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The relationship between sleep apnoea and sleep-related performance impairment and crashes


Sleep apnoea is defined by the American Psychiatric Association as a breathing-related sleep disorder which causes sleep disruption leading to excessive sleepiness (DSM-IV TR: American Psychiatric Association, 2000). Due to these effects the relationship between sleep apnoea and crashes has been extensively studied. As the results of this body of research are relatively consistent a sample of the most relevant studies are summarised in Table 5 .13. The evidence related to sleep apnoea and crash risk or driver impairment indicates that sleep apnoea is likely to lead to impairment in driving performance as well as increased risk of crash. The reason for this relationship may be due to a number of factors including poor quality sleep and excessive sleepiness.

The finding that sleep apnoea leads to increased crash risk is of particular concern in the trucking industry as sleep apnoea is prevalent within the trucking population and truck drivers are more likely to develop sleep apnoea due to lifestyle factors. Sleep apnoea may also interact with other sleep-related crash risk factors found more commonly in truck drivers leading to even greater crash risk.

The research findings presented in Table 5 .13 also demonstrate that treatments for sleep apnoea can be effective in reducing the increased risk of crash associated with the disorder. Continuous Positive Airway Pressure (CPAP) is one particular therapy that has been focused on in previous research and shows promising results, however not all sleep apnoea patients respond to CPAP therapy and therefore other interventions should also be considered.

Substance use


Studies regarding heavy vehicle drivers’ use of legal and illegal substances are somewhat contradictory. Crash statistics (see Table 1 .1) indicate that heavy vehicle drivers involved in crashes are less likely to have used illicit substances compared to the drivers of the passenger vehicles that are involved in crashes. However, these statistics also indicate that in crashes where the heavy vehicle driver is at fault the incidence of illicit substance use appears to be much higher. To further cloud the issue, research regarding the substance use of HV drivers tends to suggest that the prevalence of substance use amongst this population is at least comparable to the broader Australian population. Given the general prevalence of substance use in Australia it would be expected that some substance users will appear in the workforce in general and, therefore, within the HV industry however, this problem is not isolated to the HV industry. Taken as a whole this evidence at least suggests the presence of a sub-population of substance using drivers who have an increased risk of crashing compared to drivers who do not use substances.

Further evidence regarding substance use by HV drivers suggests the following:



  • The substances most commonly used by HV drivers are stimulants (e.g., amphetamines, stay-awake-pills, pseudoephedrine, etc.) with around 25-35% of HV drivers reporting that they generally use these substances to combat fatigue.

  • Substance use may differ among different sub-populations of HV drivers. For example, the prevalence of stimulant use appears to be higher among long-haul drivers, drivers who work through the night, and drivers whose payment is contingent on the amount of work they do, while younger drivers are generally more likely to use illicit substances.

  • There is little published literature providing details of current substance use management practices. Although there is mention of zero tolerance policies towards substance use, there is a lack of published information on testing regimes (mandatory or otherwise).

Table 5.10
Human factors in heavy vehicle road safety


Author

Type

Availability

Research

Findings

Symmons, Rose, & Van Doorn (2009)

Report

Public

An evaluation of the benefits observed during a trial of ecodriving with heavy vehicle drivers involving follow-ups at 6 and 12 weeks and control group comparisons.

Improvements were observed in the following areas: fuel use, number of braking applications, and number of gear changes. No sacrifice in overall speed or driving time were observed.

Effects remained at the 12 week follow up and in some cases progressive improvements were observed.



Symmons & Rose (2009)

Conference paper

Public

Outlines the results of an ecodrive training course for heavy vehicle drivers.

Drivers reduced fuel consumption by 27%, the number of gear changes by 29% and number of brake applications by 41%.

No increases in travel time were observed.

Members of a control group comparison used more fuel, changed gears more, and applied their brakes more often.

Safety benefits were inconclusive.



Watanabe, Matsunaga, Shidoji, Matsuki, & Goshi (2005)

Journal article

Public

Describes a driver support system designed to warn drivers when the headway between the truck and vehicle it is following is shorter than the recommended stopping distance.

