Risk of Motor Vehicle Accidents Related to Sleepiness at the Wheel: A Systematic Review and Meta-Analysis.
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 vehicle accidents.


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 = 83%).


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.
['Bioulac|Stéphanie|S|', 'Micoulaud-Franchi|Jean-Arthur|JA|', 'Arnaud|Mickael|M|', 'Sagaspe|Patricia|P|', 'Moore|Nicholas|N|', 'Salvo|Francesco|F|', 'Philip|Pierre|P|']
D000063:Accidents, Traffic D001334:Automobile Driving D016022:Case-Control Studies D015331:Cohort Studies D003430:Cross-Sectional Studies D005260:Female D006801:Humans D008297:Male D018986:Motor Vehicles D016017:Odds Ratio D012307:Risk Factors D012890:Sleep D012893:Sleep Wake Disorders
motor vehicle accidents Sleepiness sleepiness at the wheel systematic review