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Sleep debt, sleepiness and accidents among males in the general population and male professional drivers
Abstract
Men from the general population and male professional lorry and bus drivers were surveyed with regard to sleep habits and motor vehicle and other types of accidents. A random sample of 4000 men in the general population of Dalarna County in mid-Sweden were mailed a questionnaire and served as referents. A total of 1389 male professional lorry and bus drivers from this county responded to the same questionnaire. A total of 161 of the drivers also underwent a sleep study in their homes. The proportion of total accidents was higher among the professional drivers as compared with the males in the population, P=0.03. Reports on traffic accidents were the same in both groups, but the professional drivers reported more accidents at leisure compared with referents, P<0.0001. Accidents of any kind, traffic accidents included, among those affected by both snoring and apneas, were not reported more in either of the groups. At the sleep study, 17% of those examined received the diagnosis of obstructive sleep-apnea syndrome (OSAS). The professional drivers reported proportionally more sleep debt than the referents, P<0.001. Among referents, traffic accidents at leisure, traffic accidents while commuting and accidents at work increased in proportion to sleep debt (P<0.001, 0.006 and 0.002, respectively). The finding that self-perceived sleep debt may have an adverse effect on males in the general population and male professional drivers concerning accident likelihood should have an impact on prevention. These results stress the need to educate the general population on the importance of complying with our biological need of sleep.
... 3 (2)(3)(4) sichtlich der Gesamtpunktzahl im PSQI (p = 0,038) auf, was insbesondere auf die Schlafdauer (p = 0,004) sowie die Schlaflatenz zurückzuführen war (p = 0,008; . Tab. 7). ...
... 7,0 ± 2,2 5,6 ± 3,3 Gesamtpunktzahl PSQI 7 (3)(4)(5)(6)(7)(8)(9)(10) 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) 0,038 ...
... 7,0 ± 2,2 5,6 ± 3,3 Gesamtpunktzahl PSQI 7 (3)(4)(5)(6)(7)(8)(9)(10) 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) 0,038 ...
Zusammenfassung
Hintergrund
Berufskraftfahrer*innen im Personenverkehr sind bei ihrer Arbeit diversen Belastungen ausgesetzt. Dazu gehören neben dem Schichtdienst unter anderem die hohe Verantwortung gegenüber den Fahrgästen oder auch die Gewährleistung von Pünktlichkeit mit der Einhaltung von Fahrplänen. Ziel dieser Arbeit ist es, psychische Beanspruchungsfolgen bei Bus- und Straßenbahnfahrer*innen mit Schichtdienst zu identifizieren und deren Beanspruchungszustand und Schlafverhalten dem von Beschäftigten aus der Verwaltung des gleichen Unternehmens, jedoch ohne Schichtdienst, gegenüberzustellen.
Methodik
An der Studie nahmen 24 Bus- und Straßenbahnfahrer*innen mit Schichtdienst (Alter 46,3 ± 11,0 Jahre) und 29 Verwaltungsangestellte des gleichen Unternehmens ohne Schichtdienst (Alter 46,5 ± 10,5 Jahre) teil. Die subjektive Beanspruchung wurde mit Fragebögen (Pittsburgh Sleep Quality Index [PSQI], General-Health-Questionnaire [GHQ-12], Epworth Sleepiness Scale [ESS] und Erholungsunfähigkeit) erfasst.
Ergebnisse
Bus- und Straßenbahnfahrer*innen klagten über eine signifikant schlechtere Schlafqualität im Vergleich zu Verwaltungsangestellten (PSQI-Gesamtpunktzahl 7,0 ± 2,2 vs. 5,6 ± 3,3 Punkte; p = 0,038). Von den Fahrer*innen wurden 69 % als schlechte Schläfer im Vergleich zu 41 % der Verwaltungsangestellten eingestuft (pChi2\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p_{\text{Chi}^2}$$\end{document} = 0,037). Die subjektiv eingeschätzte psychische Gesundheit, die Tagesschläfrigkeit und auch die Erholungsunfähigkeit unterschieden sich in beiden Gruppen nicht.
Diskussion
Aufgrund des hohen Anteils von Bus- und Straßenbahnfahrer*innen mit eingeschränkter Schlafqualität besteht in diesem Verkehrsunternehmen Handlungsbedarf zur Verbesserung des Schlafes in dieser Berufsgruppe.
