Conclusions
Î Automobile crashes are the fifth leading cause of death and injury in the
United States.
Î The number of crashes and severity of injury by distance driven are highest
in young drivers (15-25 yr) and in those >65 yr.
Î Crashes due to sleepiness typically involve running off the road or into the
back of another vehicle.
Î Sleepiness is most commonly caused by insufficient sleep, which is
associated with prolonged wakefulness or chronic sleep restriction due
to long hours of work or play, shift work (comprising 7.4% of all those
employed), or a variety of medical and neurological disorders.
Î Fatality reduction currently targets increasing seat belt use and reducing
speeding and alcohol. However, inattentiveness, fatigue, and sleepiness are
increasingly recognized as contributing, and possibly primary, factors.
Î Obstructive sleep apnea (OSA) is the most common medical disorder that
causes excessive daytime sleepiness, increasing the risk for motor vehicle
crashes two to three times.
Î Sleepiness may account for up to 20% of crashes on monotonous roads,
especially highways.
Î A high-risk driver is defined as one who has moderate to severe daytime
sleepiness and a recent unintended motor vehicle crash or a near-miss
attributable to sleepiness, fatigue, or inattention.
Î There is no compelling evidence to restrict driving privileges in patients
with sleep apnea if there has not been a motor vehicle crash or an equivalent
event.
Î Treatment of OSA improves performance on driving simulators and might
reduce the risk of drowsy driving and drowsy driving crashes.
Î Timely diagnostic evaluation and treatment and education of the patient and
family are likely to decrease the prevalence of sleepiness-related crashes in
patients with OSA who are high-risk drivers.