CA. Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing. Sci Rep. 2017 Jun 12;7(1):3216. doi: 10.1038/s41598-017-03171-4. PMID: 28607474

Paruthi S, Brooks LJ, D'Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA,Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. J Clin Sleep Med. 2016;12:1549-61 [Epub ahead of print] 2016 Sep 29. pii: jc-00365-16.

Czeisler, CA. Duration, timing and quality of sleep are each vital for health, performance and safety. Sleep Health: Journal of the National Sleep Foundation, Vol. 1, Issue 1, p5–8. 2015.

Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, Dinges DF, Gangwisch J, Grandner MA, Kushida C, Malhotra RK, Martin JL, Patel SR, Quan SF, Tasali E. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. J Clin Sleep Med 2015; 931-52; Sleep. 2015;38:1161–1183; [Epub ahead of print] 2015 Jul 13. pii: sp-00367-15;

Barger LK, Wright KP Jr, Hughes RJ, Czeisler CA. Daily exercise facilitates phase delays of circadian melatonin rhythm in very dim light. Am J Physiol Regul Integr Comp Physiol. 2004 Jun;286(6):R1077-84. PMID: 15031136

Patient and Occupational Safety

Quan SF, Barger LK, Weaver MD, Czeisler CA. Saving lives or saving dollars: The Trump administration rescinds plans to require sleep apnea testing in commercial transportation operators. Southwest J Pulm Crit Care. 2017;15:84-6. doi:

Liang Y, Horrey WJ, Howard ME, Lee ML, Anderson C, Shreeve MS, O'Brien CS, Czeisler CA. Prediction of drowsiness events in night shift workers during morning driving. Accid Anal Prev. 2017 Nov 7. pii: S0001-4575(17)30391-3. doi: 10.1016/j.aap.2017.11.004. [Epub ahead of print] PMID: 29126462

Quan SF. Screening for obstructive sleep apnea in the transportation industry—the time is now. Southwest J Pulm Crit Care. 2016;13:285-7. doi:

Lee ML, Howard ME, Horrey WJ, Liang Y, Anderson C, Shreeve MS, O'Brien CS, Czeisler CA. High risk of near-crash driving events following night-shift work. Proc Natl Acad Sci U S A. 2016 Jan 5;113(1):176-81. doi: 10.1073/pnas.1510383112. Epub 2015 Dec 22. PMID: 26699470

Quan SF, Barger LK. Brief Review: Sleep Health and Safety for Transportation Workers: A Persistent Problem. Southwest J Pulm Crit Care 2015;10:130-9

Quan SF. Guns and Sleep. Southwest J Pulm Crit Care. 2015; 11:68-9. doi:

Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers. Occ Env Med. 2015; 72(11): 798-804.

Weaver MD, Patterson PD, Fabio A, Moore CG, Freiberg MS, Songer TJ. The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers. Am J Ind Med. 2015; 58(12): 1270-7.

Gordon JA, Alexander EK, Lockley SW, Flynn-Evans E, Venkatan SK, Landrigan CP, Czeisler CA; Harvard Work Hours, Health, and Safety Group (Boston, Massachusetts). Does simulator-based clinical performance correlate with actual hospital behavior? The effect of extended work hours on patient care provided by medical interns. Acad Med. 2010 Oct;85(10):1583-8.

Barger LK, Lockley SW, Rajaratnam SM, Landrigan CP. Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Curr Neurol Neurosci Rep. 2009 Mar;9(2):155-64. Review. PMID: 19268039

Rothschild JM, Keohane CA, Rogers S, Gardner R, Lipsitz SR, Salzberg CA, Yu T, Yoon CS, Williams DH, Wien MF, Czeisler CA, Bates DW, Landrigan CP. Risks of complications by attending physicians after performing nighttime procedures. JAMA. 2009 Oct 14;302(14):1565-72.

Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, Edwards S, Wiedermann BL, Landrigan CP. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008 Mar 1;336(7642):488-91.