Assessment of the ASSIST system successfully increased following distance by warning the driver to increase the gap.

Hickman (2005)

Conference paper

Public

An evaluation of the impact of a self-management for safety process for short haul truck drivers. Pre-driving intentions were self-reported prior to leaving the terminal. Post-driving measures of actual driving behaviour was recorded using an on-board computer monitoring device measuring speeding and extreme braking.

During the intervention the pre-driving group reduced their mean percentage of time speeding by 30% and mean braking percentage by 64%. The post-driving group reduced mean speeding percentage by 20% and their mean extreme braking percentage by 50%.

Winkler, Sullivan, Bogard, & Hagan (2004)

Conference paper

Public

Examines the influence of speed, load condition and individual driving style on the lateral performance of truck drivers. Uses data recorded from six tractor-semitrailer combinations that were heavily instrumented and tracked for one year.

Interesting asymmetries in lateral performance are presented.

Other factors identified as having a significant influence on lateral performance include weather, lighting, and turn direction.



Kuncyte, Laberge-Nadeau, Crainic, & Read (2003)

Journal article

Public

This paper outlines the approaches to truck driver training for the transportation of dangerous goods that have been adopted in the U.S., Canada, The Netherlands, and Sweden.

In Canada and the U.S. the responsibility to ensure drivers are adequately trained lies with the employer; driver assessment is also an employer responsibility. Many employers use commercial training firms, however there is no accreditation scheme for these programs.

In Europe training and testing must receive national accreditation, however the details of this accreditation are not clearly spelled out.

Sweden places an emphasis on the accreditation of those providing training.

The Netherlands places emphasis on the examinations used to assess the results of training.

The same goal in four different countries has resulted in four different schemes.


Lang (2007)

FMCSA technical brief

Public

A synthesis of knowledge regarding heavy vehicle driver training strategies intended to identify driver training tools and techniques with the greatest potential for improving the safety of commercial motor vehicles.

Recommendations:

Industry-wide acceptance of and adherence to recognised standards for minimum requirements for drivers and driver trainers.

Completion of training for 1st seat drivers.

Replace printed classroom materials and practices with multimedia instructional tools.

Expansion of the use of skid pads in driver training.

Integration of video and experienced driver testimonials to provide a realistic introduction/orientation to fitness to drive.



Hickman, Hanowski, & Bocanegra (2010)

FMCSA report

Public

A study of the prevalence of mobile phone distractions and the risk associated with driving performance tasks utilising naturalistic data from buses and trucks.

Talking/listening on a mobile phone while driving was generally not found to significantly impact the odds of involvement in a safety-critical event.

Mobile phone sub-tasks such as texting, dialling, and reaching for the phone were found to significantly increase the odds of involvement in a safety-critical event.



Cook, Hoggins, & Olson (2008)

Journal article

Public

An observational study of heavy commercial vehicle drivers’ seat belt use.

Observed seat belt usage rate was 64%, approximately 20% lower than national (US) rates for passenger vehicle drivers.

Poulter, Chapman, Bibby, Clarke, & Crundall (2008)

Journal article

Public

Uses the Theory of Planned Behaviour to understand factors that influence truck drivers’ behaviour and compliance with regulations.

Law abiding behaviour was related more to attitudes, subjective norms, and intentions.

Perceived behavioural control had the largest direct effect on compliance with UK truck regulations.

Future interventions that seek to improve on-road behaviour or compliance with regulations require different approaches.


Howarth, Alton, Arnopolskaya, Barr, & Di Domenico (2007)

FMCSA report

Public

A literature review of the non-regulatory factors that influence the safety of commercial motor vehicle drivers.

Employee turnover is an issue that may lead to poor safety performance associated with inexperienced drivers.

Drivers’ decisions to stay with an organisation were largely based on the compensation they received; carriers that paid better wages were more likely to retain drivers.

A driver’s driving history is an important factor with future crash involvement being predicted by past driver behaviours, particularly prior involvement in a crash.

Increased pay was also associated with a reduction in crashes, although the mechanisms for this interaction were the subject of speculation.

