Short communicationSleep debt, sleepiness and accidents among males in the general population and male professional drivers
Introduction
Sleepiness and reduced vigilance are important risk factors for accident proneness at work (Åkerstedt, 1994). Leger (1994) calculated that as many as 52.5% of all work-related accidents in 1988 in US were potentially related to sleepiness. Sleepiness and sleep disturbances have been shown to increase the frequency of occupational accidents (Ulfberg et al., 2000, Lindberg et al., 2001). Driver alertness may have a great impact on safety. Sleepiness and reduced vigilance are hypothesized to reduce the capability of a driver to function in the traffic milieu.
Numerous factors contribute to fatigue and sleepiness but knowledge about the relations between these factors and accidents continues to be limited. Several studies (George et al., 1987, Findley et al., 1988, Haraldsson et al., 1990) have shown a 2–12-fold greater rate of driving accidents in patients with snoring and obstructive sleep-apnea syndrome (OSAS) than in subjects without sleep-apnea. On the other hand, according to a recent review by Connor et al. (2001) there are few accurate studies on the relationship between disordered sleep and traffic accidents. These authors also found that the direct epidemiological evidence for a causal role of fatigue in car crashes is weak.
In a North American survey, long-haul truck drivers are reported to have obtained 2 h less sleep than required to stay alert in the job (Mitler et al., 1997). Arnold et al. (1997) reported on significant sleep debt among professional drivers in an Australian state, and recently it was also reported that self-reported short sleep was predictive of falling asleep at the wheel (McCartt et al., 2000).
In this study, we assessed the accident likelihood in different situations in daily life among male professional drivers and males in the general population according to sleep-disordered breathing and self-reported sleep debt. The Ethics Committee of the Faculty of Medicine, Uppsala University approved the study.
Section snippets
Professional drivers
The names and addresses of essentially all male professional long-haul lorry and bus drivers, aged 18–64 years, in Dalarna County were obtained through organisations representing employees and employers. A total of 1827 names and addresses were obtained. Each person was mailed a questionnaire (described later). One and two months following the initial mailing, non-responders were sent reminders with additional questionnaires. A total of 1389 individuals were eligible for inclusion in the study.
Results
The professional drivers were heavier than the referents; mean BMI among the drivers was 26.9 versus 26 among the referents (P<0.001). The mean ESS score among the drivers was 7.1 versus 6.7 among the referents (P=0.02). Snoring sometimes per week/daily was reported by 30.6% of the drivers and 29.8% by the referents (NS). Apneas witnessed by spouses were reported by 14% of the professional drivers and 10.7% of the referents (P=0.04).
Among the professional drivers, 36.6% reported accidents in at
Discussion
The data obtained in this study give further support to the hypothesis that sleep debt is common among professional drivers. The results also indicate that self-perceived sleep debt is directly related to accident likelihood for males in the general population and male professional drivers. However, our results did not corroborate earlier data claiming that sleep-disordered breathing is a risk factor for involvement in both traffic and other kinds of accidents.
A previous epidemiological study
Acknowledgements
The research described in this paper was supported by a grant from the Swedish Council for Work Life Research. We thank Jan Ifver for assistance with statistical calculations.
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