title: Three measures of sleep, sleepiness, and sleep deprivation and the risk of injury: a case-control and case-crossover study.
abstract: OBJECTIVE
  Sleepiness and sleep deprivation are associated with injury, but few case-control studies have addressed them. We sought to add to the body of analytic observational studies.
  
  
  METHODS
  Case-control and case-crossover study of 2517 injured patients interviewed in person in 3 emergency departments and matched by age, sex, rural versus urban, day of week, and hour of day with 1856 controls. Sleep constructs were measured by the following: (1) self-perceived sleepiness at injury or matched control time using 3 adjectives (tired, sleepy, drowsy); (2) usual sleep quality and quantity, and differences in those in the past 7 days; and (3) hours of sleep in the 24 hours before injury and the 24 hours before that.
  
  
  RESULTS
  Better sleep quality in the past 7 days was associated with a lower risk of injury (odds ratio (OR) 0.88, 95% confidence interval (CI) 0.80 to 0.97). Self-reported sleepiness just before injury compared with control time was associated with a lower risk of injury, with ORs of 0.82 per unit on a 0-to-12 scale (95% CI 0.78 to 0.86) in case-control analysis and 0.76 (0.73 to 0.80) in case-crossover analysis. In case-crossover analysis, additional sleep in the 24 hours before injury compared with the 24 hours before that was associated with an increased risk of injury (OR 1.06 per hour, 95% CI 1.03 to 1.09), but this effect disappeared when we controlled for activity, location, and recent alcohol consumption.
  
  
  CONCLUSIONS
  Better recent sleep quality was associated with a lower risk of injury, but surprisingly, feeling sleepy was also.
authors.affiliation: Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO 65212-0001, USA.
authors.forename: Jason N
authors.initials: JN
authors.lastname: Edmonds
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Vinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D018592:Cross-Over Studies; D005221:Fatigue; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008923:Missouri; D018570:Risk Assessment; D012890:Sleep; D012892:Sleep Deprivation; D014947:Wounds and Injuries / Q000209:etiology*