{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:01:08Z","timestamp":1785438068936,"version":"3.56.0"},"reference-count":25,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004410","name":"Scientific and Technological Research Council of T\u00fcrkiye","doi-asserted-by":"publisher","award":["7180670"],"award-info":[{"award-number":["7180670"]}],"id":[{"id":"10.13039\/501100004410","id-type":"DOI","asserted-by":"publisher"}]},{"award":["7180670"],"award-info":[{"award-number":["7180670"]}],"id":[{"id":"https:\/\/ror.org\/04w9kkr77","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Obstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle accidents, traditionally attributed to excessive daytime sleepiness (EDS). However, subjective sleepiness may be underreported and does not consistently reflect functional impairment. We aimed to examine the association between objectively measured drowsiness during simulated driving and traffic accidents in OSA, and to compare the predictive roles of objective drowsiness, subjective sleepiness, and OSA severity. Methods: Fifty-one male drivers underwent overnight polysomnography followed by a 50-min driving simulation. OSA severity was categorized as moderate-to-severe (AHI \u2265 15 events\/h) or no\/mild (AHI &lt; 15 events\/h). A frontal camera captured facial expressions. Drowsiness was quantified using eye-closure-based metrics: PERCLOS, the ratio of frames with closed eyes to total observable frames, and CLOSDUR, representing eye-closure duration. Drowsiness was defined as PERCLOS \u2265 0.3 or CLOSDUR \u2265 2 s. Drowsiness-related traffic accidents were recorded. Multivariable logistic regression models were adjusted for age, body mass index, Epworth Sleepiness Scale (ESS), and total sleep time. Results: Drowsiness-related traffic accidents occurred more frequently in participants with moderate-to-severe OSA than in those with no or mild OSA (72.2% vs. 40.0%, p = 0.030). Drowsiness duration, but not ESS, was positively associated with the number of traffic accidents (r = 0.46, p = 0.001). While continuous AHI was not associated with accidents, moderate-to-severe OSA was independently associated with higher accident risk (adjusted OR 6.45, 95% CI 1.43\u201329.13; p = 0.015). Conclusions: Driving-related accident risk in OSA was associated with objectively measured drowsiness and moderate-to-severe disease, whereas subjective sleepiness assessed by the ESS showed no significant association. These findings suggest that functional impairment, rather than self-reported symptoms, may be more relevant for identifying high-risk drivers.<\/jats:p>","DOI":"10.3390\/jcm15135116","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T10:41:01Z","timestamp":1782902461000},"page":"5116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Moderate-to-Severe OSA and Objective Drowsiness Are Associated with Driving-Related Accidents, but Not Subjective Sleepiness: A Simulator Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Erdal","family":"Aksoy","sequence":"first","affiliation":[{"name":"Department of Administration and Forensic Medicine, Koc University Hospital, 34450 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Semih","family":"Arbatli","sequence":"additional","affiliation":[{"name":"Graduate School of Sciences and Engineering, Koc University, 34450 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4041-4529","authenticated-orcid":false,"given":"Yeliz","family":"Celik","sequence":"additional","affiliation":[{"name":"Koc University Research Center for Translational Medicine, Koc University, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2468-2627","authenticated-orcid":false,"given":"Nur Yasin","family":"Peker","sequence":"additional","affiliation":[{"name":"Department of Mechatronics Engineering, Sakarya University of Applied Sciences, 54050 Sakarya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baran","family":"Balcan","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9067-6538","authenticated-orcid":false,"given":"Y\u00fcksel","family":"Peker","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Koc University School of Medicine, 34010 Istanbul, T\u00fcrkiye"},{"name":"Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden"},{"name":"Department of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, 22100 Lund, Sweden"},{"name":"Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.jacc.2024.02.059","article-title":"Interactions of Obstructive Sleep Apnea With the Pathophysiology of Cardiovascular Disease, Part 1: JACC State-of-the-Art Review","volume":"84","author":"Javaheri","year":"2024","journal-title":"J. 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