... Data were extracted from 10 studies [23,28,42,49,51,54,55,[59][60][61]. In this analysis, the cases were defined as car accidents with OSAS (total of 1000) over the total car accidents (2964), and the controls were defined as non-car accidents with OSAS (total 2093) over total non-car accidents (5328). ...
... Indeed, one study [51] reported a positive significant association, and two [42,54] reported significant negative associations ( Figure 4). [23,28,42,49,51,54,55,[59][60][61]. Events Cases are defined as car accident with OSAS (total of 1000) and Total Cases as car accidents (2964); Events Controls are defined as non-car accidents with OSAS (total 2093) and Total Controls as non-car accidents (5328). ...
... Considering the study design, 2 studies were cross-sectional [23,28] and 8 were casecontrol [42,49,51,54,55,[59][60][61]. In each group, the pooled OR was not significant (crosssectional pooled OR = 2.08, 95% CI 0.59-7.39; ...
Obstructive sleep apnea syndrome (OSAS) is an under-recognized clinical condition and is correlated with sleepiness and impaired cognitive function.
Objectives:
The primary aim of this systematic review, developed within the Sleep@OSA project, was to determine the correlations of obstructive sleep apnea syndrome, daytime sleepiness and sleep-disordered breathing with the risk of car accidents in adult working populations; a secondary aim was to analyze the epidemiologic data with a gender-based approach to identify differences between women and men in the data and in associated risk factors.
Methods:
Clinical trials and studies reporting data on the frequency of car accidents involving adult working population with daytime sleepiness and/or OSAS compared with a control group of participants were included. Literature searches of free text and MeSH terms were performed using PubMed, Google Scholar, the Cochrane Library and Scopus from 1952 to 3 May 2021.
Results and conclusions:
The search strategy identified 2138 potential articles. Of these, 49 papers were included in the qualitative synthesis, and 30 were included in the meta-analysis. Compared with controls, the odds of car accidents were found to be more than double in subjects with OSAS (OR = 2.36; 95% CI 1.92-2.91; p < 0.001), with a similar risk between commercial motor vehicle drivers (OR = 2.80; 95% CI 1.82-4.31) and noncommercial motor vehicle drivers (OR = 2.32; 95% CI 1.84-2.34). No significant correlation was found between sleepiness and car crashes, but subjects with sleep-disordered breathing were at increased risk of car accidents (OR = 1.81; 95% CI 1.42-2.31; p < 0.001). To our surprise, although epidemiological studies on the risk of road accidents in the adult population with OSAS and daytime sleepiness are currently very abundant, specific data on the female population are not available.
... Regarding sleep quantity, sleeping less than 6 hours is a risk factor for traffic accidents in all drivers [19] and professional truck drivers [12]. Additionally, Carter et al. [25] found that traffic accidents, either recreational or commuting to work, and workplace accidents, were related to lack of sleep using self-report accidents among Swedish men. Similarly, the lack of sleep has been linked to impaired driving in simulated commuting trips [14]. ...
... In sum, deficits in sleep quantity and quality-with their adverse effects on people's normal functioning and health-are linked to either workplace and commuting accidents [21,28]. However, this latter association is specifically when workers drive to or from work [25]. Nevertheless, comparing the strength of the relationships between sleep problems and both types of accidents remains an issue. ...
... This raises an essential question about causation: are detriments in sleep quantity causing commuting accidents, or are worse sleep hours a by-product of having had commuting accidents? Although our research does not clarify the direction of the relationship, robust previous evidence shows that sleep problems are a predisposing factor for accidents [11,19,24,25,27]. ...
Background
This study aimed to verify the relationships between sleep problems and both commuting and workplace accidents in workers of both sexes.
Methods
The study was carried out with a sample of workers ( n = 2993; 50.2% female) from the Chilean Quality of Life Survey (ENCAVI) 2015–2016, while the rates of both workplace and commuting accidents were extracted from the statistics of the Superintendence of Social Security (SUSESO 2015; 180,036 and 52,629 lost-time accidents, respectively).
Results
Chilean workers sleep less than the rest of the people in the country ( M W = 7.14 vs. M O = 7.33; t (6789) = − 5.19; p < .001), while the Chilean people as a whole sleep less compared to those of other countries (7.24 h per day). Likewise, it was found that sleep problems are more strongly related to commuting than to workplace accidents. In this vein, sleep quantity can explain 24% of the variance in commuting accidents’ rates (Stepwise Method; R ² = .30, F (1.14) = 5.49, p < .05; β = −.55, p < .05), by using aggregated data with all types of commuting roles (driver of a vehicle, a passenger of public or private transport, or as a pedestrian).
