Sleep and Breathing

, Volume 18, Issue 1, pp 59–68 | Cite as

Sleepiness and sleep-disordered breathing in truck drivers

Risk analysis of road accidents
  • Rosa CatarinoEmail author
  • Jorge Spratley
  • Isabel Catarino
  • Nuno Lunet
  • Manuel Pais-Clemente
Original Article



Portugal has one of the highest road traffic fatality rates in Europe. A clear association between sleep-disordered breathing (SDB) and traffic accidents has been previously demonstrated. This study aimed to determine prevalence of excessive daytime sleepiness (EDS) and other sleep disorder symptoms among truck drivers and to identify which individual traits and work habits are associated to increased sleepiness and accident risk.


We evaluated a sample of 714 truck drivers using a questionnaire (244 face-to-face interviews, 470 self-administered) that included sociodemographic data, personal habits, previous accidents, Epworth Sleepiness Scale (ESS), and the Berlin questionnaire (BQ).


Twenty percent of drivers had EDS and 29 % were at high risk for having obstructive sleep apnea syndrome (OSAS). Two hundred sixty-one drivers (36.6 %) reported near-miss accidents (42.5 % sleep related) and 264 (37.0 %), a driving accident (16.3 % sleep related). ESS score ≥11 was a risk factor for both near-miss accidents (odds ratio (OR) = 3.84, p < 0.01) and accidents (OR = 2.25, p < 0.01). Antidepressant use was related to accidents (OR = 3.30, p = 0.03). We found an association between high Mallampati score (III–IV) and near misses (OR = 1.89, p = 0.04).


In this sample of Portuguese truck drivers, we observed a high prevalence of EDS and other sleep disorder symptoms. Accident risk was related to sleepiness and antidepressant use. Identifying drivers at risk for OSAS should be a major priority of medical assessment centers, as a public safety policy.


Accidents Antidepressants Sleepiness Truck drivers 



The authors would like to thank all drivers and managers of the transport companies, who generously provided us with the necessary information.

