Sleep disorders accident risk

A variety of known sleep disorders have been documented to affect waking function. Sleep apnea is one example that can degrade waking alertness and performance and has been shown to increase risk for car accidents (64,65). Healthy sleep activities could range from informational materials to actual diagnostic screening of individuals in safety-sensitive positions. 

Obviously, sleep disorders are a major cause of traffic accidents because of their prevalence but also because of their danger (high-risk ratio of death and injury). If OS AS is a well-covered field, other diseases such as narcolepsy and hypersomnias are not as frequently investigated. This could be explained by the low prevalence and therefore the limited public-health impact of accidents generated by these patients. We strongly believe that research must be conducted in this field to provide better information on the driving aptitude of these patients. 

VII. The Impact of Treatment of Sleep Disorders on Accident Risk... 

As described previously, sleep disorders can be related to an increase in traffic accidents. It seems reasonable to believe that the treatment of these disorders will decrease the risk of accident. 

Evidence suggests that moderate to severe sleepiness is virtually omnipresent for night shift workers. A recent assessment of 363 shift workers with symptoms of shift work sleep disorder (23) found their nocturnal sleepiness level, studied the night after 3-5 consecutive night shifts, to approximate sleepiness levels after a night of total sleep deprivation (24). The shift workers mean score on the Multiple Sleep Latency Test (MSLT) at night was 2.75 min. Further, the MSLT score for 90.1% of the shift workers was < 6 min, a level most experts believe to be associated with behavioral impairment and increased accident risk. 

Associated with sleep-loss-induced decreases in neurobehavioral functioning is an increased risk of and increased incidence of accidents. On-the-job and motor vehicle accidents have both been found to increase when individuals are sleep deprived. Although data are not consistently collected, it has been estimated that between 20% and 60% of single-vehicle motor accidents may be attributed to fatigue from sleep loss. While this includes sleep loss associated with working shiftwork and voluntary sleep loss, many of the individuals may experience sleep loss due to sleep and other medical disorders. Although the symptom of sleep disturbance with medical disorders is often recognized, the potential safety and public health impact may be overlooked. 

In the late 80s, Findley et al. (28) published a study on a small population of apneic patients compared to controls (29 apneics vs. 35 controls). A higher risk of traffic accidents was found among patients suffering from sleep-related breathing disorders compared to the controls. 

Insomnia is characterized as being primary where there is no obvious medical or psychiatric cause. It is a common clinical problan wherein 10-20% of people have chronic insomnia, characterized by trouble sleeping more than three nights a week. It has been directly linked to numerous impacts on individuals such as daytime fatigue, inattention, irritability, poor mood, and reduced energy levels. Consequently, they have reduced productivity, higher woik absenteeism, and an increased risk of depression or substance abuse. There is also a greater risk of traffic and woik-related accidents. Furthermore, studies have shown direct links between circadian rhythm disturbance and an increased risk in health problems, such as diabetes, metabolic disorders and depression. Insomnia is considered secondary if it is caused by external factors such as health conditions, for example, cancer, heart problems, depression, asthma, arthritis, or pain, or as a side effect of medication, or a substance, such as alcohol. 

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