Sleep deprivation and fatigue in residency training: Results of a national survey of first- and second-year residents

Study Objectives: To examine the relationship between residents' self-reported sleep hours, work hours, and other empirical correlates. Design: Using the American Medical Association's Graduate Medical Education database, a national, random sample of PGY (postgraduate year) 1 and PGY2 residents in the 1998-1999 training year was surveyed by mail. Measurements and Results: Residents completed a 5-page survey with 44 questions requiring 144 separate responses about their residency experience. Completed surveys were received from 3,604 of 5,616 residents contacted, a 64.2% response rate. Although work hours and sleep hours were significantly correlated (r = -.39), this relationship was less robust than is generally assumed. Total average sleep hours varied across specialties but also within specialties. Just over 20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors. Conclusions: Reduced sleep hours were significantly related to a number of work-related, learning, and personal health variables. Capping residents' work hours is unlikely to fully address the sleep deficits and resulting impairments reported by residents.