title: Prevalence of sleep disturbances in a cohort of older drivers.
abstract: BACKGROUND
  Lower levels of driving capacity in older persons are typically attributed to cognitive, visual, and/or physical impairments, with sleep disturbances rarely considered. This is in contrast to the general adult population for whom sleep disturbances are established risk factors for crashes. We thus set out to determine the prevalence of sleep disturbances in the form of insomnia symptoms, daytime drowsiness, and sleep apnea risk in a cohort of older drivers and to assess how these relate to self-reported driving capacity.
  
  
  METHODS
  Participants included 430 active drivers aged > or =70 years. Questionnaires measured self-reported insomnia symptoms (Insomnia Severity Index [ISI]), drowsiness (Epworth Sleepiness Scale [ESS]), apnea risk (Sleep Apnea Clinical Score [SACS]), driving mileage, driver self-ratings (overall and nighttime), and prior adverse driving events.
  
  
  RESULTS
  Mean age was 78.5 years, with 85% being male. Overall, 64% were dissatisfied with sleep patterns and 26% had an abnormal ISI (> or =8). A large proportion (60%) reported a moderate-to-high chance of dozing in the afternoon, and 19% had an abnormal ESS (> or =10). Habitual snoring was noted by 43%, with 20% at risk for sleep apnea (SACS > 15). Regarding driving, the most consistent finding was for lower levels of nighttime driver self-ratings in participants with insomnia symptoms or drowsiness. Lower levels of driving mileage were also noted but only with difficulty falling asleep. Otherwise, sleep disturbances were not associated with prior adverse driving events.
  
  
  CONCLUSIONS
  In our cohort of older drivers, insomnia symptoms and daytime drowsiness were prevalent and associated with lower levels of nighttime driver self-ratings. Although sleep apnea risk was also prevalent, it was not associated with self-reported driving capacity. These preliminary findings suggest that insomnia symptoms and drowsiness merit continued consideration as risk factors for lower levels of driving capacity in older persons, particularly given that effective interventions are available.
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, New Haven, CT 06250-8025, USA. carlos.fragoso@ynhh.org
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Vaz Fragoso
authors.forename: Katy L B
authors.initials: KL
authors.lastname: Araujo
authors.forename: Peter H
authors.initials: PH
authors.lastname: Van Ness
authors.forename: Richard A
authors.initials: RA
authors.lastname: Marottoli
mesh_terms: D000368:Aged; D001334:Automobile Driving; D005260:Female; D006801:Humans; D008297:Male; D012647:Self-Assessment; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology; D012894:Sleep Stages; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology*