title: Sleep, sleepiness and motor vehicle accidents: a national survey.
abstract: OBJECTIVE
  To assess the role of sleep-related factors, ethnicity and socioeconomic deprivation in self-reported motor vehicle accidents while driving, after controlling for gender, age and driving exposure.
  
  
  METHODS
  Mail survey to a random electoral roll sample of 10,000 people aged 30-60 years, stratified by age decades and ethnicity (71% response rate). The analytical sample included 5,534 current drivers (21.6% Maori men, 21.2% Maori women, 30% non-Maori men, 27.2% non-Maori women).
  
  
  RESULTS
  Multiple logistic regression analyses revealed the following independent risk factors for accident involvement while driving (last three years): being younger; higher average weekly driving hours; never/rarely getting enough sleep (OR=1.26, 95% CI 1.06-1.49); reporting any chance of dozing in a car while stopped in traffic (Epworth Sleepiness Scale question 8, OR=1.52, 95% CI 1.15-2.02); and among women, being non-Maori. Total Epworth score was not significantly related to reported accident involvement.
  
  
  CONCLUSIONS
  Chronic sleep restriction, and any likelihood of dozing off at the wheel of a motor vehicle, were significant independent predictors of self-reported involvement in all types of motor vehicle accidents, not only those identified as fatigue-related. The Epworth Sleepiness Scale alone is not a reliable clinical tool for identifying individuals at higher risk of crashes.
  
  
  CONCLUSIONS
  Factors relating to chronic sleepiness were as important as established demographic risk factors for self-reported motor vehicle accident involvement among 30-60 year-old drivers. The findings reinforce the need for multi-faceted campaigns to reduce sleepy driving.
authors.affiliation: Sleep/Wake Research Centre, Research School of Public Health, Massey University, Wellington, New Zealand. p.h.gander@massey.ac.nz
authors.forename: Philippa H
authors.initials: PH
authors.lastname: Gander
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Marshall
authors.forename: Ricci B
authors.initials: RB
authors.lastname: Harris
authors.forename: Papaarangi
authors.initials: P
authors.lastname: Reid
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D020920:Dyssomnias / Q000175:diagnosis* / Q000453:epidemiology*; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012890:Sleep / Q000502:physiology; D011795:Surveys and Questionnaires; D015996:Survival Rate