Abstract
Everyday experience, knowledge about the physiology and sleep, and research under controlled conditions all suggest that driving ability is impaired by sleepiness. Epidemiological studies attempt to characterize and quantify the association between sleepiness and the risk of crashing under usual driving conditions in real populations, with the overall goal of preventing injuries. All studies are hampered to some degree by methodological challenges that arise from the multi-causal and acute nature of car crashes, and the difficulties of defining and measuring sleepiness in this context.
Despite the challenges, there is considerable evidence that sleepiness and its determinants contribute to car crashes and related injuries. Sleep deprivation, driving at time of circadian impairment, and self-identified sleepiness have been shown to increase risk. The magnitude of the risk cannot be precisely estimated due to heterogeneity in study designs, in populations studied, and in measurement of sleep-related variables. However it appears that risk increases substantially with less than 5 hours sleep in the previous 24 hours and when driving in the early hours of the morning. Some groups in the population are at particular risk, including young adults, shift workers, people with sleep disorders and people driving long distances. The road environment appears to modify the risk associated with sleepiness, with monotony exacerbating the effect. There also appears to be an important interaction of sleepiness with alcohol, even at very modest levels of drinking.
Taken together, the evidence suggests that 15–20% of car crashes may be attributable to driver sleepiness in high income countries, although there is still uncertainty about this.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Dinges D (1995) Overview of sleepiness and accidents. J Sleep Res 4, Suppl 2: 4–14
Brown ID (1994) Driver fatigue. Human Factors 36: 298–314
Expert Panel on Driver Fatigue and Sleepiness (1997) Drowsy Driving and Automobile Crashes. National Center for Sleep Disorders Research/National Highway Traffic Safety Authority, Washington DC
Feyer AM, Williamson A, Friswell R (1997) Balancing work and rest to combat driver fatigue: an investigation of two-up driving in Australia. Accid Anal Prev 29: 541–553
Mitler M, Carskadon M, Czeisler C, Dement W, Dinges D, Graeber R (1988) Castrophes, Sleep and Public Policy: Consensus Report. Sleep 11: 100–109
Roth T, Roehrs T, Carskadon M, Dement W (1994) Daytime sleepiness and alertness. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. WB Saunders, Philadelphia, 40–49
Akerstedt T (1995) Work hours, sleepiness and the underlying mechanisms. J. Sleep Res. 4: 15–22
Dinges D, Kribbs N (1991) Performing while sleepy: effects of experimentally-induced sleepiness. In: T Monk (ed): Sleep, sleepiness and performance. John Wiley & Sons, New York, 98–128
Horne J, Reyner L (1995) Driver Sleepiness. J Sleep Res 4(S2): 23–29
Rosekind MR, Gander PH, Gregory KB, Smith RM, Miller DL, Oyung R, Webbon LL, Johnson JM (1996) Managing fatigue in operational settings. 1: Physiological considerations and countermeasures. Behav Med 21: 157–165
Itoi A, Cilveti R, Voth M, Dantz B, Hyde P, Gupta A, Dement W (1993) Can Drivers Avoid Falling Asleep at the Wheel? Relationship Between Awareness of Sleepiness and Ability to Predict Sleep Onset. AAA Foundation for Traffic Safety, Washington DC
Pack AI, Pack AM, Rodgman E, Cucchiara A, Dinges DF, Schwab CW (1995) Characteristics of crashes attributed to the driver having fallen asleep. Accid Anal and Prev 27: 769–775
Akerstedt T, Gillberg M (1990) Subjective and objective sleepiness in the active individual. Int J Neurosci 52: 29–37
Hoddes E, Dement W, Zarcone V (1972) The history and use of the Stanford Sleepiness Scale. Psychophysiology 9: 150
Hoddes E, Zarcone V, Smythe H, Phillips R, Dement W (1973) Quantification of Sleepiness: A New Approach. Psychophysiology 10: 431–436
Wewers M, Low N (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13: 227–236
Mitler M, Miller J (1996) Methods of testing for sleepiness. Behav Med 21: 171–183
Mitler M, Carrskadon M, Hirshkowitz M (2000) Evaluating Sleepiness. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, Philadelphia, 1251–1257
National Sleep Foundation (2002) Sleep in America Poll. National Sleep Foundation, Washington D.C.
National Sleep Foundation (2005) Sleep in America Poll. National Sleep Foundation, Washington D.C.
Partinen M, Hublin C (2000) Epidemiology of Sleep Disorders. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, Philadelphia, 558–579
D’Alessandro R, Rinaldi R, Cristina E, Gamberini G, Lugaresi E (1995) Prevalence of excessive daytime sleepiness. An open epidemiological problem [letter]. Sleep 18: 389–391
Gallup Organisation (2002) Distracted and drowsy driving attitudes and behaviours 2002. Volume 1. National Highway Traffic Safety Administration, Washington D.C.