Conclusions
Our findings show that sleep quantity has a more robust relationship with commuting than workplace accidents, a neglected issue so far. Future prevention programs should emphasize sleep hygiene and focus on commuting to and from work.
... Vila och återhämtning påverkar minnet, de kognitiva funktionerna och produktiviteten positivt (53) . Brist på återhämtning, trötthet, sömnbrist och sömnstörningar kan försämra människors fysiska uthållighet, minne, koncentration, och ökar risken för arbetsrelaterade olyckor (54,55) . Skiftarbete riskerar också öka risken för hälsoproblemen och arbetsrelaterade olyckor (56) . ...
... 29,3 procent angav att andra arbetsuppgifter på deras arbetsplatsskulle öka deras möjlighet att arbeta till 69 år eller längre, medan 70,7 procent inte instämde med detta.Det var 39,2 procent som angav att minskning av de mentala arbetskraven skulle öka deras möjlighet att arbeta till 69 år eller längre, medan 60,8 procent inte instämde med detta. 47,8 procent angav att ökad egenkontroll över arbetes utförande skulle höja deras möjlighet att arbeta till 69 år eller längre, medan 52,2 procent inte instämde med detta.Det var 55,9 procent som angav att sänkning av arbetstakten skulle öka deras möjlighet att arbeta till 69 år eller längre, medan 44,1 procent inte instämde med detta.54,0 procent angav att mer återhämtningstid mellan arbetspassen skulle öka deras möjlighet att arbeta till 69 år eller längre, medan 46,0 procent inte instämde med detta.Det var 43,7 procent som angav att förändring av arbetstidens förläggning skulle öka deras möjlighet att arbeta till 69 år eller längre, medan 56,3 procent inte instämde med detta. ...
... According to another survey, over half of the truck drivers worked unrealistic schedules, with more than 50 h of driving each week, and 27% of drivers reported poor sleep quality (Braeckman et al. 2011). Professional drivers were found to have a higher prevalence of sleep debt than control participants (Carter et al. 2003). These examples demonstrate the consequences of prolonged partial sleep loss on MVA risk. ...
Every year, a substantial number of people are killed or injured due to motor vehicle accidents (MVAs). A large number of these collisions are caused by driving errors. Vehicles travel at fast speeds, necessitating the driver’s constant attention and alertness. However, scientific evidence suggests that tired drivers or drivers who drive at unusual hours are more prone to make mistakes. When drivers have sleep disorders such as obstructive sleep apnea (OSA) or central hypersomnolence disorders, the situation worsens. Patients with OSA and narcolepsy have been found to have an increased risk of falling asleep behind the wheel and crashing. Narcolepsy and OSA treatment has increased driver vigilance and minimized the likelihood of MVAs. Motorists susceptible to dozing off while driving can benefit from tests that determine the level of daytime sleepiness or drowsiness while driving. As a result, unambiguous standards must be developed to oversee the periodic assessment of drivers’ risk of falling asleep behind the wheel, particularly commercial drivers.
... One previous study in truck drivers noted a similar magnitude sleep debt of 1 h was not associated with more motor vehicle accidents (Garbarino et al., 2016). However, sleep debt may accumulate across the shift schedule (Onninen et al., 2021) and lead to increased sleepiness and motor vehicle crashes (Carter et al., 2003;Garbarino et al., 2016;Onninen et al., 2021;Sallinen et al., 2004). Therefore, it is important to further assess break-related factors that impact sleep between consecutive work shifts and whether sleep debt accumulates across shift schedules in HVDs. ...
This study aimed to examine the impact of break duration between consecutive shifts, time of break onset, and prior shift duration on total sleep time (TST) between shifts in heavy vehicle drivers (HVDs), and to assess the interaction between break duration and time of break onset. The sleep (actigraphy and sleep diaries) and work shifts (work diaries) of 27 HVDs were monitored during their usual work schedule for up to 9 weeks. Differences in TST between consecutive shifts and days off were assessed. Linear mixed models (followed by pairwise comparisons) assessed whether break duration, prior shift duration, time of break onset, and the interaction between break duration and break onset were related to TST between shifts. Investigators found TST between consecutive shifts (mean [SD] 6.38 [1.38] h) was significantly less than on days off (mean [SD] 7.63 [1.93] h; p < 0.001). Breaks starting between 12:01 and 8:00 a.m. led to shorter sleep (p < 0.05) compared to breaks starting between 4:01 and 8:00 p.m. Break durations up to 7, 9, and 11 h (Australian and European minimum break durations) resulted in a mean (SD) of 4.76 (1.06), 5.66 (0.77), and 6.41 (1.06) h of sleep, respectively. The impact of shift duration prior to the break and the interaction between break duration and time of break were not significant. HVDs’ sleep between workdays is influenced independently by break duration and time of break onset. This naturalistic study provides evidence that current break regulations prevent sufficient sleep duration in this industry. Work regulations should evaluate appropriate break durations and break onset times to allow longer sleep opportunities for HVDs.
