Poorer objective but not subjective driving performance in drivers vulnerable to sleep loss effects during extended wake

Sleepiness-related errors are a leading cause of driving accidents, requiring drivers to effectively monitor sleepiness levels. However, there are inter-individual differences in driving performance after sleep loss, with some showing poor driving performance while others show minimal impairment. This research explored if there are differences in self-reported sleepiness and driving performance in healthy drivers who exhibited vulnerability or resistance to objective driving impairment following extended wakefulness. Thirty-two adults (female = 18, mean age = 33.0 ± 14.6 years) completed five × 60-min simulated drives across 29-hr of extended wakefulness. Subjective sleepiness (Karolinska Sleepiness Scale) and subjective driving performance ratings (nine-point Likert scale) were assessed at 10-min intervals while driving. Cluster analysis using simulator steering deviation and crash data categorised participants as vulnerable (n = 16) or resistant (n = 16) to driving impairments following extended wakefulness. No differences in self-ratings between the vulnerable and resistant groups were observed except during the last drive (25 hr awake), where the vulnerable group reported higher sleepiness (p = 0.008) and worse driving performance (p = 0.001) than the resistant group. For each 1-point increase on the Karolinska Sleepiness Scale and subjective driving scales, the vulnerable group showed about threefold greater steering impairment relative to resistant drivers. Although self-reported sleepiness and driving performance were correlated with objective driving performance, vulnerable drivers reported similar sleepiness and driving performance as resistant drivers. Thus, self-reported sleepiness and driving performance are not reliably sensitive to sleep loss effects on objective driving performance, which may impact the vulnerable driver's decisions to continue driving and delay engagement in countermeasures to reduce crash risk (e.g. napping), warranting further research.