Abstract
Young drivers (18–24 years) are over-represented in sleep-related crashes (comprising one in five fatal crashes in developed countries) primarily due to decreased sleep opportunity, lower tolerance for sleep loss, and ongoing maturation of brain areas associated with driving-related decision making. Impaired driving performance is the proximal reason for most car crashes. There is still a limited body of evidence examining the effects of sleep loss on young drivers’ performance, with discrepancies in the methodologies used, and in the definition of outcomes. This study aimed to identify the direction and magnitude of the effects of sleep loss on young drivers’ performance, and to appraise the quality of current evidence via a systematic review. Based on the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) approach, 16 eligible studies were selected for review, and their findings summarised. Next, critical elements of these studies were identified, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines augmented to rate those elements. Using those criteria, the quality of individual papers was calculated and the overall body of evidence for each driving outcome were assigned a quality ranking (from ‘very low’ to ‘high-quality’). Two metrics, the standard deviation of lateral position and number of line crossings, were commonly reported outcomes (although in an overall ‘low-quality’ body of evidence), with significant impairments after sleep loss identified in 50% of studies. While speed-related outcomes and crash events (also with very low- quality evidence) both increased under chronic sleep loss, discrepant findings were reported under conditions of acute total sleep deprivation. It is crucial to obtain more reliable data about the effects of sleep loss on young drivers’ performance by using higher quality experimental designs, adopting common protocols, and the use of consistent metrics and reporting of findings based on GRADE criteria and the PRISMA statement. Key words: Young drivers, sleep loss, driving performance, PRISMA, the GRADE, systematic review.
Highlights
Sleepiness is a primary cause of road crashes [1,2,3], underlying an average of 20% of all crashes in developed countries [2, 4,5,6,7,8] (17% in Australia [9, 10], and 25% in the UK [11, 12])
This paper aims to systematically review all peer-reviewed original research studies, and to rate the quality of the available body of evidence on effects of sleep deprivation on young drivers’ driving performance over the last 12 years
Based on the PRISMA-based systematic search in this review there is only limited (16 peerreviewed original papers) available evidence, with no systematic reviews, for impact of sleep loss on driving performance of young drivers over the last decade. This limited literature suffers from considerable inconsistencies in study designs, sample sizes, sleep deprivation regimes, definition and measurement of outcomes, driving settings, time-of-day, duration of drives, control for confounding factors, reporting of methodologies and results and magnitudes of effects
Summary
Sleepiness is a primary cause of road crashes [1,2,3], underlying an average of 20% of all crashes in developed countries [2, 4,5,6,7,8] (17% in Australia [9, 10], and 25% in the UK [11, 12]). Based on a conservative estimates derived from police reports, sleep-related crashes cost $12.5 billion monetary losses in the US annually [14]. Some specific characteristics of young drivers such as late maturation of their brains’ decision-making areas [21, 22], their slower reaction times while sleepy [23, 24], and a lower tolerance for sleep loss than older adults [25], results in greater vulnerability to sleep deprivation [26, 27] and their over representation in sleep-related crashes [20, 26, 28]
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