Advertisement

The role of driver sleepiness in car crashes: a review of the epidemiological evidence

  • Jennie L. Connor

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.

Keywords

Sleep Debt Driver Sleepiness Accid Anal KDYH EHHQ DVVRFLDWHG ZLWK 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dinges D (1995) Overview of sleepiness and accidents. J Sleep Res 4, Suppl 2: 4–14Google Scholar
  2. 2.
    Brown ID (1994) Driver fatigue. Human Factors 36: 298–314PubMedGoogle Scholar
  3. 3.
    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 DCGoogle Scholar
  4. 4.
    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: 541–553PubMedCrossRefGoogle Scholar
  5. 5.
    Mitler M, Carskadon M, Czeisler C, Dement W, Dinges D, Graeber R (1988) Castrophes, Sleep and Public Policy: Consensus Report. Sleep 11: 100–109PubMedGoogle Scholar
  6. 6.
    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, 40–49Google Scholar
  7. 7.
    Akerstedt T (1995) Work hours, sleepiness and the underlying mechanisms. J. Sleep Res. 4: 15–22PubMedCrossRefGoogle Scholar
  8. 8.
    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, 98–128Google Scholar
  9. 9.
    Horne J, Reyner L (1995) Driver Sleepiness. J Sleep Res 4(S2): 23–29PubMedCrossRefGoogle Scholar
  10. 10.
    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: 157–165PubMedGoogle Scholar
  11. 11.
    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 DCGoogle Scholar
  12. 12.
    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: 769–775CrossRefGoogle Scholar
  13. 13.
    Akerstedt T, Gillberg M (1990) Subjective and objective sleepiness in the active individual. Int J Neurosci 52: 29–37PubMedCrossRefGoogle Scholar
  14. 14.
    Hoddes E, Dement W, Zarcone V (1972) The history and use of the Stanford Sleepiness Scale. Psychophysiology 9: 150Google Scholar
  15. 15.
    Hoddes E, Zarcone V, Smythe H, Phillips R, Dement W (1973) Quantification of Sleepiness: A New Approach. Psychophysiology 10: 431–436PubMedCrossRefGoogle Scholar
  16. 16.
    Wewers M, Low N (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13: 227–236PubMedCrossRefGoogle Scholar
  17. 17.
    Mitler M, Miller J (1996) Methods of testing for sleepiness. Behav Med 21: 171–183PubMedGoogle Scholar
  18. 18.
    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, 1251–1257Google Scholar
  19. 19.
    National Sleep Foundation (2002) Sleep in America Poll. National Sleep Foundation, Washington D.C.Google Scholar
  20. 20.
    National Sleep Foundation (2005) Sleep in America Poll. National Sleep Foundation, Washington D.C.Google Scholar
  21. 21.
    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, 558–579Google Scholar
  22. 22.
    D’Alessandro R, Rinaldi R, Cristina E, Gamberini G, Lugaresi E (1995) Prevalence of excessive daytime sleepiness. An open epidemiological problem [letter]. Sleep 18: 389–391PubMedGoogle Scholar
  23. 23.
    Gallup Organisation (2002) Distracted and drowsy driving attitudes and behaviours 2002. Volume 1. National Highway Traffic Safety Administration, Washington D.C.Google Scholar
  24. 24.
    National Sleep Foundation (2000) Omnibus Sleep in America Poll. National Sleep Foundation, Washington D.C.Google Scholar
  25. 25.
    Johns M (1997) Daytime sleepiness and the habits of Australian workers. Sleep 20: 844–849PubMedGoogle Scholar
  26. 26.
    Maycock G (1995) Driver sleepiness as a factor in car and HGV accidents, Transport Research Laboratory, Berkshire, 39Google Scholar
  27. 27.
    Benbadis S, Perry M, Sundstad L, Wolgamuth B (1999) Prevalence of daytime sleepiness in a population of drivers. Neurology 52: 209–210PubMedGoogle Scholar
  28. 28.
    Cummings P, Koepsell T, Moffat J, Rivara F (2001) Drowsiness, counter-measures to drowsiness, and the risk of motor vehicle crash. Injury Prevention 7: 194–199PubMedCrossRefGoogle Scholar
  29. 29.
    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: 688–694PubMedGoogle Scholar
  30. 30.
    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: 249–253PubMedGoogle Scholar
  31. 31.
    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, PhiladelphiaGoogle Scholar
  32. 32.
    Bonnet M (2000) Sleep deprivation. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, PhiladelphiaGoogle Scholar
  33. 33.
    Monk T (2000) Shift Work. In: M Kryger, T Roth, W Dement (eds): Principles and Practice of Sleep Medicine. W.B. Saunders, Philadelphia, 600–605Google Scholar
  34. 34.
    Gillberg M, Akerstedt T (1997) Sleep loss and time on task. Sleep Research 26: 614Google Scholar
  35. 35.
    American Thoracic Society (1994) Sleep apnea, sleepiness, and driving risk. Am J Respir Crit Care Med 150: 1463–1473Google Scholar
  36. 36.
    American Medical Association (1998) Sleepiness, Driving, and Motor Vehicle Crashes. JAMA 279: 1908–1913CrossRefGoogle Scholar
  37. 37.
    Pierce R (1999) Driver sleepiness: occupational screening and the physician’s role. Aust NZ J Med 29: 658–661Google Scholar
  38. 38.
    Fell DL, Black B (1997) Driver fatigue in the city. Accid Anal Prev 29: 463–469PubMedCrossRefGoogle Scholar
  39. 39.
    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, 424–425Google Scholar
  40. 40.
    Horne J, Reyner L (1995) Sleep related vehicle accidents. BMJ 6979: 565–567Google Scholar
  41. 41.
    Maycock G (1996) Sleepiness and driving: the experience of UK car drivers. J Sleep Res 5: 229–237PubMedCrossRefGoogle Scholar
  42. 42.
    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: 511–517CrossRefGoogle Scholar
  43. 43.
    Baker S, O’Neill B, Ginsburg M, Li G (1991) The Injury Fact Book. Oxford University PressGoogle Scholar
  44. 44.
    Fell D (1995) The road to fatigue: circumstances leading to fatigue accidents. In: L Hartley (ed): Fatigue and Driving. Taylor and Francis, London, 97–105Google Scholar
  45. 45.
    Sagberg F (1999) Road accidents caused by drivers falling asleep. Accid Anal Prev 31: 639–649PubMedCrossRefGoogle Scholar
  46. 46.
    Summala H, Mikkola T (1994) Fatal accidents among car and truck drivers: effects of fatigue, age, and alcohol consumption. Human Factors 36: 315–326PubMedGoogle Scholar
  47. 47.
    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: 337–344PubMedCrossRefGoogle Scholar
  48. 48.
    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): 306Google Scholar
  49. 49.
    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): 235Google Scholar
  50. 50.
    Dawson D, Reid K (1997) Fatigue, alcohol and performance impairment. Nature 388: 235PubMedCrossRefGoogle Scholar
  51. 51.
    Arnedt J, MacLean A (1999) Simulated driving performance during sleep loss and following alcohol consumption: independent versus combined effects. Sleep 22: 248Google Scholar
  52. 52.
    Roehrs T, Beare D, Zorisk F, Roth T (1994) Sleepiness and ethanol effects on simulated driving. Alcohol Clin Exp Res 18: 154–158PubMedCrossRefGoogle Scholar
  53. 53.
    Alloway C, MacLean A (1999) Night-time simulated driving and on-line judgements of sleepiness/alertness. Sleep 22 (1 Suppl): 90Google Scholar
  54. 54.
    Reyner L, Horne J (1998) Falling asleep whilst driving: are drivers aware of prior sleepiness. Int J Legal Med 111: 120–123PubMedCrossRefGoogle Scholar
  55. 55.
    Lenne M, Triggs T, Redman J (1997) Time of day variations in driving performance. Accid Anal Prev 29: 431–437PubMedCrossRefGoogle Scholar
  56. 56.
    Lenne M, Triggs T, Redman J (1998) Interactive effects of sleep deprivation, time of day, and driving experience on a driving task. Sleep 21: 38–44PubMedGoogle Scholar
  57. 57.
    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: 335–342PubMedCrossRefGoogle Scholar
  58. 58.
    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: 142–148PubMedCrossRefGoogle Scholar
  59. 59.
    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: 529–530PubMedGoogle Scholar
  60. 60.
    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: 1511–1516PubMedGoogle Scholar
  61. 61.
    Alsop J, Langley J (2001) Under-reporting of motor vehicle traffic crash victims in New Zealand. Accid Anal Prev 33: 353–359PubMedCrossRefGoogle Scholar
  62. 62.
    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, 125–143Google Scholar
  63. 63.
    Benichou J (1991) Methods of adjustment for estimating the attributable risk in case-control studies: a review. Stat Med 10: 1753–1773PubMedCrossRefGoogle Scholar
  64. 64.
    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: 31–41PubMedCrossRefGoogle Scholar
  65. 65.
    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: 847–851PubMedCrossRefGoogle Scholar
  66. 66.
    Wu H, Yan-Go F (1996) Self-reported automobile accidents involving patients with obstructive sleep apnea. Neurology 46: 1254–1257PubMedGoogle Scholar
  67. 67.
    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: 608–613PubMedGoogle Scholar
  68. 68.
    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: 1125–1129PubMedCrossRefGoogle Scholar
  69. 69.
    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: 75PubMedCrossRefGoogle Scholar
  70. 70.
    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: 475–480PubMedGoogle Scholar
  71. 71.
    George C (2004) Sleep. 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome. Thorax 59: 804–807PubMedCrossRefGoogle Scholar
  72. 72.
    Young T, Peppard P, Gottlieb D (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165: 1217–1239PubMedCrossRefGoogle Scholar
  73. 73.
    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: 116–127PubMedGoogle Scholar
  74. 74.
    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: 1050–1053PubMedCrossRefGoogle Scholar
  75. 75.
    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.Google Scholar
  76. 76.
    Horne J, Reyner L, Barrett P (2003) Driving impairment due to sleepiness is exacerbated by low alcohol intake. Occup Environ Med 60: 689–692PubMedCrossRefGoogle Scholar
  77. 77.
    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: 1057–1062PubMedGoogle Scholar
  78. 78.
    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: 1063–1067PubMedGoogle Scholar
  79. 79.
    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: 1480–1485PubMedCrossRefGoogle Scholar

Copyright information

© Birkhäuser Verlag/Switzerland 2009

Authors and Affiliations

  • Jennie L. Connor
    • 1
  1. 1.Department of Preventive and Social Medicine, Dunedin School of MedicineUniversity of OtagoDunedin

Personalised recommendations