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

Sergio Garbarino,Francesca Bersi,Alessandra Toletone,Stefania Fornarino,Nicola Magnavita,Paolo Durando,Ottavia Guglielmi,Carlo Chiorri,Guglielmo Dini,Andrea Romigi

doi:10.1371/journal.pone.0166262

Sergio Garbarino, Francesca Bersi + Show 8 more

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https://doi.org/10.1371/journal.pone.0166262

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Abstract

BackgroundRecent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents.Study ObjectivesTo investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers.Methods949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS.ResultsMVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68–3.20), SD (OR = 1.45 CI95% = 1.29–1.63), EDS (OR = 1.73 CI95% = 1.15–2.61) and prevented by naps (OR = 0.59 CI95% = 0.44–0.79) or rest breaks (OR = 0.63 CI95% = 0.45–0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47–3.87) and SD (OR = 1.49 CI95% = 1.27–1.76) and prevented by naps (OR = 0.52 CI95% = 0.32–0.85) or rest breaks (OR = 0.49 CI95% = 0.29–0.82).ConclusionsWhen OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents.

Highlights

In the last three decades or so, several studies demonstrated a clear relationship between excessive daytime sleepiness (EDS) and motor vehicle accidents (MVAs) [1,2,3,4,5]
MVAs and near miss accidents (NMAs) were reported by 34.8% and 9.2% of participants, respectively
MVAs were significantly predicted by Obstructive Sleep Apnea (OSA) (OR = 2.32 CI95% = 1.68–3.20), sleep debt (SD) (OR = 1.45 CI95% = 1.29–1.63), EDS (OR = 1.73 CI95% = 1.15–2.61) and prevented by naps (OR = 0.59 CI95% = 0.44–0.79) or rest breaks (OR = 0.63 CI95% = 0.45–0.89)

Summary

Introduction

In the last three decades or so, several studies demonstrated a clear relationship between excessive daytime sleepiness (EDS) and motor vehicle accidents (MVAs) [1,2,3,4,5]. Obstructive sleep apnea (OSA) is the main medical cause of EDS and is associated with an increased risk of MVAs [6]. Professional drivers suffer from other risk factors for OSA. Individuals with OSA show intermittent hypoxemia [11], reduced frontoparietal activation, failure in top-down prefrontal control and attentional networks [12]. Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers

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Conclusion