To identify risk factors for sleep-related near miss accidents in highway drivers. Cross-sectional survey including the Epworth sleepiness questionnaire, Basic Nordic Sleep Questionnaire, a travel questionnaire, sleep data for the past 24 h, and usual sleep schedules. Highway-patrol officers in France invited a random sample of automobile drivers to participate. 3051 drivers (mean age, 46 ± 13 years; 75% males) completed the survey, yielding an 80% participation rate; 87 (2.9%) drivers reported sleepiness- related near-miss events during the trip and 8.5% during the past year and 2.3% reported sleepiness-related accidents in the past year. Mean driving time was 181 ± 109 min, mean sleep duration during workweeks was 468 ± 74 min, and mean sleep duration in the past 24 h was 480 ± 104 min. Significant risk factors for sleep-related near misses during the trip were near miss in the past year, non-restorative sleep and snoring in the past 3 months, and sleepiness during the interview. Neither sleep time in the past 24 h nor acute sleep debt (sleep time difference between workweeks and past 24 h) correlated with the occurrence of near misses. Sleep-related near miss accidents remain unacceptably common during long drives on the highway, despite improvements in sleep time before the departure. The exact contribution of sleep-related breathing disorders to sleepiness at the wheel needs to be investigated. The study was funded by a grant from the Fondation Vinci pour une conduit responsable.