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

Daniel J Gottlieb,Charles A Czeisler,Jeffrey M Ellenbogen,Matt T Bianchi

doi:10.1186/s12916-018-1025-7

Abstract

BackgroundInsufficient sleep duration and obstructive sleep apnea, two common causes of sleep deficiency in adults, can result in excessive sleepiness, a well-recognized cause of motor vehicle crashes, although their contribution to crash risk in the general population remains uncertain. The objective of this study was to evaluate the relation of sleep apnea, sleep duration, and excessive sleepiness to crash risk in a community-dwelling population.MethodsThis was a prospective observational cohort study nested within the Sleep Heart Health Study, a community-based study of the health consequences of sleep apnea. The participants were 1745 men and 1456 women aged 40–89 years. Sleep apnea was measured by home polysomnography and questionnaires were used to assess usual sleep duration and daytime sleepiness. A follow-up questionnaire 2 years after baseline ascertained driving habits and motor vehicle crash history. Logistic regression analysis was used to examine the relation of sleep apnea and sleep duration at baseline to the occurrence of motor vehicle crashes during the year preceding the follow-up visit, adjusting for relevant covariates. The population-attributable fraction of motor vehicle crashes was estimated from the sample proportion of motor vehicle crashes and the adjusted odds ratios for motor vehicle crash within each exposure category.ResultsAmong 3201 evaluable participants, 222 (6.9%) reported at least one motor vehicle crash during the prior year. A higher apnea-hypopnea index (p < 0.01), fewer hours of sleep (p = 0.04), and self-reported excessive sleepiness (p < 0.01) were each significantly associated with crash risk. Severe sleep apnea was associated with a 123% increased crash risk, compared to no sleep apnea. Sleeping 6 hours per night was associated with a 33% increased crash risk, compared to sleeping 7 or 8 hours per night. These associations were present even in those who did not report excessive sleepiness. The population-attributable fraction of motor vehicle crashes was 10% due to sleep apnea and 9% due to sleep duration less than 7 hours.ConclusionsSleep deficiency due to either sleep apnea or insufficient sleep duration is strongly associated with motor vehicle crashes in the general population, independent of self-reported excessive sleepiness.

Highlights

Insufficient sleep duration and obstructive sleep apnea, two common causes of sleep deficiency in adults, can result in excessive sleepiness, a well-recognized cause of motor vehicle crashes, their contribution to crash risk in the general population remains uncertain
The aim of the present investigation is to determine whether sleep apnea or short sleep duration are associated with increased crash risk in the general population, and whether self-reported sleepiness identifies those at increased crash risk
Motor vehicle crashes were somewhat more common in men than in women and were significantly associated with number of miles driven per year, Apnea-hypopnea index aORAdjusted odds ratio (AHI), sleep duration, and self-reported sleepiness (Table 1)

Summary

Introduction

Insufficient sleep duration and obstructive sleep apnea, two common causes of sleep deficiency in adults, can result in excessive sleepiness, a well-recognized cause of motor vehicle crashes, their contribution to crash risk in the general population remains uncertain. The potential health impact of insufficient sleep duration was first reported in the 1960s, when a general population survey of over one million adults found that individuals who reported sleeping fewer than 7 hours per night had increased mortality compared to those sleeping 7 to 8 hours per night [2, 3]. Data from the U.S Centers for Disease Control indicate that habitual sleep duration of 6 or fewer hours per night is associated with a 2.6-fold higher risk of reporting having fallen asleep while driving, compared to those sleeping 7–9 hours per night, motor vehicle crashes were not assessed [8]. There are individual differences in impairment from sleep deprivation [9], the perception of impairment quickly plateaus in individuals whose sleep duration is chronically restricted, despite continued declines in objective measures of performance [10, 11], suggesting that individuals may be unaware of their degree of impairment from sleep deficiency

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