Risk of motor vehicle accidents related to sleepiness at the wheel: a systematic review and meta-analysis.
Sleep. 2017-07-28; 40(10):
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1. Sleep. 2017 Oct 1;40(10). doi: 10.1093/sleep/zsx134.
Risk of Motor Vehicle Accidents Related to Sleepiness at the Wheel: A Systematic
Review and Meta-Analysis.
Bioulac S(1)(2)(3), Franchi JM(1)(2)(3), Arnaud M(4), Sagaspe P(1)(2), Moore
N(4)(5)(6), Salvo F(4)(5), Philip P(1)(2)(3).
(1)University of Bordeaux, SANPSY, Bordeaux, France.
(2)CNRS, SANPSY, Bordeaux, France.
(3)CHU Pellegrin, Clinique du Sommeil, Bordeaux, France.
(4)University of Bordeaux, INSERM U657, Bordeaux, France.
(5)CHU Bordeaux, Bordeaux, France.
(6)CIC Bordeaux, Bordeaux, France.
Study Objectives: Sleepiness at the wheel is widely believed to be a cause of
motor vehicle accidents. Nevertheless, a systematic review of studies
investigating this relationship has not yet been published. The objective of this
study was to quantify the relationship between sleepiness at the wheel and motor
Methods: A systematic review was performed using Medline, Scopus, and ISI Web of
Science. The outcome measure of interest was motor vehicle accident defined as
involving four- or two-wheeled vehicles in road traffic, professional and
nonprofessional drivers, with or without objective consequences. The exposure was
sleepiness at the wheel defined as self-reported sleepiness at the wheel. Studies
were included if they provided adjusted risk estimates of motor vehicle accidents
related to sleepiness at the wheel. Risk estimates and 95% confidence intervals
(95% CIs) were extracted and pooled as odds ratios (ORs) using a random-effect
model. Heterogeneity was quantified using Q statistics and the I2 index. The
potential causes of heterogeneity were investigated using meta-regressions.
Results: Ten cross-sectional studies (51,520 participants), six case-control
studies (4904 participants), and one cohort study (13,674 participants) were
included. Sleepiness at the wheel was associated with an increased risk of motor
vehicle accidents (pooled OR 2.51 [95% CI 1.87; 3.39]). A significant
heterogeneity was found between the individual risk estimates (Q = 93.21; I2 =
Conclusions: Sleepiness at the wheel increases the risk of motor vehicle
accidents and should be considered when investigating fitness to drive. Further
studies are required to explore the nature of this relationship.
Systematic review registration number: PROSPERO 2015 CRD42015024805.
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PMID: 28958002 [Indexed for MEDLINE]