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Falling asleep at the wheel across Europe

It is well established that falling asleep is a critical factor in approximately 10–30% of driving accidents, and probably an even more significant contributor to fatal accidents. Analyses of the circumstances in which this occurs have identified time of day (greater risk at night), age (higher risk when young) and duration of driving (higher risk with longer driving bouts) as important determinants – so why is a publication on ‘Sleepiness at the wheel across Europe: a survey of 19 countries’ (Gonc alves et al., 2015) of any news interest? The study documents the responses to a survey in which participants volunteered information on falling asleep while driving during the past 2 years and factors that may have contributed to this. The overall period prevalence averaged across the participating countries is estimated at 17%, which is a staggering percentage that is in accordance with other estimates. The prevalence of accidents associated with falling asleep is 7%, with accidents involving fatalities estimated at 3.6%. Interesting between-country differences in the prevalence of falling asleep at the wheel emerge: 34.7% in the Netherlands to 6.1 in Croatia, but remain unexplained. A better understanding of the between-country differences is needed urgently. Does it relate to differences in awareness, policies, sleeping habits or traffic characteristics? The identified ‘risk factors’ confirm previous reports and include time of day, age, etc. Two aspects are worth mentioning. Forty-two per cent of falling-asleep events are attributed to poor sleep during the previous night and/or poor sleep in general (34%). This self-reported awareness clearly provides opportunities for a change in behaviour. Furthermore, the STOPbang questionnaire-derived risk for obstructive sleep apnea (OSA) (University Health Network, Toronto, ON, Canada) was related to the risk for falling asleep. European legislation will require that the OSA risk of all driving licence holders, i.e. commercial and non-commercial drivers, are assessed and that those with moderate to severe sleep apnea are treated adequately before being allowed to drive. Although this is to be welcomed, we should not forget that most incidents of falling asleep at the wheel appear not to be related to OSA but to other factors, including modifiable lifestyle factors. The take-home message must be: ‘don’t drive when you feel sleepy, whatever the cause may be’.