Safety management best practices were also important, particularly commitment to safety by management, employee involvement, prioritising safety through all aspects of operations, and making safety management a continuous process.


Brock, McFann, Inderbitzen, & Bergoffen (2007)

Book

Public

Evaluates the effectiveness of commercial motor vehicle driver training curricula and delivery methods.

There are no national standards on content however there is a general consensus across the industry regarding the core content of training curricula.

The preferred method of training involves a combination of classroom lectures and supervised driving, however these approaches do not incorporate many of the advances in adult learning and instructional techniques.

There is a tendency to use older experienced drivers as instructors, however there is no evidence that someone who is a job expert is necessarily a good teacher.

There is a lack of standards for measuring the effectiveness of driver training programs beyond simply how many graduates pass their CDL test.



Hagge & Romanowicz (1996)

Journal article

Public

An early evaluation of the traffic-safety impact of the California Department of Motor Vehicles' Commercial Driver License (CDL) program introduced in 1989.

The CDL program did not have a significant effect on traffic safety.

Kim & Yamashita (2007)

Journal article

Public

A survey of 791 commercial vehicle drivers regarding their attitudes towards seat belt use.

67% reported always using a seat belt when driving a commercial vehicle.

The major reasons reported for not wearing a seat belt included stopping frequently, inconvenience, and not being safety conscious.



Burgewood Ltd (2005)

NTC discussion document

Public

Examines the links between seat comfort and seat belt use among HV drivers.

There are some commonly held assumptions about seat and belt configurations that, when tested, do not hold up.

Other misconceptions, including the perception that wearing seat belts is dangerous, also contribute to low rates of compliance with seat belt laws.

There are a range of options to address better seat belt design that may help remove the perceived barriers to seat belt use.


Haworth, Bowland, & Foddy (1999)

Report

Public

A study of truck driver seat belt wearing based on interviews with 184 truck drivers.

72% of drivers reported never using a seat belt in the truck they were driving. 16% indicated that the seat belt had been removed or one was never fitted.

4% of drivers reported wearing a seat belt all the time.

Drivers of rigid trucks were more likely to report using a seat belt compared to articulated truck drivers.

Reasons for not wearing: 35% indicated that seat belts were uncomfortable, 27% believed they had no safety value or were dangerous.

Reasons for wearing included safety or enforcement consequences.


Krueger, Bergoffen, Knipling, Hickman, Short, Murray, Inderbitzen, & Reagle (2005)

Conference paper

Public

Interviews and surveys were used to obtain HV drivers and fleet safety managers opinions regarding HV drivers’ use of seat belts.

The findings confirm many of the issues already reported in other studies throughout the literature base.

An ergonomics assessment of the most commonly found seat belts in class 8 trucks was also undertaken.



Bergoffen, Knipling, Tidwell, Short, Krueger, Inderbitzen, Reagle, & Murray (2005)

Book

Public

A synthesis of research focussing on the factors that influence commercial vehicle drivers’ decisions to wear seat belts and potential areas for improving seat belt use amongst these drivers. Involved interviews with managers, drivers, and an ergonomic assessment of old and new seat belt technologies.

The majority of drivers indicated that they wore seat belts either all or most of the time. Their reasons for wearing included safety, because it was the law, it was habit, and they had seen or been involved in a crash.

The major complaints of drivers regarding seat belts were that the belt: rubs or vibrates against the neck or shoulder, locks, is uncomfortable, is too tight, and has a limited range of motion.

Drivers indicated seat belts would be easier to use if they were not too tight, did not interfere with driving, were easy to put on or off, and easy to position.

Ergonomic assessment indicated that the majority of seat belts were practical and functional; newer belts have features that make them more user friendly and older belts are not as effective with large- or small-statured individuals.

It was also found that drivers were not fully aware of the features that made seat belts comfortable and easy to use..

New technologies for seat belt comfort and design are also discussed.



MacLeod (2002)

CTHRC report

Public

An investigation to identify learning needs in the professional driver and dispatcher work force.