Epub 2008 Feb 7. PMID: 18258931

Lockley SW, Barger LK, Ayas NT, Rothschild JM, Czeisler CA, Landrigan CP; Harvard Work Hours, Health and Safety Group. Effects of health care provider work hours and sleep deprivation on safety and performance. Jt Comm J Qual Patient. 2007 Nov;33(11 Suppl):7-18. PMID: 18173162

Sleep Disorders

Barger LK, Rajaratnam SM, Wang W, O'Brien CS, Sullivan JP, Qadri S, Lockley SW, Czeisler CA. Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters. Harvard Work Hours Health and Safety Group. J Clin Sleep Med. 2015 Mar 15;11(3):233-40. doi: 10.5664/jcsm.4534. PMID: 25580602

Crowley KE, Rajaratnam SM, Shea SA, Epstein LJ, Czeisler CA, Lockley SW; Harvard Work Hours, Health and Safety Group. Evaluation of a single-channel nasal pressure device to assess obstructive sleep apnea risk in laboratory and home environments. J Clin Sleep Med. 2013 Feb 1;9(2):109-16.

Barger LK, Ogeil RP, Drake CL, O'Brien CS, Ng KT, Rajaratnam SM. Validation of a questionnaire to screen for shift work disorder. Sleep. 2012 Dec 1;35(12):1693-703. doi: 10.5665/sleep.2246. PMID: 23204612

Rajaratnam SM, Barger LK, Lockley SW, Shea SA, Wang W, Landrigan CP, O'Brien CS, Qadri S, Sullivan JP, Cade BE, Epstein LJ, White DP, Czeisler CA; Harvard Work Hours, Health and Safety Group. Sleep disorders, health, and safety in police officers. JAMA. 2011 Dec 21;306(23):2567-78. doi: 10.1001/jama.2011.1851. PMID: 22187276

Work Hours and Schedule Design

Patterson PD, Runyon MS, Higgins JS, Weaver MD, Teasley EM, Kroemer AJ, Matthews ME, Curtis BR, Flickinger KL, Xun X, Bizhanova Z, Weiss PM, Condle JP, Renn ML, Sequeira DJ, Coppler PJ, Lang ES, Martin-Gill C. Shorter versus longer shift durations to mitigate fatigue and fatigue-related risks in emergency medical services personnel and related shift workers: A systematic review. Prehosp Emerg Care. 2018; DOI: 10.1080/10903127.2017.1376135.

Patterson PD, Weaver MD, Fabio A, Teasley EM, Renn ML, Curtis BR, Matthews ME, Kroemer AJ, Xun X, Bizhanova Z, Weiss PM, Sequeira DJ, Coppler PJ, Lang ES, Higgins JS. Reliability and validity of survey instruments to measure work-related fatigue in the emergency medical services setting: A systematic review. Prehosp Emerg Care. 2018; DOI: 10.1080/10903127.2017.1376134.

Quan SF. Interns Shall Not Sleep: The Duty Hours Boomerang. Southwest J Pulm Crit Care. 2017;14:153-6. doi:

Ftouni S, Sletten TL, Nicholas CL, Kennaway DJ, Lockley SW, Rajaratnam SM. Ocular Measures of Sleepiness Are Increased in Night Shift Workers Undergoing a Simulated Night Shift Near the Peak Time of the 6-Sulfatoxymelatonin Rhythm. J Clin Sleep Med. 2015 Jun 11. pii: jc-00268-14.

Kevat DA, Cameron PA, Davies AR, Landrigan CP, Rajaratnam SW. Safer hours for doctors and improved safety for patients. Med J Aust. 2014 Apr 21;200(7):396-8.

Barger LK, Wright, KP, Jr, Burke, TM, Chinoy, ED, Ronda, JM, Lockley SW, Czeisler CA. Sleep and Cognitive Function of Crewmembers and Mission Controllers Working 24-Hour Shifts During a Simulated 105-day Spaceflight Mission. Acta Astronautica. January 2014 93: 230-242.

Cohen IG, Czeisler CA, Landrigan CP. Making residency work hour rules work. J Law Med Ethics. 2013 Spring;41(1):310-4.

Barger LK, Sullivan JP, Vincent, AS, Fiedler, ER, McKenna, LM, Flynn-Evans, EE, Gilliland, K, Sipes, WE, Smith, PH, Brainard, GC, Lockley SW. Learning To Live on a Martian Day: Fatigue Countermeasures during the Phoenix Mars Lander Mission. 2012. Oct 1; 35(10): 1423-35. PMID: 23024441.

Gordon MB, Sectish TC, Elliott MN, Klein D, Landrigan CP, Bogart LM, Amrock S, Burke A, Chiang VW, Schuster MA. Pediatric residents' perspectives on reducing work hours and lengthening residency: a national survey. 2012 Jul;130(1):99-107.

Blum AB, Shea S, Czeisler CA, Landrigan CP, Leape L. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety. Nat Sci Sleep. 2011 Jun 24;3:47-85.

