Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers

Garbarino, Sergio; Durando, Paolo; Guglielmi, Ottavia; Dini, Guglielmo; Bersi, Francesca Maria; Fornarino, S.; Toletone, Alessandra; Chiorri, Carlo; Magnavita, Nicola · 2016 · OpenAlex-citations

DOI: 10.1371/journal.pone.0166262

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Summary

This cross-sectional study investigates the independent associations between obstructive sleep apnea (OSA), sleep debt (SD), excessive daytime sleepiness (EDS), and the occurrence of motor vehicle accidents (MVAs) and near-miss accidents (NMAs) among professional truck drivers. The research was motivated by the high lethality of truck accidents and the need to distinguish between medical causes of sleepiness (OSA) and non-medical factors (SD), while also evaluating the protective effects of behavioral countermeasures like naps and rest breaks. The study recruited 949 male truck drivers from major Italian trucking hubs between 2014 and 2015. Participants underwent medical examinations and completed standardized questionnaires, including the Berlin Questionnaire to assess OSA risk and the Epworth Sleepiness Scale to measure EDS. Sleep debt was calculated as the difference between desired and actual sleep hours. Data on accident history (MVAs in the previous three years and NMAs in the previous six months) and habits regarding rest breaks and naps were collected. Hierarchical logistic regression analyses were performed to determine the independent predictive value of each factor while controlling for background variables such as age, smoking, and coffee consumption. The results indicated that 34.8% of participants reported MVAs and 9.2% reported NMAs. Suspect OSA, sleep debt, and EDS were all significant independent risk factors for both types of accidents. Specifically, OSA increased the odds of MVAs (OR = 2.32) and NMAs (OR = 2.39). Sleep debt also significantly predicted both outcomes, with odds ratios of 1.45 for MVAs and 1.49 for NMAs. EDS was a significant predictor for MVAs (OR = 1.73) but did not reach statistical significance for NMAs in the final model. Conversely, taking naps and rest breaks were found to be protective factors. Naps significantly reduced the risk of both MVAs (OR = 0.59) and NMAs (OR = 0.52). Rest breaks significantly reduced the risk of NMAs (OR = 0.49) and showed a protective trend for MVAs (OR = 0.63). The study concludes that OSA, sleep debt, and excessive daytime sleepiness independently increase the risk of road accidents among truck drivers. It highlights that sleep debt is a critical risk factor distinct from medical conditions like OSA. Furthermore, the findings demonstrate that routine use of countermeasures, particularly naps and rest breaks, significantly mitigates accident risk. These results suggest that occupational health strategies for professional drivers should address both medical screening for sleep disorders and the promotion of adequate sleep hygiene and strategic rest periods to enhance road safety.

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Topics

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• truck driver fatigue
• sleep deprivation
• drowsiness
• shift work driving