National Sleep Foundation (2000) Omnibus Sleep in America Poll. National Sleep Foundation, Washington D.C.
Johns M (1997) Daytime sleepiness and the habits of Australian workers. Sleep 20: 844–849
Maycock G (1995) Driver sleepiness as a factor in car and HGV accidents, Transport Research Laboratory, Berkshire, 39
Benbadis S, Perry M, Sundstad L, Wolgamuth B (1999) Prevalence of daytime sleepiness in a population of drivers. Neurology 52: 209–210
Cummings P, Koepsell T, Moffat J, Rivara F (2001) Drowsiness, counter-measures to drowsiness, and the risk of motor vehicle crash. Injury Prevention 7: 194–199
Connor J, Norton R, Ameratunga S, Robinson E, Wigmore B, Jackson R (2001) Prevalence of driver sleepiness in a random population-based sample of car driving. Sleep 24: 688–694
Gander P, Marshall N, Harris R, Reid P (2005) The Epworth Sleepiness Scale: Influence of Age, Ethnicity, and Socioeconomic Deprivation. Epworth Sleepiness Scores of Adults in New Zealand. Sleep 28: 249–253
Roehrs T, Carskadon M, Dement W (2000) Daytime sleepiness and alertness. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, Philadelphia
Bonnet M (2000) Sleep deprivation. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, Philadelphia
Monk T (2000) Shift Work. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, Philadelphia, 600–605
Gillberg M, Akerstedt T (1997) Sleep loss and time on task. Sleep Research 26: 614
American Thoracic Society (1994) Sleep apnea, sleepiness, and driving risk. Am J Respir Crit Care Med 150: 1463–1473
American Medical Association (1998) Sleepiness, Driving, and Motor Vehicle Crashes. JAMA 279: 1908–1913
Pierce R (1999) Driver sleepiness: occupational screening and the physician’s role. Aust NZ J Med 29: 658–661
Fell DL, Black B (1997) Driver fatigue in the city. Accid Anal Prev 29: 463–469
Hell W, Langwieder K, Sporner A, Zulley J (1997) Driver inattention and other causative factors in fatal highway crashes: 41st Annual Conference of the Association for the Advancement of Automotive Medicine, 424–425
Horne J, Reyner L (1995) Sleep related vehicle accidents. BMJ 6979: 565–567
Maycock G (1996) Sleepiness and driving: the experience of UK car drivers. J Sleep Res 5: 229–237
McCartt A, Ribner S, Pack A, Hammer M (1996) The scope and nature of the drowsy driving problem in New York State. Accid Anal and Prev 28: 511–517
Baker S, O’Neill B, Ginsburg M, Li G (1991) The Injury Fact Book. Oxford University Press
Fell D (1995) The road to fatigue: circumstances leading to fatigue accidents. In: L Hartley (ed): Fatigue and Driving. Taylor and Francis, London, 97–105
Sagberg F (1999) Road accidents caused by drivers falling asleep. Accid Anal Prev 31: 639–649
Summala H, Mikkola T (1994) Fatal accidents among car and truck drivers: effects of fatigue, age, and alcohol consumption. Human Factors 36: 315–326
Arnedt J, Wilde G, Munt P, MacLean A (2001) How do prolonged wakefulness and alcohol compare in the decrements they produce on a simulated driving task? Accid Anal Prev 33: 337–344
Thorne D, Thomas M, Russo M, Sing H, Balkin T, Wesensten N, Redmond D, Johnson D, Welsh A, Rowland L et al (1999) Performance on a driving-simulator divided-attention task during one week of restricted nightly sleep. Sleep 22 (1 Suppl): 306
Thorne D, Thomas M, Sing H, Balkin T, Wesensten N, Hall S, Cephus R, Redmond D, Russo M, Welsh A et al (1998) Driving-simulator accident rates before, during and after one week of restricted nightly sleep. Sleep 21 (suppl 3): 235
Dawson D, Reid K (1997) Fatigue, alcohol and performance impairment. Nature 388: 235
Arnedt J, MacLean A (1999) Simulated driving performance during sleep loss and following alcohol consumption: independent versus combined effects. Sleep 22: 248
Roehrs T, Beare D, Zorisk F, Roth T (1994) Sleepiness and ethanol effects on simulated driving. Alcohol Clin Exp Res 18: 154–158
Alloway C, MacLean A (1999) Night-time simulated driving and on-line judgements of sleepiness/alertness. Sleep 22 (1 Suppl): 90
Reyner L, Horne J (1998) Falling asleep whilst driving: are drivers aware of prior sleepiness. Int J Legal Med 111: 120–123
Lenne M, Triggs T, Redman J (1997) Time of day variations in driving performance. Accid Anal Prev 29: 431–437
Lenne M, Triggs T, Redman J (1998) Interactive effects of sleep deprivation, time of day, and driving experience on a driving task. Sleep 21: 38–44
