Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers

RESEARCH ARTICLE Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers Sergio Garbarino1,2☯, Paolo Durando2☯, Ottavia Guglielmi1, Guglielmo Dini2, Francesca Bersi2, Stefania Fornarino1, Alessandra Toletone2, Carlo Chiorri3, Nicola Magnavita4* a11111 1 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal/Child Sciences (DINOGMI), University of Genoa, Genoa, Italy, 2 Department of Health Sciences, Postgraduate School in Occupational Medicine, University of Genoa and Occupational Medicine Unit, IRCCS AOU San Martino IST, Genoa, Italy, 3 Department of Educational Sciences, University of Genoa, Genoa, Italy, 4 Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy ☯ These authors contributed equally to this work. * OPEN ACCESS Citation: Garbarino S, Durando P, Guglielmi O, Dini G, Bersi F, Fornarino S, et al. (2016) Sleep Apnea, Sleep Debt and Daytime Sleepiness Are Independently Associated with Road Accidents. A Cross-Sectional Study on Truck Drivers. PLoS ONE 11(11): e0166262. doi:10.1371/journal. pone.0166262 Editor: Andrea Romigi, University of Rome Tor Vergata, ITALY Received: July 28, 2016 Abstract Background Recent research has found evidence of an association between motor vehicle accidents (MVAs) or near miss accidents (NMAs), and excessive daytime sleepiness (EDS) or its main medical cause, Obstructive Sleep Apnea (OSA). However, EDS can also be due to non-medical factors, such as sleep debt (SD), which is common among professional truck drivers. On the opposite side, rest breaks and naps are known to protect against accidents. Accepted: October 25, 2016 Published: November 30, 2016 Copyright: © 2016 Garbarino et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Study Objectives To investigate the association of OSA, SD, EDS, rest breaks and naps, with the occurrence of MVAs and NMAs in a large sample of truck drivers. Methods Data Availability Statement: Data is available from the Dryad Digital Repository: http://dx.doi.org/10. 5061/dryad.j6fj6. 949 male truck drivers took part in a cross-sectional medical examination and were asked to complete a questionnaire about sleep and waking habits, risk factors for OSA and EDS. Funding: Medical examinations were funded by the CNH-Iveco Industrial Corporation (Grant number 25171877) within the “CNH Iveco Industrial CheckStop Project", an international project for road safety, supported by the European Union Road Safety Action and the Italian Ministry of Transport. The funders had no role in study design, data collection and analysis, decision to publish, or Results MVAs and NMAs were reported by 34.8% and 9.2% of participants, respectively. MVAs were significantly predicted by OSA (OR = 2.32 CI95% = 1.68–3.20), SD (OR = 1.45 CI95% = 1.29–1.63), EDS (OR = 1.73 CI95% = 1.15–2.61) and prevented by naps (OR = 0.59 CI95% = 0.44–0.79) or rest breaks (OR = 0.63 CI95% = 0.45–0.89). NMAs were significantly predicted by OSA (OR = 2.39 CI95% = 1.47–3.87) and SD (OR = 1.49 CI95% = 1.27–1.76) PLOS ONE | DOI:10.1371/journal.pone.0166262 November 30, 2016 1 / 12 Sleep and Accidents in Truck Drivers preparation of the manuscript. Print expenses will be covered with University funds from NM. Competing Interests: Medical examinations were funded by CNH-Iveco. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Print expenses will be covered with University Funds D.1 (year 2015) of the corresponding author (NM). and prevented by naps (OR = 0.52 CI95% = 0.32–0.85) or rest breaks (OR = 0.49 CI95% = 0.29–0.82). Conclusions When OSA, SD or EDS are present, the risk of MVAs or NMAs in truck drivers is severely increased. Taking a rest break or a nap appear to be protective against accidents. Introduction In the last three decades or so, several studies demonstrated a clear relationship between excessive daytime sleepiness (EDS) and motor vehicle accidents (MVAs) [1–5]. EDS accounts for 20% of total MVAs, with lethality rates higher than those reported for MVAs associated with other risk-factors (11.4% vs 5.6%) [2]. Obstructive sleep apnea (OSA) is the main medical cause of EDS and is also associated with an increased risk of MVAs [6]. Unfortunately, professional drivers suffer from other risk factors for OSA. These include obesity, hypertension, dyslipidemia, smoking, drinking, and insufficient physical exercise [7,8], as well as gender (i.e., male) and increasing age [9,10]. Individuals with OSA show intermittent hypoxemia [11], reduced frontoparietal activation, failure in top-down prefrontal control and attentional networks [12]. These conditions tend to impair executive functions, alertness, sustained attention, and cognitive performance [13]. EDS in professional drivers can also be induced by other non-medical factors, such as sleep debt (SD), which, in turn, may be the result of organizational work factors (i.e., overtime, irregular schedules, night shifts), bad sleep habits (i.e., inadequate rest, extended wakefulness) and excessive physical and mental activity [14–19]. These factors are known to impair driving ability and induce subjective feelings of tiredness, slowed reaction times, lapses of attention to critical details and performance deterioration [20–23]. As a result, sleep- and EDS-related MVAs are more likely to occur among professional male drivers than in males in the general population [24,25]. Among road crashes, it has been reported that more than half of truck accidents cause fatal injuries and/or chronic disabilities and that the truck driver is found at fault in more than 80% of the cases [26]. Therefore, investigation of the risk and protective factors in truck drivers that maybe associated with MVAs and NMAs appears to be of crucial importance. Previous studies that addressed the above mentioned issue confirmed that EDS represent a specific risk factor for both MVAs and NMAs in this work category [27–29]. Nevertheless, to the best of our knowledge, no previous study simultaneously investigated OSA and EDS on one hand and SD on the other, in order to analyze the relative importance of these risk factors. The present study aims to fill this gap by also taking into account two behavioral countermeasures to sleepiness, such as naps [30] and rest breaks [31], that have already proved to be protective factors against accidents. In particular, the protective effect of these habits was investigated to confirm their specific contribution when associated with the above mentioned risk factors. Methods Recruitment of Participants Be (...truncated)