Sleepiness, Sleep-disordered Breathing, and Accident Risk Factors in Commercial Vehicle Drivers

Institute of Breathing and Sleep, Bowen Centre, Austin Health and University of Melbourne, Heidelberg, Victoria, Australia.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 11/2004; 170(9):1014-21. DOI: 10.1164/rccm.200312-1782OC
Source: PubMed


Sleep-disordered breathing and excessive sleepiness may be more common in commercial vehicle drivers than in the general population. The relative importance of factors causing excessive sleepiness and accidents in this population remains unclear. We measured the prevalence of excessive sleepiness and sleep-disordered breathing and assessed accident risk factors in 2,342 respondents to a questionnaire distributed to a random sample of 3,268 Australian commercial vehicle drivers and another 161 drivers among 244 invited to undergo polysomnography. More than half (59.6%) of drivers had sleep-disordered breathing and 15.8% had obstructive sleep apnea syndrome. Twenty-four percent of drivers had excessive sleepiness. Increasing sleepiness was related to an increased accident risk. The sleepiest 5% of drivers on the Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire had an increased risk of an accident (odds ratio [OR] 1.91, p = 0.02 and OR 2.23, p < 0.01, respectively) and multiple accidents (OR 2.67, p < 0.01 and OR 2.39, p = 0.01), adjusted for established risk factors. There was an increased accident risk with narcotic analgesic use (OR 2.40, p < 0.01) and antihistamine use (OR 3.44, p = 0.04). Chronic excessive sleepiness and sleep-disordered breathing are common in Australian commercial vehicle drivers. Accident risk was related to increasing chronic sleepiness and antihistamine and narcotic analgesic use.

Download full-text


Available from: Mark E Howard,
    • "Sleepiness is an on-going occupational hazard amongst professional heavy vehicle drivers as a result of long work hours, sleep restriction, circadian influences, irregular shifts and sleep disorders, all of which are related to increased accident risk (Folkard, 1997; Howard et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Slow eyelid closure is recognized as an indicator of sleepiness in sleep deprived individuals, although automated ocular devices are not well validated. This study aimed to determine whether changes in eyelid closure is evident following acute sleep deprivation as assessed by an automated device, and how ocular parameters relate to performance after sleep deprivation. Twelve healthy professional drivers (45.58±10.93 years) completed two randomized sessions; after a normal night of sleep and after 24-hours of total sleep deprivation. Slow eye closure (PERCLOS) was measured while drivers performed a simulated driving task. Following sleep deprivation, drivers displayed significantly more eyelid closure (p<0.05), greater variation in lane position (p<0.01) and more attentional lapses (p<0.05) compared to after normal sleep. PERCLOS was moderately associated with variability in both vigilance performance (r=0.68, p<0.05) and variation in lane position on the driving task (r=0.61, p<0.05). Automated ocular measurement appears to be an effective means of detecting impairment due to sleep loss in the laboratory.
    Traffic Injury Prevention 05/2015; DOI:10.1080/15389588.2015.1055327 · 1.41 Impact Factor
  • Source
    • "or sleep quality , short sleep time and increased sleep pressure with increased crash risk ( Horne and Reyner , 1995 ; Sagberg , 1999 ) . Our previous validation study in a subcohort of the current population demonstrated that severe daytime sleepiness expressed as ESS≥16 was associated strongly with risk of MVA . A similar finding was reported by Howard et al . ( 2004 ) , while the ESS was not proven to predict MVA risk in other OSA populations ( Amra et al . , 2012 ) . Therefore , the ESS is likely to reflect components of vigilance and cognitive function that are not sufficiently sensitive or specific to identify all OSA patients at risk ."
    [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea is associated with increased motor vehicle accident risk, and improved detection of patients at risk is of importance. The present study addresses potential risk factors in the European Sleep Apnea Database and includes patients with suspected obstructive sleep apnea [n = 8476, age 51.5 (12.5) years, body mass index 31.0 (6.6) kg m−2, 82.4% driver's licence holders]. Driving distance (km year−1), driver's licence type, sleep apnea severity, sleepiness and comorbidities were assessed. Previously validated risk factors for accident history: Epworth Sleepiness Scale ≥16; habitual sleep time ≤5 h; use of hypnotics; and driving ≥15 000 km year−1 were analysed across European regions. At least one risk factor was identified in male and female drivers, 68.75 and 51.3%, respectively. The occurrence of the risk factors was similar across Europe, with only a lower rate in the eastern region (P = 0.001). The mean number of risk factors increased across classes of sleep apnea severity. Frequent driving was prevalent [14.0 (interquartile range 8.0–20.0) × 103 km year−1] and 32.7% of drivers had severe obstructive sleep apnea [apnea–hypopnea index 50.3 (38.8–66.0) n h−1]. Obesity, shorter sleep time and younger age were associated with increased traffic exposure (P ≤ 0.03). In conclusion, the risk factors associated with accident history were common among European patients with suspected obstructive sleep apnea, but varied between geographical regions. There was a weak covariation between occurrence of risk factors and clinically determined apnea severity but frequent driving, a strong risk factor for accidents, was over-represented. Systematic evaluation of accident-related risk factors is important to detect sleep apnea patients at risk for motor vehicle accidents.
    Journal of Sleep Research 06/2014; 23(6). DOI:10.1111/jsr.12171 · 3.35 Impact Factor
  • Source
    • "Sleep disorders and excessive daytime sleepiness are associated with occupational and industrial accidents [48,49]. OSA is a risk factor for car accidents [50], and many studies have demonstrated a higher accident rate among sleep apnea patients compared to the general population [51,52]; patients with an AHI score ≥ 10 had a 6.3-fold higher accident rate compared to the general population [53]. Furthermore, Garbarino et al. reported that occupational drivers have a higher prevalence of OSA than the general population, and the correlation between commutation car accidents and daytime sleepiness in shift workers was prominent [54]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Obstructive sleep apnea is a common sleep disorder that can cause excessive daytime sleepiness and impairment of cognition. These symptoms may lead to the occurrence of occupational accidents in workers with obstructive sleep apnea. A 36-year-old man who worked as a dimensional control surveyor caused a vehicle accident while he was driving at the work site. Although he experienced loss of consciousness at the time of the accident, he had no other symptoms. His brain computed tomography and laboratory test did not show any specific findings. Medical tests were conducted to evaluate his fitness for work. Decreased sleep latency was observed on the electroencephalography image, which is suggestive of a sleep disorder. He frequently experienced daytime sleepiness and his Epworth sleepiness score was 13. The polysomnography showed a markedly increased apnea-hypopnea index of 84.3, which led to a diagnosis of severe obstructive sleep apnea. The patient was advised to return to work only when his obstructive sleep apnea improved through proper treatment. Proper screening for obstructive sleep apnea among workers is important for preventing workplace accidents caused by this disorder, but screening guidelines have not yet been established in Korea. An effort toward preparing practical guidelines for obstructive sleep apnea is needed.
    04/2014; 26(1):7. DOI:10.1186/2052-4374-26-7
Show more