Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 20;16(1):44.
doi: 10.1186/s12916-018-1025-7.

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

Daniel J Gottlieb  1   2   3 , Jeffrey M Ellenbogen  4   5 , Matt T Bianchi  4   5 , Charles A Czeisler  6   4
Affiliations

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

Daniel J Gottlieb et al. BMC Med. .

Abstract

Background: 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, 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.

Methods: This 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.

Results: Among 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.

Conclusions: Sleep 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.

Keywords: Epidemiology; Motor vehicle accident; Motor vehicle crash; Sleep apnea; Sleep deficiency; Sleep deprivation; Sleep duration.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by the institutional review board of each participating center and signed informed consent was provided by each participant. The IRB/Human Subjects Committee protocol numbers are as follows: Boston University School of Medicine: H-22384 Johns Hopkins University: H.34.94.05.23.A University of Minnesota: 9406M8378 New York University: H8185 University of Pittsburgh: 9406129 University of California at Davis: 200210023 University of Arizona: 94-0248-01.

Consent for publication

Not applicable.

Competing interests

DJG has received consulting fees or served as a paid member of scientific advisory boards for ResMed Corporation, VIVUS, Inc., and T. Leland Seeger & Associates, Inc.

JME has received consulting fees from Bose Corporation and Invenergy Renewables.

MTB has received funding from the Center for Integration of Medicine and Innovative Technology, the Milton Family Foundation, the MGH-MIT Grand Challenge, the American Sleep Medicine Foundation, and the Department of Neurology. He has a patent pending on a home sleep-monitoring device, has research agreements with MC10 and Insomnisolv, consulting agreements with McKesson, International Flavors and Fragrances, and Apple, Inc., serves as a medical monitor for Pfizer, and has provided expert testimony in sleep medicine. None of these entities had any role in the study.

CAC has received consulting fees from or served as a paid member of scientific advisory boards for Bose, Boston Red Sox, Columbia River Bar Pilots, Institute of Digital Media and Child Development, Purdue Pharma, Samsung, and Vanda Pharmaceuticals. He owns an equity interest in Vanda Pharmaceuticals. He has served as an expert witness on various legal cases related to sleep and circadian rhythms and he has received research support from Optum, San Francisco Bar Pilots, Schneider, Sysco, Philips Respironics, Vanda Pharmaceuticals, and the State of Washington Board of Pilotage Commissioners. The Harvard Medical School Sleep and Health Education Program and Brigham Sleep Health (CAC) have received funding for educational activities from Cephalon, Jazz Pharma, ResMed, Takeda Pharmaceuticals, Sanofi-Aventis, Sepracor, Simmons, and Mary Ann & Stanley Snider via Combined Jewish Philanthropies. CAC is the incumbent of an endowed professorship provided to Harvard University by Cephalon, and holds several process patents in the specialty of sleep and circadian rhythms (e.g., photic resetting of the human circadian pacemaker). CAC has received royalties from Houghton Miflin Harcourt, and from Koninklijke Philips Electronics/Philips Respironics for the Actiwatch-2 and Actiwatch Spectrum devices. CAC’s interests were reviewed and are managed by Brigham Health and Partners HealthCare in accordance with their conflict of interest policies.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Ascertainment of the study sample
Fig. 2
Fig. 2
The relation of sleep apnea (a) and reported usual sleep duration (b) to motor vehicle crash risk, adjusted for age, sex, and miles driven. Data are shown separately for non-sleepy (black, n = 2402) and sleepy (gray, n = 799) participants, where sleepiness is defined as a score ≥ 11 on the Epworth Sleepiness Scale. The referent group for a is non-sleepy participants with apnea-hypopnea index < 5. The referent group for b is non-sleepy participants reporting a usual sleep duration of 8 hours per night
Fig. 3
Fig. 3
The joint association of sleep apnea and reported usual sleep duration to motor vehicle crash risk. The referent group is individuals with an apnea-hypopnea index < 5 and a usual sleep duration of ≥7 hours per night
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. National Center on Sleep Disorders Research. National Institutes of Health Sleep Disorders Research Plan; NIH Publication No. 11–7820; November 2011.
    1. Hammond EC. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Public Health Nations Health. 1964;54:11–23. doi: 10.2105/AJPH.54.1.11. - DOI - PMC - PubMed
    1. Kripke DF, Simons RN, Garfinkel L, Hammond EC. Short and long sleep and sleeping pills. Is increased mortality associated? Arch Gen Psychiatry. 1979;36:103–116. doi: 10.1001/archpsyc.1979.01780010109014. - DOI - PubMed
    1. Colten HR, Altevogt BM, editors. Sleep disorders and sleep deprivation: an unmet public health problem. Washington, D.C.: The National Academies Press; 2006. - PubMed
    1. Connor J, Whitlock G, Norton R, Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accid Anal Prev. 2001;33:31–41. doi: 10.1016/S0001-4575(00)00013-0. - DOI - PubMed

Publication types

LinkOut - more resources