Conflict of interest



  1. 1.
    Road safety PIN report: 2010 road safety target outcome: 100,000 fewer deaths since 2001. Date last updated: June 1 2011. Date last accessed: January 4 2012.
  2. 2.
    Talmage JB, Hudson TB, Hegmann KT, Thiese MS (2008) Consensus criteria for screening commercial drivers for obstructive sleep apnea: evidence of efficacy. J Occup Environ Med 53:324–329CrossRefGoogle Scholar
  3. 3.
    Howard ME, Desai AV, Grunstein RR, Hukins C, Armstrong JG, Joffe D, Swann P, Campbell DA, Pierce RJ (2004) Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. Am J Respir Crit Care Med 170:1014–1021PubMedCrossRefGoogle Scholar
  4. 4.
    Akerstedt T (2000) Consensus statement: fatigue and accidents in transport operations. J Sleep Res 9:395PubMedCrossRefGoogle Scholar
  5. 5.
    Vennelle M, Engleman HM, Douglas NJ (2010) Sleepiness and sleep-related accidents in commercial bus drivers. Sleep Breath 14:39–42PubMedCrossRefGoogle Scholar
  6. 6.
    Åkerstedt T (2003) Shift work and disturbed sleep/wakefulness. Occup Med 53(2):89–94CrossRefGoogle Scholar
  7. 7.
    Morrow PC, Crum MR (2004) Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers. J Saf Res 35(1):59–69CrossRefGoogle Scholar
  8. 8.
    Harneet K, Walia AL, Hayes KA, Przepyszny PK, Sanjay RP (2012) Clinical presentation of shift workers to a sleep clinic. Sleep Breath 16(2):543–547CrossRefGoogle Scholar
  9. 9.
    Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217PubMedCrossRefGoogle Scholar
  10. 10.
    Pack, AI, Dinges, D, Maislin, G (2002) A study of prevalence of sleep apnea among commercial truck drivers. Federal Motor Carrier Safety Administration, Publication No. DOT-RT-02-030, Washington, DC.Google Scholar
  11. 11.
    Tregear S, Reston J, Schoelles K, Phillips B (2009) Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis. J Clin Sleep Med 5(6):573–581PubMedCentralPubMedGoogle Scholar
  12. 12.
    Stoohs RA, Guilleminault C, Itoi A, Dement WC (1994) Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity. Sleep 17(7):619–623PubMedGoogle Scholar
  13. 13.
    Mulgrew A, Nasvadi G, Butt A, Cheema R, Fox N, Fleetham J, Ryan C, Cooper P, Ayas N (2008) Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea. Thorax 63(6):536–541PubMedCrossRefGoogle Scholar
  14. 14.
    Kingshott RN, Cowan JO, Jones DR, Flannery EM, Smith AD, Herbison GP, Taylor DR (2004) The role of sleep-disordered breathing, daytime sleepiness, and impaired performance in motor vehicle crashes—a case control study. Sleep Breath 8:61–72PubMedGoogle Scholar
  15. 15.
    Parks PD, Durand G, Tsismenakis AJ, Vela-Bueno A, Kales SN (2009) Screening for obstructive sleep apnea during commercial driver medical examinations. J Occup Environ Med 51(3):275PubMedCrossRefGoogle Scholar
  16. 16.
    Hartenbaum N, Collop N, Rosen I, Phillips B, George C, Rowley J, Freedman N, Weaver T, Gurubhagavatula I, Strohl K (2006) Sleep apnea and commercial motor vehicle operators: statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest 130:902–905PubMedCrossRefGoogle Scholar
  17. 17.
    Simpson L, Hillman DR, Cooper MN, Ward KL, Hunter M, Cullen S, James A, Palmer LJ, Mukherjee S, Eastwood P (2012) High prevalence of undiagnosed obstructive sleep apnoea in the general population and methods for screening for representative controls. Sleep Breath; PMID: 23161476 (in press).Google Scholar
  18. 18.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545PubMedGoogle Scholar
  19. 19.
    Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP (1999) Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 131(7):485–491PubMedCrossRefGoogle Scholar
  20. 20.
    Kang K, Park KS, Kim JE, Kim SW, Kim YT, Kim JS, Lee HW (2012) Usefulness of the Berlin Questionnaire to identify patients at high risk for obstructive sleep apnea: a population-based door-to-door study. Sleep Breath; PMID: 23054593 (in press).Google Scholar
  21. 21.
    Vaz A, Drummond M, Mota PC, Severo M, Almeida J, Winck JC (2011) Tradução do Questionário de Berlim para língua Portuguesa e sua aplicação na identificação da SAOS numa consulta de patologia respiratória do sono. Rev Port Pneumol 17(2):59–65PubMedCrossRefGoogle Scholar
  22. 22.
    Gonçalves M, AR. P, Ferreira J: Conduzir com sono pode matar. 2011, Portuguese Sleep Association. Date last updated: March 1 2011. Date last accessed: February 2 2012.
  23. 23.
    Hui D, Chan J, Ko F, Choy D, Li T, Chan A, Wong K, Lai C (2002) Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong. Intern Med J 32(4):149–157PubMedCrossRefGoogle Scholar
  24. 24.
    Krieger J (2007) Sleep apnoea and driving: how can this be dealt with? Eur Respir Rev 16(106):189–195CrossRefGoogle Scholar
  25. 25.
    Hoekema A, Stegenga B, Bakker M, Brouwer WH, de Bont LG, Wijkstra PJ, van der Hoeven JH (2007) Simulated driving in obstructive sleep apnoeahypopnoea; effects of oral appliances and continuous positive airway pressure. Sleep Breath 11:129–138PubMedCrossRefGoogle Scholar
  26. 26.
    Lemos LC, Marqueze EC, Sachi F, Lorenzi-Filho G, Moreno CRC (2009) Obstructive sleep apnea syndrome in truck drivers. J Bras Pneumol 35(6):500–506PubMedGoogle Scholar
  27. 27.
    Amra B, Dorali R, Mortazavi S, Golshan M, Farajzadegan Z, Fietze I, Penzel T (2011) Sleep apnea symptoms and accident risk factors in Persian commercial vehicle drivers. Sleep Breath 16(1):187–191PubMedCrossRefGoogle Scholar
  28. 28.
    Christensen LQ, Nielsen LM, Nielsen SL (1990) Traffic accidents and drivers suspected for drug influence. Forensic Sci Int 45(3):273–280PubMedCrossRefGoogle Scholar
  29. 29.
    Masa JF, Rubio M, Findley LJ (2000) Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med 162(4):1407PubMedCrossRefGoogle Scholar
  30. 30.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  31. 31.
    Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J (1999) The association between sleep apnea and the risk of traffic accidents. N Engl J Med 340(11):847–851PubMedCrossRefGoogle Scholar
  32. 32.
    Hoekema A, Stegenga B, Bakker M, Brouwer WH, de Bont LG, Wijkstra PJ, van der Hoeven JH (2007) Simulated driving in obstructive sleep apnoea–hypopnoea: effects of oral appliances and continuous positive airway pressure. Sleep Breath 11(3):129–138PubMedCrossRefGoogle Scholar
  33. 33.
    Stoohs RA, Barger K, Dement WC (1997) Sleep disordered breathing in primary care medicine. Sleep Breath 2(1):11–22PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Rosa Catarino
    • 1
    • 3
    Email author
  • Jorge Spratley
    • 1
  • Isabel Catarino
    • 1
  • Nuno Lunet
    • 2
  • Manuel Pais-Clemente
    • 1
  1. 1.Department of Sensory Organs–OtorhinolaryngologyUniversity of Porto Medical SchoolPortoPortugal
  2. 2.Department of Clinical Epidemiology, Predictive Medicine and Pubic HealthUniversity of Porto Medical SchoolPortoPortugal
  3. 3.Hospital São João–Serviço de Otorrinolaringologia, Alameda Professor Hernâni MonteiroPortoPortugal

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