A prospective study of the role of sleep related disordered breathing as a risk factor for motor vehicle crashes and the development of systemic complications in non-commercial drivers

World Journal of Emergency Surgery

Greg Beilman²  Craig Matticks²  Matthew Byrnes¹  Alan Beal²  Patricia Reicks²  Eric D Irwin² 

[1] 1116 Gillespie, Garden City, KS, USA;3300 Oakdale Ave, Robbinsdale, MN 55422, USA

关键词: Motor vehicle crashes;    Sleep related disordered breathing;   

Others  :  791506
DOI  :  10.1186/1749-7922-9-2

 received in 2013-10-11, accepted in 2013-11-18,  发布年份 2014

【 摘 要 】

Introduction

Sleep related disordered breathing (SRDB), is an established risk factor for motor vehicle crashes (MVCs) involving commercial drivers. The role of SRDB in motor vehicle crashes involving non-commercial drivers is not well established.

Methods

Drivers involved in MVCs who were admitted to an American College of Surgeons accredited Level I trauma center for treatment of their injuries, and who could give informed consent and provide verbal responses to screening questionnaires were eligible for enrolment in this study. Two questionnaires previously validated for screening patients at risk for sleep disturbances (The Epworth Sleepiness Scale (ESS) and The Berlin Questionnaire (BQ)) were administered. Questionnaire results associated with an 85% sensitivity for predicting obstructive sleep apnea were considered positive. In this study we tested the hypothesis that patients at risk for SRDB, as measured by validated questionnaires, are at an increased risk being involved in MVCs.

Results

Between March and October 2010, 71 consecutive patients were offered enrolment in this study with 56 agreeing to participate in this study. Six were previously diagnosed with SRDB with only one being compliant and effectively treated at the time of their MVC. Forty-two patients (75%) had responses to the questionnaires that indicated that the patients were at high risk for SRDB. Six patients suffered systemic complications, including pleural effusions, pneumonia and arrhythmias, during their hospitalization with five (83%) having abnormal questionnaire responses indicating that the patient was at high risk for SRDB.

Conclusions

The high incidence of positive responses to the sleep questionnaires is consistent with the hypothesis that SRDB is potentially a significant risk factor for MVCs. Furthermore the observation that systemic complications were seen more commonly in those with SRDB, while not unexpected, is a novel observation. Further studies are needed to validate these findings in a larger cohort of patients as well as determining if these patients are truly at a greater risk for systemic complications. If replicated these observations would suggest that effective therapy for disordered sleep could play a significant role in an injury prevention process.

【 授权许可】

   
2014 Irwin et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Howard M, Desai A, Grunstein R, et al.: Sleepiness, sleep disordered breathing and accident risk factors in commercial vehicle drivers. Am J Respir Crit Care Med 2004, 170:1014-1021.
• [2]Stoohs R, Bingham L, Itoi A, et al.: Sleep and sleep-disordered breathing in commercial long-haul truck drivers. Chest 1995, 107:1275-1282.
• [3]Horstmann S, Hess C, Bassetti C, et al.: Sleep related accidents in sleep apnea patients. Sleep 2000, 23:383-389.
• [4]Barbe F, Pericas J, Munoz A, et al.: Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med 1998, 158:18-22.
• [5]Yaggi HK, Strohl KP: Adult obstructive sleep apnea/hypopnea syndrome: definitions, risk factors and pathogenesis. Clin Chest Med 2012, 31(2):179-186.
• [6]Young T, Peppard P, Gottlieb D: Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 2002, 165:1217-1239.
• [7]Salminen S, Oksanen T, Vahtera J, et al.: Sleep disturbances as a predictor of occupational injuries among public sector workers. J Sleep Res 2010, 19(1pt2):207-213.
• [8]Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J: The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 1999, 340:847-851.
• [9]Turkington P, Sicar M, Alligar V, et al.: Relationship between obstructive sleep apnea, driving simulator performance, and risk of road traffic accidents. Thorax 2001, 56:800-805.
• [10]Ziegler M, Mills P, Loredo J, et al.: Effect of continuous positive airway pressure and placebo treatment on sympathetic nervous activity in patients with obstructive sleep apnea. Chest 2001, 120:887-892.
• [11]Bobinsky G, Miller M, Ault B, et al.: Spontaneous platelet activation and aggregation during obstructive sleep apnea and its response to therapy with nasal continuous positive airway pressure: a preliminary investigation. Chest 1994, 108:625-630.
• [12]Gjorup P, Sadauskiene L, Wessels J, et al.: Abnormal increase in endothelin-1 in plasma during the night in obstructive sleep apnea: relation to blood pressure and severity of disease. Am J Hypertens 2007, 20(1):44-52.
• [13]Moller D, Lind P, Strunge B, et al.: Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea. Am J Hypertens 2003, 16(4):274-280.
• [14]Zhao H, Chen B, Cao J, et al.: Effects of obstructive sleep apnea style intermittent hypoxia on endothelin-1, nitric oxide and nitric oxide synthase in endothelium: experiment with human umbilical vein endothelial cells. Zhonghua Yi Xue Az Ahi 2007, 87(31):2189-2192.
• [15]Dincer HE, O’Neill W: Deleterious effects of sleep-disordered breathing on the heart and vascular system. Respiration 2006, 73:124-130.
• [16]De Jesus EV, Dias-Filho ED, Mota B, et al.: Suspicion of obstructive sleep apnea by Berlin questionnaire predices events in patients with acute coronary syndrome. Arq Bras Cardiol 2010, 95(3):313-320.
• [17]Redline S, Strohl KP: Recognition and consequences of obstructive sleep apnea hypopnoea syndrome. Clin Chest Med 1998, 19:1-19.
• [18]Flemons WW, Remmers JE: The diagnosis of sleep apnea: questionnaires and home studies. Sleep 1996, 19(10 Suppl):S243-S247.
• [19]Wu H, Yan-Go F: Self-reported automobile accidents involving patients with obstructive sleep apnea. Neurology 1996, 46:1254-1257.
• [20]Maislin G, Pack AI, Kribbs NB, et al.: A survey screen for prediction of apnea. Sleep 1995, 18:158-166.
• [21]Johns MW: A new method for measuring daytime sleepiness; the epworth sleepiness scale. Sleep 1991, 14:540-545.
• [22]Johns MW: Reliability and factor analysis of the epworth sleepiness scale. Sleep 1992, 15:376-381.
• [23]Johns MW: Daytime sleepiness, snoring, and obstructive sleep apnea; the epworth sleepiness scale. Chest 1933, 103:30-36.
• [24]Davies R, Ali Nabeel NJ, Stradling J: Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnea syndrome. Thorax 1992, 47:101-105.
• [25]Horne J, Reyner L: Vehicle accidents related to sleep: a review. Occup Environ Med 1999, 56:289-294.
• [26]Longo MC, Hunter CE, Lokan RJ, et al.: The prevalence of alcohol, cannabinoids, benzodiazepines and stimulants amongst injured drivers and their role in driver culpability. Part I: the prevalence of drug use in drivers, and characteristics of the drug-positive group. Accid Anal Prev 2000, 32:613-622.
• [27]Matthews KA, Zheng H, Kravitz HM, et al.: Are inflammatory and coagulation biomarkers related to sleep characteristics in mid-life women?: study of women’s health across the nation sleep study. Sleep 2010, 33(12):1649-1655.