Sleepy drivers : high time for action

Poor sleep hygiene—which refers to habits and practices that are unconducive to sleeping well on a regular basis—is usually the cause of insufficient sleep duration, while sleeping disorders such as sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA) can result in poor-quality sleep.3 Identifying patients with chronic sleep deprivation can be challenging, especially those suffering from partial sleep deficit over longer periods of time.4 One manifestation of sleep deprivation is excessive daytime sleepiness (EDS), defined as an inability to stay awake and alert during the major waking hours of the day, with sleep occurring unintentionally or at inappropriate times almost daily for at least three months.5 In addition, patients may experience brief involuntary episodes of ‘microsleep’, in which there is a temporary lapse in consciousness that can last up to 30 seconds, during which the individual is unable to respond to sensory stimuli. [...]most individuals are unaware of a microsleep episode and believe they have been awake continuously.6,7 Sleep deprivation can lead to numerous adverse health consequences. In a recent large prospective study by Deng et al., short sleep duration was associated with the development of several cardiometabolic conditions—including central obesity, elevated fasting glucose hypertension, low- and high-density lipoprotein cholesterol levels, hypertriglyceridaemia and metabolic syndrome—among over 160,000 healthy non-obese adults over an 18-year period.8 Similarly, Baldwin et al. found that the health scores of subjects with severe SDB (in terms of difficulty initiating and maintaining sleep) and EDS were comparable to those of patients with hypertension, type 2 diabetes mellitus and clinical depression.9 Apart from physical manifestations, sleep deprivation can impair a number of important cognitive functions such as judgment, attention, executive function, cognitive processing speed, memory, reaction time and muscular coordination, all of which are critical when driving.10 In a survey conducted by the Foundation for Traffic Safety in the USA, 41% of participants reported having nodded off or fallen asleep at the wheel at least once in their lifetime; of these, 11% admitted to having done so within the past year and 3.9% within the past month.11 Unfortunately, sleep deprivation and associated daytime sleepiness increases the risk of being involved in a motor vehicle crash, which can be up to 2.5–7-fold higher com