title: Car Crashes and Central Disorders of Hypersomnolence: A French Study.
abstract: BACKGROUND
  Drowsiness compromises driving ability by reducing alertness and attentiveness, and delayed reaction times. Sleep-related car crashes account for a considerable proportion of accident at the wheel. Narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) are rare central disorders of hypersomnolence, the most severe causes of sleepiness thus being potential dangerous conditions for both personal and public safety with increasing scientific, social, and political attention. Our main objective was to assess the frequency of recent car crashes in a large cohort of patients affected with well-defined central disorders of hypersomnolence versus subjects from the general population.
  
  
  METHODS
  We performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 527 patients and 781 healthy subjects. All participants included needed to have a driving license, information available on potential accident events during the last 5 years, and on potential confounders; thus analyses were performed on 282 cases (71 IH, 82 NT2, 129 NT1) and 470 healthy subjects.
  
  
  RESULTS
  Patients reported more frequently than healthy subjects the occurrence of recent car crashes (in the previous five years), a risk that was confirmed in both treated and untreated subjects at study inclusion (Untreated, OR = 2.21 95%CI = [1.30-3.76], Treated OR = 2.04 95%CI = [1.26-3.30]), as well as in all disease categories, and was modulated by subjective sleepiness level (Epworth scale and naps). Conversely, the risk of car accidents of patients treated for at least 5 years was not different to healthy subjects (OR = 1.23 95%CI = [0.56-2.69]). Main risk factors were analogous in patients and healthy subjects.
  
  
  CONCLUSIONS
  Patients affected with central disorders of hypersomnolence had increased risk of recent car crashes compared to subjects from the general population, a finding potentially reversed by long-term treatment.
authors.affiliation: Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pizza
authors.affiliation: Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.affiliation: Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Pesenti
authors.affiliation: Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche, ASL di Bologna, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Plazzi
authors.affiliation: CHU de Poitiers, Clinical Neurophysiology Department, 8600 Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Drouot
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France; Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, AP-HP, Brain Research Institute (CRICM-UPMC-Paris6, Inserm UMR_S 975, CNRS UMR 7225), Sorbonne Universities, UPMC Univ Paris 06, Paris, F-75005, France.
authors.forename: Smaranda
authors.initials: S
authors.lastname: Leu-Semenescu
authors.affiliation: Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France.
authors.forename: Severine
authors.initials: S
authors.lastname: Beziat
authors.affiliation: National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France; Sleep Disorders Unit, Pitié-Salpêtrière University Hospital, AP-HP, Brain Research Institute (CRICM-UPMC-Paris6, Inserm UMR_S 975, CNRS UMR 7225), Sorbonne Universities, UPMC Univ Paris 06, Paris, F-75005, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
authors.affiliation: Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Inserm U1061, Montpellier, France, Université Montpellier 1, Montpellier, France; National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome (CNR narcolepsie-hypersomnie), Paris, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D005602:France / Q000453:epidemiology; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D020177:Idiopathic Hypersomnia / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012890:Sleep; D055815:Young Adult