Sleep deficiency and motor vehicle crash risk in the general population: a prospective cohort study

Gottlieb, Daniel J.; Ellenbogen, Jeffrey M.; Bianchi, Matt T.; Czeisler, Charles A. · 2018 · OpenAlex-citations

DOI: 10.1186/s12916-018-1025-7

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Summary

This prospective cohort study investigates the relationship between sleep deficiency—specifically obstructive sleep apnea and insufficient sleep duration—and motor vehicle crash risk in the general population. The research addresses a critical gap in understanding whether sleep deficiency increases crash risk independently of self-reported excessive daytime sleepiness, a factor often used to diagnose sleep disorders. The study aims to determine if individuals with sleep apnea or short sleep duration are at elevated risk even if they do not perceive themselves as sleepy. The analysis utilized data from the Sleep Heart Health Study, a community-based prospective cohort. The final sample included 3,201 men and women aged 40–89 years who reported driving habits. Baseline assessments included home polysomnography to measure the apnea-hypopnea index (AHI) and questionnaires to determine usual sleep duration and daytime sleepiness via the Epworth Sleepiness Scale. Crash history was ascertained via a follow-up questionnaire approximately two years later. Logistic regression models examined the association between baseline sleep metrics and crash occurrence during the preceding year, adjusting for age, sex, and miles driven. Among the participants, 6.9% reported at least one motor vehicle crash. Higher AHI, fewer hours of sleep, and self-reported excessive sleepiness were each significantly associated with increased crash risk. Severe sleep apnea (AHI ≥30) was associated with a 123% increased crash risk compared to no sleep apnea. Sleeping 6 hours per night was associated with a 33% increased risk compared to sleeping 7–8 hours, while sleeping 5 or fewer hours carried a 47% increased risk. Notably, these associations persisted even among participants who did not report excessive sleepiness. For instance, the odds ratio for crash risk increased by 17% for every 10-unit increase in AHI in non-sleepy participants. The population-attributable fraction of crashes was estimated at 10% for sleep apnea and 9% for sleep duration of less than 7 hours. The findings demonstrate that sleep deficiency significantly elevates motor vehicle crash risk in the general population, independent of subjective sleepiness. This challenges clinical practices that require excessive daytime sleepiness for the diagnosis and treatment of obstructive sleep apnea. The results suggest that many individuals with severe sleep apnea or short sleep duration are unaware of their impairment, highlighting the need for broader screening and treatment to mitigate public health risks associated with drowsy driving.

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Topics

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• sleep deprivation
• drowsiness

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• Empirical Findings: crash risk outcomes