... Sleepiness is a major risk factor in road traffic accidents (Bioulac et al. 2017). Among professional truck drivers, difficulties staying alert at work and insufficient sleep are not uncommon (Carter et al. 2003;Mitler et al. 1997;Philip et al. 2002;Pylkkönen et al. 2015). Sleepiness at the wheel for truck drivers can be partly attributed to shift work that causes circadian disruption and limited sleep opportunities (Horne and Reyner 1999). ...
Sleep loss is known to contribute to road traffic accidents. Professional drivers are vulnerable to curtailment of sleep due to long driving bouts and shift work. To fill in the gap in the literature related to the build-up of sleep loss in irregular shift systems, we recorded the sleep and working hours of 47 shift-working long-haul truck drivers during a two-week period. Sleep (time in bed) was verified by actigraphy and sleep logs. Sleepiness was measured using the Karolinska Sleepiness Scale (KSS). Individual sleep need was based on self-assessments. We examined the accumulated sleep versus self-reported sleep need across the study period, using midnights as points of observation, and the accumulated sleep loss within 72h prior to shift end (sleep versus need, SVN72). Across the study period, the drivers’ sleep was close to their self-reported sleep need, but 45% of the drivers showed accumulated sleep loss of >6h at least once. SVN72 averaged -1.5h and was 2.87h shorter in connection with morning shifts compared to day or evening shifts. Night shifts showed no such difference. During days off, sleep exceeded sleep need by 1.13h and was not dependent on the type of preceding work shift. SVN72 showed small-to-medium negative associations with on-duty KSS even after accounting for sleep within the 24h prior to shift end. Our results show that long-haul truck drivers are exposed to severe levels of accumulated sleep loss while working irregular shifts, but they can catch up on their lost sleep especially during days off.
Keywords: long-haul truck drivers, cumulative sleep loss, sleepiness, shift work, recovery, transportation, sleep need
The aim of the present study was to determine the prevalence of insomnia among three United Arab Emirates (UAE) university students, of different majors; namely, Ajman University, University of Sharjah and the American University of Sharjah from March 2021 to June 2021, through comparing components of everyday behavioral activities with their sleep patterns and overall sleep quality. The questionnaire was distributed in two forms; online via the Planet Survey Website and paper-based. Three hundred and eighty out of four hundred, with 95% response rate, UAE university students, 48.7% males and 51.3% females, average aged 24 years completed a questionnaire on insomnia that includes sociodemographic, the Pittsburg Sleep Quality Index (PSQI) and lifestyle details. Most of the participants were Muslims (95.5%), 74.5% of them were Arabs, 94.3% were singles and 91.6% were full-time students. The resultant prevalence of insomnia among the students was assessed by three criteria. These are, time to fall asleep, quality of sleep and respondents with and without problem sleeping. With respect to time to fall asleep, 51.8% of respondents needs ≥ 30 minutes to fall asleep, 29.2% of them were females and 22.6% males. Regarding quality of sleep, both genders scored almost identical figures of 19.5% and 2% for fairly and bad quality of sleep respectively. With respect to problem sleeping, 37.9% of respondents were having problem sleeping, 22.4% of them females and 15.5% males. Our results identified some significant relations between some sleep disorders and behavior or diseases. Nightmares had a significant relation with listening to rap music (p<0.031), play with cell phone or tablet before sleeping (p <0.023), drinking tea and coffee (p<0.004), energy drinks (p<0.034) take a medicine to promote sleeping (p <0.017), as well as allergic rhinitis (p<0.009). Whereas falling experience had a significant relation with listening to pop music (p<0.018), play with cell phone or tablet before sleeping (p<0.009) and diseases like hypothyroidism (p<0.009) and diabetes (p<0.009). On the other hand, spinning room experience had a significant relation with cardiac diseases (p<0.019), take a medicine to promote sleeping (p<0.003), hyperthyroidism (p <0.009) and listening to rap music (p<0.015). The results also identified that sleep-walk had a significant relation with listening to rock music (p<0.050), and rap music (p< 0.035) before bed. Whereas sleep-talk had a significant relation with asthma (p<0.048) and hypertension (p< 0.034). This study provides preliminary data on sleep quality and risk factors for insomnia, which may be used to guide sleep hygiene promotion and intervention among university students.