Blum AB, Raiszadeh F, Shea S, Mermin D, Lurie P, Landrigan CP, Czeisler CA. US public opinion regarding proposed limits on resident physician work hours. BMC Med. 2010 Jun 1;8:33.

Levine AC, Adusumilli J, Landrigan CP. Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review. Sleep. 2010 Aug;33(8):1043-53.

Cappuccio FP, Bakewell A, Taggart FM, Ward G, Ji C, Sullivan JP, Edmunds M, Pounder R, Landrigan CP, Lockley SW, Peile E; Warwick EWTD Working Group. Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. QJM. 2009 Apr;102(4):271-82.

Landrigan CP, Fahrenkopf AM, Lewin D, Sharek PJ, Barger LK, Eisner M, Edwards S, Chiang VW, Wiedermann BL, Sectish TC. Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety. 2008 Aug;122(2):250-8. PMID: 18676540.

Landrigan CP, Czeisler CA, Barger LK, Ayas NT, Rothschild JM, Lockley SW; Harvard Work Hours, Health and Safety Group. Effective implementation of work-hour limits and systemic improvements. Jt Comm J Qual Patient Saf. 2007 Nov;33(11 Suppl):19-29. PMID: 18173163.

Ayas, NT, Barger, LK, Cade BE, Hashimoto, D, Rosner, B, Cronin, JW, Speizer, FE and Czeisler, CA. Extended Work Duration and the Risk of Self-Reported Percutaneous Injuries in Interns. 2006; 296:1055-1062.

Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer FE, Czeisler CA. Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures. PLoS Med. 2006; 3(12):e487.

Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler, CA. Interns’ Compliance with Accreditation Council for Graduate Medical Education Work-Hour Limits. 2006; 296(9):1063-1070.

Lockley SW, Landrigan CP, Barger LK, Czeisler CA. When Policy Meets Physiology: The Challenge of Reducing Resident Work Hours. Clin Orthop Relat Res. 2006; 449:116-127.

Landrigan CP, Lockley SW, Czeisler CA. Effect of intern's consecutive work hours on safety, medical education and professionalism. Crit Care. 2005 Oct 5;9(5):528-30; author reply 528-30. Epub 2005 May 24.

Barger LK, Cade BE, Ayas NT, Cronin JW, Rosner B, Speizer FE, Czeisler CA; Harvard Work Hours, Health, and Safety Group. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005; 352(2):125-34.

Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, Lilly CM, Stone PH, Lockley SW, Bates DW, Czeisler CA. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004 Oct 28;351(18):1838-48.

Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, Rothschild JM, Katz JT, Lilly CM, Stone PH, Aeschbach D, Czeisler CA; Harvard Work Hours, Health and Safety Group. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med. 2004 Oct 28;351(18):1829-37.

Sleep Health and Wellness Programs

Sullivan JP, O'Brien CS, Barger LK, Rajaratnam SM, Czeisler CA, Lockley SW; Harvard Work Hours, Health and Safety Group. Randomized, Prospective Study of the Impact of a Sleep Health Program on Firefighter Injury and Disability. Sleep. 2017 Jan 1;40(1). doi: 10.1093/sleep/zsw001. PMID: 28364446

Quan SF, Ziporyn PS. The Impact of an Online Prematriculation Sleep Course (Sleep 101) on Sleep Knowledge and Behaviors in College Freshmen: A Pilot Study. Southwest J Pulm Crit Care. 2017; 14(4):159-63. doi:

Barger LK, O'Brien CS, Rajaratnam SM, Qadri S, Sullivan JP, Wang W, Czeisler CA, Lockley SW. Implementing a Sleep Health Education and Sleep Disorders Screening Program in Fire Departments: A Comparison of Methodology. J Occup Environ Med. 2016 Jun;58(6):601-9. doi: 10.1097/JOM.0000000000000709. PMID: 27035103

Barger L; Quan SF. A movement to promote healthy sleep: the case for corporate involvement. J Clin Sleep Med. 2013;9(8):739-740. PMID: 23946701

Quan SF, Anderson JL, Hodge GK. Use of a Supplementary Internet Based Education Program Improves Sleep Literacy in College Psychology Students. J Clin Sleep Med. 2013; 9:155-60

Quan SF, Budhiraja R, Parthasarathy S. Healthy Sleep Education—A Salve for Obesity? J Clin Sleep Med. 2010; 6:18-19