Moller H, Kayumov L, Bulmash E, Nhan J, Shapiro C (2006) Simulator performance, microsleep episodes, and subjective sleepiness: normative data using convergent methodologies to assess driver drowsiness. J Psychosom Res 61: 335–342
Ingre M, Akerstedt T, Peters B, Anund A, Kecklund G, Pickles A (2006) Subjective sleepiness and accident risk avoiding the ecological fallacy. J Sleep Res 15: 142–148
Findley L, Fabrizio M, Knoght H, Norcross B, Laforte A, Suratt P (1989) Driving simulator performance in patients with sleep apnea. Am Rev Respir Dis 140: 529–530
Philip P, Sagaspe P, Taillard J, Valtat C, Moore N, Akerstedt T, Charles A, Bioulac B (2005) Fatigue, sleepiness, and performance in simulated versus real driving conditions. Sleep 28: 1511–1516
Alsop J, Langley J (2001) Under-reporting of motor vehicle traffic crash victims in New Zealand. Accid Anal Prev 33: 353–359
Connor J (2004) Risk factor identification: the role of epidemiology. In: R McClure, MR Stevenson, S McEvoy (eds): The Scientific Basis of Injury Control. IP Communications Pty Ltd, Melbourne, 125–143
Benichou J (1991) Methods of adjustment for estimating the attributable risk in case-control studies: a review. Stat Med 10: 1753–1773
Connor J, Whitlock G, Norton R, Jackson R (2001) The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accid Anal Prev 33: 31–41
Terán-Santos J, Jiménez-Gömez A, Cordero-Guevara J (1999) The association between sleep apnea and the risk of traffic accidents. N Engl J Med 340: 847–851
Wu H, Yan-Go F (1996) Self-reported automobile accidents involving patients with obstructive sleep apnea. Neurology 46: 1254–1257
Young T, Blustein J, Finn L, Palta M (1997) Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep 20: 608–613
Connor J, Norton R, Ameratunga S, Robinson E, Civil I, Dunn R, Bailey J, Jackson R (2002) Driver sleepiness and the risk of serious injury to car occupants:population based case control study. BMJ 324: 1125–1129
Nabi H, Gueguen A, Chiron M, Lafont S, Zins M, Lagarde E (2006) Awareness of driving while sleepy and road traffic accidents: prospective study in GAZEL cohort. BMJ 333: 75
Philip P, Taillard J, Guilleminault C, Quera Salva M, Bioulac B, Ohayon M (1999) Long distance driving and self-induced sleep deprivation among automobile drivers. Sleep 22: 475–480
George C (2004) Sleep. 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome. Thorax 59: 804–807
Young T, Peppard P, Gottlieb D (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165: 1217–1239
Lockley S, Landrigan C, Barger L, Czeisler C (2006) When policy meets physiology. The challenge of reducing resident working hours. Clinical Orthopaedics and Related Research 449: 116–127
Steele M, Ma O, Watson W, Thomas H, Muelleman R (1999) The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med 6: 1050–1053
Flatley D, Reyner L, Horne J (2004) Sleep related crashes on sections of different road types in the UK (1995–2001). Department for Transport. Road Safety Research Report No. 52, London.
Horne J, Reyner L, Barrett P (2003) Driving impairment due to sleepiness is exacerbated by low alcohol intake. Occup Environ Med 60: 689–692
Barrett P, Horne J, Reyner L (2004) Sleepiness combined with low alcohol intake in women drivers: greater impairment but better perception than men? Sleep 27: 1057–1062
Banks S, Catcheside P, Lack L, Grunstein R, McEvoy R (2004) Low levels of alchol impair driving simulator performance and reduce perception of crash risk in partially sleep deprived subjects. Sleep 27: 1063–1067
Akerstedt T, Connor J, Gray A, Kecklund G (2008) Predicting road crashes from a mathematical model of alertness regulation—The Sleep/Wake predictor. Accid Anal Prev 40: 1480–1485
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2009 Birkhäuser Verlag/Switzerland
About this chapter
Cite this chapter
Connor, J.L. (2009). The role of driver sleepiness in car crashes: a review of the epidemiological evidence. In: Verster, J.C., Pandi-Perumal, S.R., Ramaekers, J.G., de Gier, J.J. (eds) Drugs, Driving and Traffic Safety. Birkhäuser Basel. https://doi.org/10.1007/978-3-7643-9923-8_12
Download citation
DOI: https://doi.org/10.1007/978-3-7643-9923-8_12
Publisher Name: Birkhäuser Basel
Print ISBN: 978-3-7643-9922-1
Online ISBN: 978-3-7643-9923-8
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)