AMA identifies the need for education and research to combat drowsy driving deaths

Chicago, IL (June 17, 1998)-In a landmark report, the American Medical Association (AMA) urged physicians across the nation to take an active role in reducing the prevalence of "drowsy driving" and fatigue-related crashes in America. The June 17 report was published in the Journal of the American Medical Association (JAMA) by the AMA's Council on Scientific Affairs. The Council reports that, because they may be less likely to perceive and report potential crash threats, fatigued or sleepy drivers may be at high risk for motor vehicle crashes. Because of this correlation, the Council maintains that there is a great need for research to understand the relationship between fatigue, sleep deprivation, and sleep disorders "to protect the health and safety of affected drivers and all highway users."

According to the report, motor vehicle crashes are a leading cause of injury and death in the United States. "In 1995, the annual death rate from motor vehicle crashes was almost 17 per 100,000 persons, which was the fifth leading cause of death for the U.S. population," the Council warns. And of the crashes which are reported by the police, drowsiness is the principal causative factor in about 100,000 crashes each year, according to estimates by the National Highway Transportation Safety Administration (NHTSA). The NHTSA has also estimated that about 4% of all fatal vehicle crashes each year are caused by driver drowsiness. However, the report warns that these estimates may be low. It cites many factors for the low numbers, including a lack of accurate techniques for identifying a driver's state of alertness and the fact that most drivers involved in accidents tend to downplay their driving condition to avoid blame. For these reasons, the Council has recommended that government agencies and private organizations devote their resources to further investigate this problem.

Although the prevalence of drowsy driving is hard to ascertain, some studies have shown that many people admit to having driven while drowsy. Authors of one study cited in the report interviewed 1,000 randomly selected automobile drivers in New York State. Their study revealed that almost 55% had driven while drowsy in the year preceding the survey, and about 23% had fallen asleep at the wheel at some time during that period. Importantly, almost 5% of the respondents stated that they had had a crash due to drowsiness or falling asleep while driving.

These statistics are particularly telling for certain groups of drivers, including shift workers, users of alcohol and other drugs, and commercial truck drivers. Because of their erratic sleep patterns, these people are more likely to suffer from excessive daytime sleepiness, which puts them at risk for drowsy driving. People with sleep disorders are also at risk, according to the report. The Council states, "Although usually unrecognized, sleep disorders may be as common as other medical conditions that affect drivers, such as alcoholism, diabetes, and seizure disorders. The potential magnitude of sleep-related problems is indicated by an estimate that obstructive sleep apnea, narcolepsy, and chronic insomnia affect 30 million to 40 million Americans." Furthermore, several studies suggest that people with untreated sleep apnea and narcolepsy are at increased risk for motor vehicle crashes, according to the report. Fortunately, says Kingman Strohl, MD, who contributed to the report, "Patients at risk for drowsy driving because of unrecognized or untreated for sleep disorders, like severe sleep apnea and narcolepsy, can benefit from behavioral measures and treatments that can reduce the risk of drowsy driving in these people to below that of the general population."

In an executive summary, the AMA has stated that "The economic, medical and public health costs of sleep-related problems may be significant, but have largely been ignored." The report published in JAMA is significant because it has directly addressed many of these problems that had previously been largely ignored. In it, the AMA made strong recommendations for further research to determine the prevalence of sleep-related disorders among the general population and the driving population, and the incidence of crashes. It also suggested investigation into strategies that can be effective in helping drivers avoid fatigue-related crashes.

Sleep-related problems can affect most people, and may result from sleep deprivation, erratic work schedules, stress, alcohol and drug use, and medical conditions such as obstructive sleep apnea and narcolepsy. The American Sleep Disorders Association is among the professional societies seeking to provide practical information to doctors and the public about the importance of getting enough sleep and the need to recognize signs and symptoms of common sleep disorders.