Background
Young drivers are over-involved in sleepiness-related crashes. The alerting effects of bright light offer a potential countermeasure for driver sleepiness, either replacing or in conjunction with current countermeasures such as the use of caffeine.
Methods
Thirty young (18-25) chronically sleep-restricted drivers drove in a simulator under randomized conditions of continuous bright light ('Light', 500 nm, 230μw/cm²), caffeine ('Caffeine', 100 mg caffeinated gum), or light and caffeine together ('Light + Caffeine'), after driving under a placebo condition ('Placebo', decaffeinated gum, 555 nm light, 0.3 μW/cm²) on three consecutive days. Using mixed-effects linear models, the associations between these conditions and physiological outcomes (EEG alpha and theta power, heart rate, and beat-to-beat intervals), driving performance (lateral lane and steering-related outcomes and lateral acceleration), and subjective sleepiness was assessed.
Results
Relative to Placebo, all conditions improved driving performance outcomes (P <0.0001), with effects of Light + Caffeine equal to Light but greater than Caffeine. Light+ Caffeine reduced EEG alpha power more than Light or Caffeine (P <0.0006), but ECG outcomes were generally worse under all conditions relative to Placebo. Subjective sleepiness improved under the Light + Caffeine condition only (P <0.0001).
Conclusions
Combining bright light and caffeine enhances their alerting effects on lateral lane variability and subjective sleepiness. A bright light could be a practical alternative to caffeine for sleepy drivers who avoid caffeine. The alerting effects of bright light could alleviate chronic community-level mild sleep restriction and provide on-road benefits to reduce severe injuries and fatal sleepiness-related crashes.
Sleep disturbance and sleepiness are established risk factors for driving accidents and obstructive sleep apnea (OSA) is the most prevalent medical disorder associated with excessive daytime sleepiness. Because effective treatment of OSA reduces accident risk, several jurisdictions have implemented regulations concerning the ability of patients with OSA to drive, unless effectively treated. This review provides a practical guide for clinicians who may be requested to certify a patient with OSA as fit to drive regarding the scope of the problem, the role of questionnaires and driving simulators to evaluate sleepiness, and the benefit of treatment on accident risk.
The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
A simplified sleep apnea investigation consisting of combined oximetry and respiration movement monitoring was compared with conventional polysomnography. These two types of recordings were performed simultaneously during one night in 77 patients with suspected obstructive sleep apnea syndrome (OSAS). A static charge sensitive bed (SCSB) was used in the simplified recording because it provides a comfortable and reliable means of recording respiration movements. Periods of obstructive apneas gave a diamond-shaped periodic respiration movement pattern in the SCSB, usually accompanied by repetitive oxygen desaturations. The average number of desaturations greater than or equal to 4 percent per sleeping hour was termed the oxygen desaturation index (ODI) and compared with the apnea index (AI). In the whole population they were well correlated (p less than 0.0001, R2 = 0.41), but in individual cases there were considerable discrepancies. Patients with periodic respiration movements less than 18 percent of total sleeping time and ODI less than 2 never had AI greater than or equal to 5, whereas patients with periodic respiration greater than 45 percent and ODI greater than 6 always had AI greater than or equal to 5. Fifty-one of the 77 patients fulfilled these criteria. A bradycardia response to apneas was absent in 29 percent of patients with AI greater than or equal to 5. A combination of respiration movement and oximetry recording thus seems to give sufficient information to confirm or negate a diagnosis of OSAS in a majority of patients with clinical symptoms. In borderline patients, further investigations should be performed.
