Employee/Employer Interactions and Responsibilities with Special Reference to Genetically Related Sleep Disorders

Although genetic diseases are not communicable in the ordinary sense, the genetic profile of some individuals can influence them to act in ways that can cause direct harm to third parties. Significant scholarly work is beginning to address ethical, legal, and social issues raised by a person's genetic susceptibility to engage in sociopathic and other forms of intentional or criminal behavior.[1] Another major type of direct harm to third parties that may be causally related to an individual's genetic endowment 6is the harm caused by accidents. (In the language of the law, the former work deals with crimes and intentional torts, while this project relates to accidental negligent or reckless torts.)

Each year, approximately 94,000 Americans die and 19 million are injured as the result of accidental injuries, which include personal injuries in the workplace, motor vehicle crashes, and disasters in the transportation industry.[2] The economic costs are estimated at $480 billion per year; noneconomic costs exceed one trillion dollars.[3]

No estimate has been made of the proportion of these accidents that are the result, at least in part, of genetic factors. However, several genetic factors are known or suspected. For example, it is well known that genetic factors predispose certain individuals to develop disorders whose symptoms include accident-prone behaviors. These include Alzheimer's disease,[4] alcoholism,[5] epilepsy,[6] vision impairments,[7] and the movement disorders associated with Huntington's disease.[8] In addition, studies currently are underway at the National Institutes of Health on the relationship between novelty-seeking, impulsivity, and criminal behavior. Similar inclinations toward risk-taking could incline individuals toward behaviors that cause accidents. It can also be expected that further genetic correlates with accident-causing behavior will be discovered in the future.

One physiologic cause of accidents that is receiving considerable attention in the policy arena is sleep disorders. Sleepiness is a causative factor in as many as 3% of all U.S. motor vehicle accidents.[9] Accident victims receiving emergency room care are more likely to have sleep apnea than a control population (odds ratio = 6.3).[10] Many sleep disorders are known or believed to be inherited. Genes for the human disease ``narcolepsy'' (a neurologic disorder of excessive daytime sleepiness and cataplexy known to cluster in families and in persons with specific inheritance of immune markers) are very likely to be discovered in the near future. Work is underway to locate genes responsible for other sleep disorders such as obstructive sleep apnea/hypopnea syndrome, dissociated REM sleep, restless legs syndrome, and parasomnia, all of which show patterns of inheritance.[11] Genetic testing for sleep disorders may be particularly important because, unlike with alcohol- or drug-induced accidents, there are no current physiologic measures for sleepiness in the immediacy of accidents, such as automobile crashes.[12] Instead, sleepiness is identified based on questionnaires and electrophysiological measures, which are not conducive to the immediate prevention of accidents nor to the detection of those at risk. Systems are under development to measure sleepiness in occupations such as commercial and noncommercial driving, where the costs of a fall-asleep accident are high.[13] These include brain-wave monitors and devices that identify steering deviation and line drift. This technology is not yet proven, however, and may be costly.

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