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Objective: To test the hypotheses that sleep deprivation in neurology residents is associated with performance deficits and that vigilance and cognitive performance is more compromised after overnight on-call duty compared to night shift. Methods:Thirty-eight neurology residents of a university teaching hospital participated in a prospective single-blind comparison study. Residents were recruited according to their working schedule and divided into 3 groups: 24 hours overnight on-call duty, night shift, and regular day shift (controls). All participants underwent serial measurements of sleepiness and cognitive performance in the morning directly after or before their shift. Pupillary sleepiness test and Paced Auditory Serial Addition Test were applied. Perceived sleepiness was assessed by a questionnaire.Results: Sleepiness was increased in residents after night shift and overnight call compared to controls while the type of night duty was not associated with the extent of sleepiness. Sleepdeprived residents did not show any performance deficits on the Paced Auditory Serial Addition Test. Cognitive performance was not associated with sleepiness measures.Conclusions: Night shift and overnight call duty have a similar impact on alertness in neurology residents. Sleep-deprived neurology residents may be able to overcome sleep loss-related performance difficulties for short periods. Despite recent changes in working schedule regulation for clinicians, long working hours remain a common feature in health care.1-3 Associated sleep deprivation and fatigue present not only a serious concern for patient safety, but also places the health of health care professionals at risk. Serious problems resulting from sleep loss range from performance deficits and erroneous decision making to increased risk for motor vehicle accidents. 2,4The majority of sleepiness studies have been performed in certain medical specialties with a reputation for demanding schedules, such as surgery or intensive care.2 Neurologists are frequently underrated in terms of intensity and heaviness of their working schedules due to their mistakenly close relationship to psychiatry. Call rotation on the neurology ward and night shifts at the neurology intensive care unit are as common as in internal medicine or surgery. Actually, neurologists are frequently challenged by the high prevalence of life-threatening strokes in the Western society, where any delay in action or poor performance may be fatal for the patient.This prompted us to investigate sleepiness and cognitive performance in sleep-deprived and alert neurologists working at a large university neurology clinic. We hypothesized that 1) sleep deprivation in neurologists is associated with performance deficits as previously demonstrated for other