A significant number of professional drivers have poor literacy skills, particularly for workers aged 40-50 with low levels of formal education.

Outlines the essential skills required for the trucking industry.



MacLeod & Kline (2004)

CTHRC report

Public

Investigates the relationship between the reading text, document use, and numeracy skills of 231 petroleum professional drivers and the likelihood of having a safety incident.

There is a correlation between essential skills proficiency and the likelihood of having a safety incident.

Drivers who did not meet or exceed the upper end of the reading text standard or the document use standard were 1.58 and 1.69 times respectively more likely to have been involved in a safety incident than drivers who met these standards.

Older drivers had poorer skills in each of the domains.

Drivers with more years of formal education had better skills in each of the domains.


Table 5.11


Health and fitness to drive/fitness for duty


Author

Type

Availability

Research

Findings

Dionne, Desjardins, Laberge-Nadeau, & Maag (1995)

Journal article

Public

A study estimating the effect of different medical conditions on truck drivers’ distribution of crashes. The study controlled for age, medical conditions, and exposure factors.

Truck drivers with diabetes licensed to drive straight trucks had more accidents than drivers of good health.

None of the other medical conditions examined in the study had a significant effect on crash distributions.

Many of the risk exposure variables were also significant.


McKnight, Shinar, & Hilburn (1991)

Journal article

Public

A comparison of the performance of 40 monocular and 40 binocular tractor-trailer drivers on measures of visual acuity and driving performance.

On the visual measures monocular drivers were deficient in a number of areas.

Of the driving measures monocular drivers did not perform as well as binocular drivers only in the aspect of sign-reading distance, a task that was correlated with binocular depth perception.

Monocular drivers are not significantly worse than binocular drivers in terms of the safety of most day-to-day driving tasks.


Duke, Guest, & Boggess (2010)

Journal article

Public

A review of age related and other safety factors contributing to the crashes of heavy vehicle drivers.

Drivers younger than 27 years of age were found to have higher rates of crash/fatality involvement.

Increased rates of crash/fatality involvement were also observed for drivers aged 63 years or more.

Other factors contributing to HV crashes included long hours and sleepiness and fatigue, vehicle configuration (particularly multiple trailers), employer safety culture, urbanisation, and road classification.


Hilton, Staddon, Sheridan, & Whiteford (2009)

Journal article

Public

A study of the impact of mental health symptoms on the performance of heavy goods vehicle (HGV) drivers. 1324 HGV drivers were surveyed.

Depression, anxiety, and stress were found to have little effect on absenteeism or self-rated driving performance.

Severe (1.5% of drivers) and very sever (1.8% of drivers) depression was associated with an increased risk of being involved in a crash or near miss in the past 28 days by 4.5 and 5 times respectively .

Given the number of HGVs and the prevalence of depression it is estimated that there are 10,950 HGV drivers with an increased statistical risk of a crash or near miss.


National Transport Commisssion (2010)

Report for comment

Public

Outlines the key changes and impact of changes to the assessment of fitness to drive, particularly a shift in emphasis towards functionality rather than simply diagnosis.

Driver licence authorities: increasing the emphasis on functionality rather than diagnosis and improving the clarity of medical criteria will simplify the application of the standards and improve administrative efficiency.

Health professionals: A focus on driving ability rather than disease diagnosis may require more professional judgement and input to the driver licensing authorities, but will improve the useability of the standards.

Drivers: A focus on function rather than diagnosis will facilitate a more relevant assessment of drivers.


Meuleners & Lee (2008)

Book chapter

Public

Documents the health profile of heavy vehicle drivers and identifies relevant work place issues based on data collected from 302 drivers in Western Australia.

The majority of drivers were either overweight or obese and engaged in low levels of physical activity, if any.

Around 50% were smokers, 58% suffered from tiredness while driving and 56% slept less than 6 hours per day.

51% did not eat the recommended daily amounts of fruits and vegetables.

53% reported chronic illness and 19% experienced a work-related injury requiring medical treatment in the past 12 months.

Companies rarely provided medical check-ups for their drivers.


