Objective and subjective measures of sleepiness, and their associations with on‐road driving events in shift workers

Aug 7, 2012Journal of sleep research

Sleepiness Levels and Their Links to Driving Problems in Shift Workers

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Abstract

Nurses commuting after night shifts reported a mean total blink duration of 7.96 seconds, indicating significant drowsiness.

Rotating shift nurses experienced higher levels of sleepiness compared to permanent night shift nurses.
Self-reported sleepiness and drowsiness were significantly elevated during commutes after night shifts versus before night shifts.
Objective drowsiness metrics were strongly associated with increased odds of driving events following night shifts.
A maximum total blink duration of 7.96 seconds was associated with a greater incidence of sleep-related driving events.
Inattention during driving was linked to a Johns Drowsiness Scale score of 4.5 or above.
Hazardous driving events were more likely when drivers had been awake for 16 hours or longer.

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To assess the relationships between sleepiness and the incidence of adverse driving events in nurses commuting to and from night and rotating shifts, 27 rotating and permanent night shift-working nurses were asked to complete daily sleep and duty logs, and wear wrist-activity monitors for 2 weeks (369 driving sessions). During all commutes, ocular measures of drowsiness, including the Johns Drowsiness Scale score, were assessed using the Optalert™ system. Participants self-reported their subjective sleepiness at the beginning and end of each drive, and any events that occurred during the drive. Rotating shift nurses reported higher levels of sleepiness compared with permanent night shift nurses. In both shift-working groups, self-reported sleepiness, drowsiness and drive events were significantly higher during commutes following night shifts compared with commutes before night shifts. Strong associations were found between objective drowsiness and increased odds of driving events during commutes following night shifts. Maximum total blink duration (mean = 7.96 s) during the drive and pre-drive Karolinska Sleepiness Scale (mean = 5.0) were associated with greater incidence of sleep-related events [OR, 5.35 (95% CI, 1.32, 21.60), OR, 1.69 (95% CI, 1.04, 2.73), respectively]. Inattention was strongly associated with a Johns Drowsiness Scale score equal to or above 4.5 [OR, 4.58 (95% CI, 1.26-16.69)]. Hazardous driving events were more likely to occur when drivers had been awake for 16 h or more [OR, 4.50 (95% CI, 1.81, 11.16)]. Under real-world driving conditions, shift-working nurses experience high levels of drowsiness as indicated by ocular measures, which are associated with impaired driving performance following night shift work.

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Objective and subjective measures of sleepiness, and their associations with on‐road driving events in shift workers

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