1.    Dijk DJ, von Schantz M., Timing and consolidation of human sleep, wakefulness, and performance by a symphony of oscillators. J Biol Rhythms, 2005 Aug;20(4)279-90.

2.    International Classification of Sleep Disorders-2nd edition. American Academy of Sleep Medicine, 2005, 117-136.

3.    Several studies have shown that shift workers are at significantly greater risk of work related accidents and injuries as well as automobile accidents: 

Average number of injuries 2-3 times higher during the first four days of the day and night shift

                             - Chronobiol Int  1990

Rotators twice the odds of falling asleep while driving to/from work and twice the odds of a reported accident or error related to sleepiness

                             - Am J Public Health 1992

Risk of injury 1.82 higher on night shift vs. morning shift self-paced work

                             - Lancet 1994

Distinct circadian pattern of accident frequency was observed

                             - J Occup Med  1991

(Additional studies below)

4.    PRC for light:  Jewett ME, Rimmer DW, Duffy JF, Klerman EB, Kronauer RE, Czeisler CA. Human circadian pacemaker is sensitive to light throughout subjective day without evidence of transients. Am J Physiol. 1997 Nov;273(5 Pt 2):R1800-9.

5.    Entrainment of the Human Circadian System by Light. Duffy, Wright, J Biol Rhythms. 2005 Aug;20(4):326-38.

6.    PRC for melatonin:  A Lewy, Chronobio Int 9(5) 1992)

7.    Melatonin for the blind:  Sack, New England Journal of Medicine, 343, 2000

8.    Additional information on Phase shifting:  Duffy, Kronauer, Czeisler, Phase Shifting In Human Circadian Rhythms Journal of Physiology, 495, 1, 1996. 

9.    Dose response relationship between years of shift work and Heart Disease (504 men, 15 year study) -  Scand J Soc Med Suppl  1989

Coronary heart disease risk 1.51 higher among those working 6 or more years of rotating shifts (79,000 women) -  Circulation 1995

10.  Graveyard shift work associated with increased breast cancer risk (OR 1.6) (n=813 case, n=793 control)  - S Davis et al, J Nat Cancer Inst  93(20)  2001

Night shift work associated with increased breast cancer risk (RR 1.36) (n=78,562) (duration=10yrs) - E Schernhammer et al, J Nat Cancer Inst  93(20)  2001

11.  Various GI problems:

Moore-Ede, Richardson, Annu Rev Med  36, 1985    (Harvard)

Vener et al, Chronobilogia 16(4) 1989        (NIH)

Tuschen et al, Int J Epidemiol 23(2) 1994        (Denmark)

Prunier-Poulmaire  et al, Scand J Work Environ Health 24(3) 1998 (Paris)

12.  Research continues to document evidence supporting this dangerous association in humans, from astronauts to medical interns: 

Odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift, as compared with a shift that was not of extended duration, were 2.3 (95 percent confidence interval, 1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3), respectively.

                                  - Czeisler C, N Engl J Med. 2005

 Documents evidence of significant sleep loss and disruption of circadian rhythms in astronauts and associated performance decrements during several space missions

                                            - Mallis M, Aviat Space Environ Med. 2005

13.  Application of this CR information yields a significant competitive advantage by increasing productivity, decreasing accidents / injuries, decreasing liability, containing costs, and generally optimizing physical and cognitive performance: 

Bunn TL, Slavova S, Struttmann TW, Browning SR, Sleepiness/fatigue and distraction/inattention as factors for fatal versus nonfatal commercial motor vehicle driver injuries. Accid Anal Prev. 2005 Sep;37(5):862-9.

Garbarino S, Mascialino B, Penco MA, Squarcia S, De Carli F, Nobili L, Beelke M, Cuomo G, Ferrillo F.,  Professional shift-work drivers who adopt prophylactic naps can reduce the risk of car accidents during night work.  Sleep. 2004 Nov 1;27(7):1295-302.

Folkard S, Lombardi DA, Tucker PT., Shiftwork: safety, sleepiness and sleep. Ind Health. 2005 Jan;43(1):20-3.

Folkard S, Akerstedt T. Trends in the risk of accidents and injuries and their implications for models of fatigue and performance.  Aviat Space Environ Med. 2004 Mar;75(3 Suppl):A161-7.

Kerin A, Aguirre A. Improving health, safety, and profits in extended hours operations (shiftwork). Ind Health. 2005 Jan;43(1):201-8.

Rajaratnam SM. Legal issues in accidents caused by sleepiness. J Hum Ergol (Tokyo). 2001 Dec;30(1-2):107-11.

Monk TH, Folkard S, Wedderburn AI. Maintaining safety and high performance on shiftwork. Appl Ergon. 1996 Feb;27(1):17-23.

Dijk DJ, Larkin W. Fatigue and performance models: general background and commentary on the circadian alertness simulator for fatigue risk assessment in transportation. Aviat Space Environ Med. 2004 Mar;75(3 Suppl):A119-21.

14.  This link has been documented with disorders such as myocardial infarction, stroke, asthma, seizure disorder, sudden death, and acute aortic dissection, which have all demonstrated diurnal patterns of incidence: 

MI increases by 40%

Cardiac death increases by 29%

Stroke increases by 49%

        - Elliot, Am J Hypertension  14(9 pt 2)  2001

Vtach peaks    

   - Kozar, Pacing Clin Electro 26(3) 2003Acute Aortic Dissection (p<.001)

        - Metha et al, Circulation  106(9)  2002

 Asthma and seizures : common knowledge