New twist in fatigue study seeks reactions

Monday, April 9, 2007 | 12:00 a.m. CDT; updated 7:16 a.m. CDT, Saturday, July 19, 2008

Daniel Vinson wants other scientists and researchers to prove that his study of the relationship between fatigue and injury is wrong. After all, it suggests that the sleepier you are, the less likely you are to suffer an injury.

The study, published in the January 2007 issue of The Journal of the American Board of Family Medicine, found that, as expected, getting a good night’s sleep was associated with a lower risk of injury. However, Vinson was startled to learn that “feeling sleepy” was not necessarily related to increased injury, but may in fact result in lower risk.

“I want researchers to be upset with this,” said Vinson, an MU professor of family and community medicine. “I want them to say, ‘I’m going to look into this and prove him wrong’” by challenging his findings with research of their own.

It appears that others are willing to take him up on the offer.

Judith Owens, a pediatrician and associate professor at Brown University, studies the effects of sleep deprivation and fatigue. Owens serves as a “sleep expert” for the National Sleep Foundation in Washington, D.C.

“This really flies in the face of a substantial amount of research that suggests such a relationship (between fatigue and injury) exists,” Owens said. “This scope of this study is too small to make any generalizations.”

Vinson’s study was based on interviews with more than 2,000 emergency room patients in three Columbia hospitals and more than 1,800 phone interviews with local residents between 1998 and 2000. The study, funded in part by the National Institute on Alcohol Abuse and Alcoholism, assessed the sleepiness of subjects according to amount of sleep, quality of sleep and overall fatigue.

About a quarter of the subjects’ injuries were the result of auto accidents, leading to one of the more intriguing findings of Vinson’s study: Driver fatigue was not associated with a greater incidence of injury.

However, he cautions, the study suggests only an associative correlation between sleep deprivation and injury, not a direct causation.

“One cannot assume this means that injury is decreased because of a lack of sleep,” Vinson said. “It only says there is some kind of association. This may mean that people are sitting out of a sports game or pulling over their car when they get tired.”

The study also may contain errors caused by a subject’s inability to accurately remember sleeping habits or feelings of fatigue that occurred one or more days before interviews with Vinson.

“I do not consider this a definitive study,” Vinson said. “There is great potential for plain error, but it does pose a problem for future research to address.”

Phil Lupo, an editorial assistant for The Journal of the American Board of Family Medicine, said he had not received any inquiries or comments concerning the article. So far, Lupo said, only about 435 people people have accessed the study via the online journal.

However, Owens said she would encourage other researchers to examine how other research responds to the findings. She said research she and others have conducted demonstrate a “clear correlation” between injury and lack of sleep, especially among children.

“I have no problem with publishing results that challenge the norm,” she said, “but this is challenging ... a particularly healthy common sense.”

Vinson doesn’t argue that. He says everyone should continue to consider sleepiness a risk for injury. After all, his data could suggest tired drivers are pulling over instead of plowing ahead.

“If I’m in my car and I’m tired, I’ll still pull over,” he said. “Thinking I should keep going would just be stupid.”

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