Risk and severity of motor vehicle crashes in patients with obstructive sleep apnoea/hypopnoea

Background:Obstructive sleep apnoea/hypopnoea (OSAH) appears to be associated with an increased risk of motor vehicle crashes (MVCs). However, its impact on crash patterns, particularly the severity of crashes, has not been well described. A study was undertaken to determine whether OSAH severity influenced crash severity in patients referred for investigation of suspected sleep-disordered breathing.Methods:Objective crash data (including the nature of crashes) for 783 patients with suspected OSAH for the 3 years prior to polysomnography were obtained from provincial insurance records and compared with data for 783 age- and sex-matched controls. The patient group was 71% male with a mean age of 50 years, a mean apnoea-hypopnoea index (AHI) of 22 events/h and a mean Epworth Sleepiness Scale score of 10.Results:There were 375 crashes in the 3-year period, 252 in patients and 123 in controls. Compared with controls, patients with mild, moderate and severe OSAH had an increased rate of MVCs with relative risks of 2.6 (95% CI 1.7 to 3.9), 1.9 (95% CI 1.2 to 2.8) and 2.0 (95% CI 1.4 to 3.0), respectively. Patients with suspected OSAH and normal polysomnography (AHI 0–5) did not have an increased rate of MVC (relative risk 1.5 (95% CI 0.9 to 2.5), p = 0.21). When the impact of OSAH on MVC associated with personal injury was examined, patients with mild, moderate and severe OSAH had a substantially higher rate of MVCs than controls with relative risks of 4.8 (95% CI 1.8 to 12.4), 3.0 (95% CI 1.3 to 7.0) and 4.3 (95% CI 1.8 to 8.9), respectively, whereas patients without OSAH had similar crash rates to controls with a relative risk of 0.6 (95% CI 0.2 to 2.5). Very severe MVCs (head-on collisions or those involving pedestrians or cyclists) were rare, but 80% of these occurred in patients with OSAH (p = 0.06).Conclusion:Patients with OSAH have increased rates of MVCs, and disproportionately increased rates of MVCs are associated with personal injury.

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European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

European Respiratory Journal ◽

10.1183/13993003.01272-2020 ◽

2020 ◽

pp. 2001272

Author(s):

Maria R Bonsignore ◽

Winfried Randerath ◽

Sofia Schiza ◽

Johan Verbraecken ◽

Mark W Elliott ◽

...

Keyword(s):

At Risk ◽

Motor Vehicle ◽

Task Force ◽

Present Report ◽

Sleep Apnoea ◽

Accident Risk ◽

European Respiratory Society ◽

Obstructive Sleep ◽

Patients At Risk ◽

The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

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Modifying effects of the R389G β1-adrenoceptor polymorphism on resting heart rate and blood pressure in patients with obstructive sleep apnoea

Clinical Science ◽

10.1042/cs20050244 ◽

2005 ◽

Vol 110 (1) ◽

pp. 117-123 ◽

Cited By ~ 10

Author(s):

Jan Börgel ◽

Tino Schulz ◽

Nina K. Bartels ◽

Jörg T. Epplen ◽

Nikolaus Büchner ◽

...

