Objective.— To assess the contribution of driver sleepiness to highway crashes and
review recent recommendations to change federal hours-of-service regulations
for commercial motor vehicle drivers.
Data Sources.— Information was derived from a search of the MEDLINE, Transportation
Research Information Service (TRIS), and Bibliographic Electronic Databases
of Sleep (BEDS) databases from 1975 through 1997 and from manual review of
the reference lists in relevant journal articles, government publications,
conference proceedings, and textbooks.
Data Synthesis.— Driver sleepiness is a causative factor in 1% to 3% of all US motor
vehicle crashes. Surveys of the prevalence of sleepy behavior in drivers suggest
that sleepiness may be a more common cause of highway crashes than is reflected
in these estimates. About 96% of sleep-related crashes involve passenger vehicle
drivers and 3% involve drivers of large trucks. Risk factors include youth,
shift work, alcohol and other drug use, over-the-counter and prescription
medications, and sleep disorders.
Conclusions.— Increased awareness of the relationship between sleepiness and motor
vehicle crashes will promote the health and safety of drivers and highway
users. Physicians can contribute by encouraging good sleep habits, recognizing
and treating sleep-related problems, and counseling patients about the risks
of driving while sleepy. To protect public health and safety, the American
Medical Association recommends continued research on devices and technologies
to detect the signs of sleepiness and prevent the deterioration of driver
alertness and performance. Educational programs about the risks of falling
asleep while driving are needed for physicians, the public, and commercial