Robinson & Burnett (2005)

Journal article

Public

Uses US mortality data to calculate proportional mortality ratios for heart disease and lung cancer for short and long-haul drivers.

The highest significant excess proportionate mortality for lung cancer, ischemic heart disease, and acute myocardial infarction was found for drivers who were under 55 years of age at death.

Moreno, Louzada, Teixeira, Borges, & Lorenzi-Filho (20060

Journal article

Public

A study to verify the association between sleep patterns and factors associated with obesity in 4,878 Brazilian truck drivers.

28% of truck drivers in the study were obese (BMI ≥30 kg/m2).

25% of drivers were on medications and 7% were diabetic.

Drivers with the greater BMI also exhibited short sleep length.

Factors associated with obesity included sleep duration of less than 8 hours per day, being over 40 years old, glucose levels over 200, cholesterol levels greater than 240, snoring, and hypertension.

Short sleep duration and being over 40 years old is associated with obesity and a number of other health care problems.


Laberge-Nadeau, Dionne, Maag, Desjardins, Vanasse, & Ekoe (1994)

Conference paper

Public

Study of the association between commercial vehicle drivers’ medical conditions and crash severity.

Truck drivers with binocular vision problems and bus drivers with hypertension were involved in more severe crashes than healthy drivers.

Variables describing crash circumstances were also significant.



Mackie & Moore (2009)

Conference paper

Public

Reports on the health issues identified for New Zealand log truck drivers, and also provides the preliminary findings of an evaluation of a driver fitness program “Fit for the road”.

Twice as many log truck drivers were obese compared with New Zealand males of similar age.

“Fit for the road” has had a positive impact on the lives of participants.

Work is needed to address wider systemic issues within the industry that may affect drivers’ health and well-being.


Gillett (2008)

Report

Public

A study to identify the prevalence of mental health disorders in NSW transport workers.

Truck drivers were found to have a slightly lower prevalence of moderate or high psychological distress than the Australian workforce in general.

13% of truck drivers were found to have some degree of depression; 91% of these were not in treatment.

HGV drivers were also found to have substantial barriers to treatment.

Being divorced increased the odds of a driver being depressed or experiencing symptoms of anxiety.

27% of NSW truck drivers were identified as having the potential for hazardous or harmful alcohol use. 24% were considered mild and 1% were in the highest risk category.

Alcohol use was significantly related to anxiety levels.

Drivers aged 34-45 years old had an increased risk of hazardous or harmful alcohol use.

Being a casual HGV driver increased the odds of crashing when compared to full or part-time drivers. Mild to severe alcohol use also increased the risk of crashing.

Depression symptoms had the largest effect on risk of crashing or having a near miss.

On average NSW truck drivers work longer hours during the week compared to other Australian full-time employees. The number of hours a truck driver worked was directly related to increased stress levels.

12% of drivers indicated the use of a drug either daily or weekly. Drivers’ marijuana use was similar to that of the general population, however drivers’ use of all other drug types was found to be at least double that of population norms.

Drivers aged 25-34 years old or 65 years and older reported the highest levels of drug use in the past month.

Other risk factors for drug use were: being single, being an owner/operator long haul driver, and working more than 80 or less than 40 hours per week.


Husting (2005)

Conference paper

Public

A summary of recent findings and research regarding truck driver health and wellness.

Factors related to work organisation have the potential to impact driver well-being, increase drivers’ lack of fitness, increase fatigue and inattention, reduce quality of life and longevity, and increase anxieties about, and exposure to violence.

Appropriate well-designed interventions and evaluations are needed to clarify and rectify these issues.



Orris, Buchanan, Smiley, Davis, Dinges, & Bergoffen (2005)

Book

Public

A literature review of health and fatigue issues for commercial motor vehicle drivers.

Lung cancer may be caused by exposure to diesel exhaust with longer exposure increasing the likelihood that a cancer will develop.

There is some evidence that cardiovascular disease is caused in part by truck driving. The risk of cardiovascular disease increases with the length of time spent driving trucks.

Disruption of circadian rhythms may have a negative impact on the general health of workers and may influence gastrointestinal disorders.

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