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Obstructive Sleep Apnoea ◽

Nervous Activity ◽

Sleep Apnoea ◽

Cpap Therapy ◽

Pressure Therapy ◽

Obstructive Sleep ◽

Significant Difference ◽

The Impact

OSA (obstructive sleep apnoea) stimulates sympathetic nervous activity and elevates resting HR (heart rate) and BP (blood pressure). In the present study in a cohort of 309 untreated OSA patients, the resting HR and BP during the daytime were correlated with AHI (apnoea/hypopnea index) and compared with patients with R389R (n=162), R389G (n=125) and G389G (n=22) genotypes of the β1-adrenoreceptor R389G polymorphism. We analysed the impact of the genotype on the decline of HR and BP in a subgroup of 148 patients (R389R, n=86; R389G, n=54; G389G, n=8) during a 6-month follow-up period under CPAP (continuous positive airway pressure) therapy during which cardiovascular medication remained unchanged. In untreated OSA patients, we found an independent relationship between AHI and resting HR (β=0.096, P<0.001), systolic BP (β=0.09, P=0.021) and diastolic BP (β=0.059, P=0.016). The resting HR/BP, however, did not differ among carriers with the R389R, R389G and G389G genotypes. CPAP therapy significantly reduced HR [−2.5 (−1.1 to −4.0) beats/min; values are mean difference (95% confidence intervals)] and diastolic BP [−3.2 (−1.5 to −5.0) mmHg]. The decline in HR was more significantly pronounced in the R389R group compared with the Gly389 carriers [−4.1 (−2.3 to −5.9) beats/min (P<0.001) compared with −0.2 (2.1 to −2.6) beats/min (P=0.854) respectively; Student's t test between groups, P=0.008]. Diastolic BP was decreased significantly (P<0.001) only in Gly389 carriers (R389G or G389G) compared with R389R carriers [−5.0 (−2.3 to −7.6) mmHg compared with −2.0 (0.4 to −4.3) mmHg respectively]. ANOVA revealed a significant difference (P=0.023) in HR reduction between the three genotypes [−4.1 (±8.4) beats/min for R389R, −0.5 (±9.3) beats/min for R389G and +1.9 (±7.2) beats/min for G389G]. In conclusion, although the R389G polymorphism of the β1-adrenoceptor gene did not influence resting HR or BP in untreated OSA patients, it may modify the beneficial effects of CPAP therapy on these parameters.

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The impact and sustainability of the graduated driver licensing program in preventing motor vehicle crashes in Massachusetts

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000000512 ◽

2015 ◽

Vol 78 (2) ◽

pp. 265-271 ◽

Cited By ~ 10

Author(s):

Haytham M.A. Kaafarani ◽

Jarone Lee ◽

Catrina Cropano ◽

Yuchiao Chang ◽

Toby Raybould ◽

...

Keyword(s):

Motor Vehicle ◽

Motor Vehicle Crashes ◽

Vehicle Crashes ◽

Graduated Driver Licensing ◽

The Impact ◽

Driver Licensing

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Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study

Australasian Psychiatry ◽

10.1177/1039856218772241 ◽

2018 ◽

Vol 26 (6) ◽

pp. 600-603 ◽

Cited By ~ 4

Author(s):

Hannah Myles ◽

Andrew Vincent ◽

Nicholas Myles ◽

Robert Adams ◽

Madhu Chandratilleke ◽

...

Keyword(s):

Relative Risk ◽

General Population ◽

Obstructive Sleep Apnoea ◽

Population Group ◽

Sleep Apnoea ◽

General Population Study ◽

Obstructive Sleep ◽

General Population Group ◽

Relative Prevalence ◽

Population Controls

Objectives: Obstructive sleep apnoea (OSA) may be more common in people with schizophrenia compared to the general population, but the relative prevalence is unknown. Here, we determine the relative prevalence of severe OSA in a cohort of men with schizophrenia compared to representative general population controls, and investigate the contribution of age and body mass index (BMI) to differences in prevalence. Methods: Rates of severe OSA (apnoea–hypopnoea index > 30) were compared between male patients with schizophrenia and controls from a representative general population study of OSA. Results: The prevalence of severe OSA was 25% in the schizophrenia group and 12.3% in the general population group. In subgroups matched by age, the relative risk of severe OSA was 2.9 ( p = 0.05) in the schizophrenia subjects, but when adjusted for age and BMI, the relative risk dropped to 1.7 and became non-significant ( p = 0.17). Conclusions: OSA is prevalent in men with schizophrenia. Obesity may be an important contributing factor to the increased rate of OSA.

