Acute sleep deprivation and culpable motor vehicle crash involvement.

Study Objectives: To quantify the relationship between acute sleep deprivation and culpable involvement in motor vehicle crashes.

Methods: Participants were 6845 drivers involved in a representative sample of crashes investigated by the US Department of Transportation in years 2005-2007. A modified case-control study design was used to compare self-reported hours of sleep in the 24 hr before crashing between drivers deemed culpable versus nonculpable. Analyses controlled for fatigue-related, driver-related, and environmental factors. Specific errors that led to crashes were also examined.

Results: Drivers who reported having slept for 6, 5, 4, and less than 4 hr in the 24 hr before crashing had 1.3 (95% confidence interval [CI] = 1.04 to 1.7), 1.9 (1.1 to 3.2), 2.9 (1.4 to 6.2), and 15.1 (4.2 to 54.4) times the odds, respectively, of having been culpable for their crashes, compared with drivers who reported 7-9 hr of sleep. Drivers who had slept less than 4 hr had 3.4 (95% CI = 2.1 to 5.6) times the increase in odds of culpable involvement in single-vehicle crashes compared with multiple-vehicle crashes. Recent change in sleep schedule, typically feeling drowsy upon waking, and driving for 3+ hr were also associated with culpability (all p ≤ 0.013). Assuming nonculpable drivers comprised a representative sample of all drivers present where crashes occurred, these odds ratios approximate incidence rate ratios for culpable crash involvement per unit of time driving.

Conclusions: Driving after having slept less than 7 hr in a 24 hr period is associated with elevated risk of culpable crash involvement. Risk is greatest for drivers who have slept less than 4 hr and is manifested disproportionately in single-vehicle crashes.