Insomnia, fatigue, and risky driving behaviors among professional drivers: A cross-sectional study in Tunisia

Professional drivers worldwide face elevated risks of sleep disturbances and fatigue due to demanding occupational conditions, contributing significantly to road traffic trauma. In Tunisia, where professional drivers are involved in nearly a quarter of all accidents but account for almost a third of fatalities, research in this North African context remains critically limited.

This cross-sectional study examined the prevalence and associations of insomnia, fatigue, and risky driving behaviors among 387 professional drivers in Tunisia (mean age 42.3 ± 10.8 years; 99.7% male). Participants completed validated questionnaires including the Insomnia Severity Index (ISI), structured fatigue assessments, and risky driving behavior scales.

Results revealed that 34.6% of drivers experienced clinically significant insomnia, with 18.3% reporting moderate-to-severe symptoms. Excessive fatigue while driving was reported by 41.3% of participants, with truck drivers showing the highest prevalence (51.4%). Binary logistic regression analyses demonstrated that insomnia severity (AOR = 2.84, 95% CI: 1.76-4.58, p < 0.001), younger age (<35 years; AOR = 2.12), longer weekly work hours (>60 h; AOR = 1.89), self-employment status (AOR = 1.71), frequent night driving (AOR = 1.68), and short sleep duration (<6 h; AOR = 2.45) were significantly associated with excessive fatigue during driving. Fatigue, in turn, was strongly associated with risky driving behaviors, including drowsy driving (AOR = 7.35, p < 0.001), speeding (AOR = 2.81), mobile phone use (AOR = 2.59), and tailgating (AOR = 2.35).

These findings underscore the critical need for multi-level interventions targeting sleep health among Tunisian professional drivers, including workplace schedule optimization, insomnia screening and treatment programs, and strengthened regulatory enforcement of work hour limits.

This study provides the first systematic evidence linking insomnia, fatigue, and driving safety in the North African context, contributing essential baseline data for culturally appropriate intervention development.