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The impact of early diagnosis and treatment of obstructive sleep apnoea in bariatric surgery patients

Journal of Sleep Research ◽

10.1111/jsr.70_12619 ◽

2017 ◽

Vol 26 ◽

pp. 59-59

Keyword(s):

Bariatric Surgery ◽

Early Diagnosis ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Diagnosis And Treatment ◽

Obstructive Sleep ◽

The Impact

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Obstructive Sleep Apnoea and Type 2 Diabetes

European Endocrinology ◽

10.17925/ee.2014.10.01.43 ◽

2010 ◽

Vol 10 (1) ◽

pp. 43 ◽

Cited By ~ 5

Author(s):

Abd A Tahrani ◽

Asad Ali ◽

◽

Keyword(s):

Type 2 Diabetes ◽

Risk Factor ◽

Obstructive Sleep Apnoea ◽

Medical Condition ◽

Diabetes Type 2 ◽

Sleep Apnoea ◽

Obstructive Sleep ◽

Increased Risk ◽

The Impact

With the growing prevalence of obesity, the burden of type 2 diabetes is increasing. Obstructive sleep apnoea (OSA) is a very common medical condition that is associated with increased risk of cardiovascular disease and mortality. Obesity is a common risk factor for OSA and type 2 diabetes and hence it is not surprising that OSA and type 2 diabetes are interlinked. OSA has been shown to be an independent risk factor for the development of incident pre-diabetes/type 2 diabetes. OSA is also associated with worse glycaemic control and vascular disease in patients with type 2 diabetes. However, evidence for the benefits of OSA treatment in patients with type 2 diabetes is still lacking. The aim of this article is to provide an overview of OSA, the relationships between OSA and dysglycaemia and the impact of OSA in patients with type 2 diabetes, highlighting recent advances in the field.

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The Role of Mobile Phones in Real World Motor Vehicle Crashes

Encyclopedia of Mobile Phone Behavior ◽

10.4018/978-1-4666-8239-9.ch108 ◽

2015 ◽

pp. 1366-1375 ◽

Cited By ~ 1

Author(s):

Suzanne P. McEvoy

Keyword(s):

Text Messaging ◽

Motor Vehicle ◽

Epidemiological Studies ◽

Motor Vehicle Crashes ◽

Vehicle Crashes ◽

Mobile Phone Use ◽

Relative Risks ◽

Increased Risk ◽

Driver Distractions

Early on, road epidemiological studies (Redelmeier & Tibshirani, 1997; McEvoy et al., 2005) indicated an increased risk of motor vehicle crashes, including injury crashes, associated with mobile phone use. However, these studies were unable to assess the relative risks pertaining to specific phone tasks (for example, conversing versus texting). Moreover, direct comparisons of risk between different types of driver distractions, while possible (McEvoy, Stevenson, Woodward, 2007), were difficult to undertake. Naturalistic driving studies using instrumented cars in every day driving have provided more details of the tasks that confer particular risk in relation to phone use and other driver distractions (Klauer et al., 2014; Olson et al., 2009; Klauer et al., 2006; Dingus et al., 2006). Interest generated in these studies has prompted current trials using similar methodologies elsewhere, for example, Australia (Regan et al., 2013). To date, phone tasks involving handling of the phone and/or multiple or prolonged eye glances away from the forward roadway (dialling, reaching for the phone and text messaging) have been shown to significantly increase the risk of crashes and near crashes.

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Obstructive Sleep Apnoea and Vascular Disease in Patients with Type 2 Diabetes

US Endocrinology ◽

10.17925/use.2015.11.02.110 ◽

2015 ◽

Vol 11 (02) ◽

pp. 110

Author(s):

Abd A Tahrani ◽

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Vascular Disease ◽

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Obstructive Sleep ◽

The Impact

Obstructive sleep apnoea (OSA) is common and is associated with many vascular risk factors, such as hypertension, insulin resistance, albuminuria, dyslipidaemia, increased inflammation and endothelial dysfunction. Epidemiological studies have shown that OSA is associated with increased cardiovascular disease (CVD) and that continuous positive airway pressure (CPAP) might reduce CVD events in patients with OSA. In addition, OSA has also been shown to be associated with albuminuria, chronic kidney disease, a wide range of ocular diseases and peripheral neuropathy. Considering that CVD and microvascular complications are major contributors to the morbidity, mortality and the economic burden of diabetes and that OSA is common in patients with type 2 diabetes (T2D), it is important to understand the role of OSA in the development and/or progression of vascular disease in patients with T2D and to explore the impact of CPAP on diabetes-related vascular outcomes. The purpose of this article is to review the evidence for the relationship and impact of OSA on vascular disease and vascular risk factors particularly in patients with T2D.

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