Understanding sleep-related attentional failures while driving in young drivers and associations with motor vehicle crashes, near misses, and nocturnal sleep

Sleep-related attentional failures are a significant contributor to road traffic fatalities, with young drivers disproportionately affected. This study explored psychological and behavioral correlates of attentional failures while driving among a geographically diverse sample of high school students. A cross-sectional survey of 923 licensed high school drivers across the United States assessed attentional failure-related behaviors, behavioral intentions, beliefs (attitudes, social norms, self-efficacy), sleep behaviors, and history of both a near miss and crash. Adjusted logistic regressions examined predictors of attentional failure-related behaviors and intentions, as well as associations between the behavior, sleep, and near miss/crash history. Participants were 50.9% female, 43.9% male, and 5.2% other. High school drivers were between 16 and 20 years of age or older, with the most commonly reported age being 18 years (50.5%). Most participants (80.1%) reported never having attentional failures, while 19.9% reported doing so with any frequency. Logistic regression revealed that unfavorable attitudes (aOR: 0.82, 95%CI: 0.75–0.88), social pressure to avoid falling asleep while driving (aOR: 0.58, 95%CI: 0.51–0.66), and self-efficacy beliefs regarding the ability to avoid falling asleep while driving (aOR: 0.64, 95%CI: 0.57–0.73) were inversely associated with reports of attentional failures. Surprisingly, long sleep (> 10 h) on school (aOR: 2.8, 95%CI: 1.6–4.8) and weekend nights (aOR: 4.1, 95%CI: 2.4–6.7) was associated with an increased risk for sleep-related attentional failures. Use of the snooze alarm on school days (aOR: 2.64, 95%CI: 1.71–4.09) and reports of obtaining insufficient sleep duration most nights per month (aOR: 1.78, 95%CI: 1.22–2.59) were associated with increased reports of attentional failures. Reports of attentional failures were associated with near misses (aOR: 2.28, 95% CI: 1.58–3.29) and crashes (aOR: 2.56, 95% CI: 1.69–3.87), with substantially stronger associations observed when attentional failures were due to sleepiness, for near misses (aOR: 5.01, 95% CI: 2.44–10.26) and crashes (aOR: 15.79, 95% CI: 4.61–54.11), respectively. Fortunately, approximately 80% of participants reported never experiencing attentional failures, yet those who did report sleep-related attentional failures were associated with poor sleep health and history of near misses and crashes. Future research is needed to support sleep health in young people.