This report, prepared for the National Commission on Sleep Disorders Research, explores the economic implications of sleepiness in relation to accidents. In Part One, I describe the frequency of accidents in the United States and explain a method for estimating the economic cost of these of accidents. Accidents are the fourth leading cause of mortality in the United States, and motor-vehicle accidents represent 51% of total deaths caused by accidents. The method used for calculating the cost of accidents is called "the human capital approach". It is based on the principle that "one person produces a sum of output during his/her life-time, which can be approximated by his/her earnings". It is necessary to understand that this estimate of human value is not intended to reduce human beings to a sum of earnings during his/her lifetime. It does, however, serve as a useful indicator in making decisions regarding public health policy for the country. The results of the total cost of accidents and the relative costs for work-related, home-based and public accidents in 1988 are discussed. In Part Two, I explore the role sleepiness plays in contributing to the total number of accidents. The difficulty of researching this subject is compounded by the fact that reports of rates of accidents related to sleepiness differ significantly from author to author. This is true both for drivers with sleep disorders and those without. We have calculated two different rates for estimating the number of motor-vehicle accidents caused by sleepiness.(ABSTRACT TRUNCATED AT 250 WORDS)
This study assesses a possible independent effect of sleep-related breathing disorders on traffic accidents in long-haul commercial truck drivers. The study design included integrated analysis of recordings of sleep-related breathing disorders, self-reported automotive and company-recorded automotive accidents. A cross-sectional population of 90 commercial long-haul truck drivers 20-64 years of age was studied. Main outcome measures included presence or absence, as well as severity, of sleep-disordered breathing and frequency of automotive accidents. Truck drivers identified with sleep-disordered breathing had a two-fold higher accident rate per mile than drivers without sleep-disordered breathing. Accident frequency was not dependent on the severity of the sleep-related breathing disorder. Obese drivers with a body mass > or = 30 kg/m2 also presented a two-fold higher accident rate than nonobese drivers. We conclude that a complaint of excessive daytime sleepiness is related to a significantly higher automotive accident rate in long-haul commercial truck drivers. Sleep-disordered breathing with hypoxemia and obesity are risk factors for automotive accidents.
Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by careful driving or not, the rate of car accidents over a 5-year period was investigated. A questionnaire was addressed to 140 patients with and 142 controls without symptoms associated to SAS. Seventy-three of the patients had a complete triad of SAS-associated symptoms. Fifty-two percent of these patients reported habitual sleep spells at the wheel, as opposed to less than one percent by the controls. The ratio of drivers being involved in one or more combined-car accident was similar for patients and control drivers, but for single-car accidents the ratio was about 7 times higher for patients with a complete triad of symptoms of SAS compared to controls (p < 0.001). When corrected for mileage driven, the total number of single-car accidents was almost 12 times higher among patients with sleep spells whilst driving, compared to controls (p < 0.001). It is concluded that drivers with the clinical features of SAS are at increased risk especially for single-car accidents and that the risk seems to vary with the severity of symptoms.
We compared self- and spouse reports of snoring and other symptoms of sleep apnea syndrome ascertained from married couples in a community-based survey. Agreement between the two types of report varied between 70-98%, but was modest (kappa = -0.01-0.52) when adjusted for chance. For men, spouse reports yielded higher prevalence rates for snoring and for four other symptoms. For women, estimates of symptom prevalence were consistently lower by spouse report than by self-report. In multivariate analyses, the effect on snoring of gender and obesity increased and of age decreased when spouse reports were compared to self-reports. Snoring, according to spouse reports, was a significant risk factor for ischemic heart disease, but snoring according to self-reports showed a smaller effect and was not statistically significant. Snoring was not associated with hypertension when defined by either self- or spouse report. These observations suggest that questionnaire data of snoring and other symptoms of sleep apnea syndrome may be misclassified in part, and that such misclassification can affect estimates of prevalence and effects.
Although patients with obstructive sleep apnea often report falling asleep while driving, the frequency of auto accidents involving these patients has not been rigorously studied. Therefore, we compared the driving records of 29 patients with obstructive sleep apnea with those of 35 subjects without sleep apnea. The patients with sleep apnea had a sevenfold greater rate of automobile accidents than did the subjects without apnea (p less than 0.01). The percentage of persons with one or more accidents was also greater in the patients with apnea than in the control subjects without apnea (31% versus 6%, p less than 0.01). The percentage of persons having one or more accidents in which they were at fault was also greater in the patients with apnea than in the control subjects (24% versus 3%, p less than 0.02). The automobile accident rate of the patients with sleep apnea was 2.6 times the accident rate of all licensed drivers in the state of Virginia (p less than 0.02). In addition, 24% of patients with sleep apnea reported falling asleep at least once per week while driving. We conclude that patients with obstructive sleep apnea have a significantly higher frequency of auto accidents than do subjects without apnea. Impaired drivers with sleep apnea may cause many preventable auto accidents.