Proposal for Prevention of Drowsy Driving-Related Motor Vehicle Accidents in Patients With Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is known to be associated with various health concerns, including sleepiness, fatigue, cognitive dysfunction, diminished quality of life, hypertension, cardiovascular diseases, and stroke. OSA-induced sleepiness at the wheel reduces vigilance and driving performance, which significantly increase the risk of motor vehicle accidents. Sleepiness-induced motor vehicle accidents are characterized by high morbidity and mortality. OSA is a well-established significant risk factor for drowsy driving-related motor vehicle accidents, which can be prevented through appropriate treatment. However, currently no clinical guidelines or regulations are available for evaluation or management of the risk of motor vehicle accidents in patients with OSA in Korea. In this review, we discuss the risk of motor vehicle accidents in patients with OSA, the effects of positive airway pressure therapy as a preventive measure to reduce this risk, and the published recommendations for OSA in other countries with regard to fitness to drive. We propose recommendations for screening, evaluation, and treatment of OSA with regard to the risk of motor vehicle accidents, which would serve as useful practical guidelines for sleep specialists in clinical practice. Further research is warranted to establish optimal strategies for effective improvements in OSA-related traffic safety.

Hit-and-run: a Swedish nationwide cohort study of serious transport accidents and convictions due to traffic offenses in obsessive–compulsive disorder

Purpose Individuals with obsessive–compulsive disorder (OCD) often report driving-related obsessions, such as fears of causing accidents, but the risk of transport accidents in OCD is unknown. We investigated whether individuals with OCD have an increased risk of serious transport accidents and convictions due to traffic offenses and explored the role of psychiatric comorbidities. Methods We included all individuals ≥ 18 years living in Sweden between 1997 and 2013 (N = 5,760,734). A total of 23,126 individuals had a diagnosis of OCD in the National Patient Register. We also identified 16,607 families with full siblings discordant for OCD. Cox proportional hazards regression models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of three outcomes in individuals with OCD, compared to unexposed individuals and their unexposed full siblings: injuries or deaths due to transport accidents, injuries or deaths due to motor vehicle accidents, and convictions related to traffic offenses. Psychiatric comorbidities were systematically adjusted for. Results Women, but not men, with OCD had a marginally increased risk of serious transport accidents (adjusted HR = 1.20 [95% CI 1.13–1.28]) and motor vehicle accidents (adjusted HR = 1.20 [95% CI 1.09–1.31]), compared to unaffected individuals. Neither women nor men with OCD had a significantly increased risk of convictions. The sibling comparisons showed no significant associations. When psychiatric comorbidities were adjusted for, several observed associations became non-significant or inversed (HRs and 95% CIs below one). Conclusion The risks of serious transport accidents and driving-related criminal convictions in OCD are negligible and heavily influenced by psychiatric comorbidity.

An Unusual Etiology of Submandibular Sialadenitis, Migration of an Ingested Fish Bone to the Submandibular Gland: A Case Report

Recurrent sialadenitis of submandibular gland can have multiple causes, one of the rare being foreign bodies. Motor vehicle accidents, assaults, bullet wounds and iatrogenic surgical fault are the most common causes of traumatic foreign bodies. Fish bone is one of the most common foreign bodies that gets lodged in the upper digestive tract, often located in the tonsil, base of tongue, epiglottis, pyriform fossa and esophagus, where it may be easily identified on routine inspection and removed. The forcible swallowing of food such as rice balls after ingesting fish bones by mistake may lead to the migration of the fish bone from the pharynx, throat or esophagus to the surrounding tissues. Migration most commonly occurs to the soft tissues of the neck, even to the thyroid gland, but migration to the submandibular gland has rarely been reported. Here, we present a case of submandibular sialadenitis due to unusual migration of ingested fish bone to submandibular gland. Foreign body ingestion may cause a series of complications and endanger a patient's life. Cases require high awareness and attentiveness on the part of the first physician to diagnose and manage the condition and appropriate health education should be imparted to the patient. Faridpur Med. Coll. J. 2021;16(1):55-57

Contributors to reduced life expectancy among Native Americans in the Four Corners States

To assess trends in life expectancy and the contribution of specific causes of death to Native American-White longevity gaps in the Four Corners states, we used death records from the National Center for Health Statistics and population estimates from the U.S. Census Bureau from 1999–2017 to generate period life tables and decompose racial gaps in life expectancy. Native American-White life expectancy gaps narrowed between 2001 and 2012 but widened thereafter, reaching 4.92 years among males and 2.06 years among females in 2015. The life expectancy disadvantage among Native American males was primarily attributable to motor vehicle accidents (0.96 years), liver disease (1.22 years), and diabetes (0.78 years). These causes of deaths were also primary contributors to the gap among females, forming three successive waves of mortality that occurred in young adulthood, midlife, and late adulthood, respectively, among Native American males and females. Interventions to reduce motor vehicle accidents in early adulthood, alcohol-related mortality in midlife, and diabetes complications at older ages could reduce Native American-White longevity disparities in the Four Corners states.

Clinical Profile on the PTSD Checklist for DSM-5 (PCL-5) of Veterans versus Patients Injured in Motor Vehicle Accidents

Background: The 20 items of PTSD Checklist for DSM-5 (PCL-5) can be rank ordered from highest to the lowest, based on item mean scores in a particular clinical group. Thus, they can provide an overview of the relative importance of each of the symptoms represented by these 20 items, i.e., a clinical profile for the particular type of patients. This study compared such ranking of PCL-5 items by US veterans with those of patients injured in high impact motor vehicle accidents (MVAs). Method: De-identified PCL-5 data were available for 80 post-MVA patients (mean age 38.9 years, SD=12.8) and for 468 US veterans (mean age 55.4 years, SD=13.8). The US veterans’ data are those published by Bovin et al. in 2016. Results and Discussion: The overall rank order of PCL-5 items was significantly similar in the two groups (Spearman’s rho=.83), perhaps due to certain similarities of the two groups (potential threat to life or of severe physical injury). Both groups rated the Item 20 (sleep difficulties) as the most prominent, and they rated Item 16 (taking too many risks) and then Item 8 (trouble remembering details of the stressful event) as least prominent. The largest clinically interesting difference in the item rank was on Item 12 (loss of interest in previously enjoyed activities) which was more prominent in the MVA patients, presumably due to their persistent post-accident pain (all but one MVA patient reported pain, and in 82.5% the pain was rated as more than mild). Conclusions: In both groups, the ratings of sleep difficulties were the most prominent and ratings of taking excessive risks and of not remembering details of stressful evens were least prominent. The overall rank order of the 20 items was significantly similar in the two groups.

Clinical Correlations of Posttraumatic Nightmares in Survivors of Motor Vehicle Accidents

Background: We evaluated the severity and clinical correlates of nightmares of persons injured in high impact motor vehicle accidents (MVAs). Method: De-identified data of 80 post-MVA patients (mean age 38.9 years, SD=12.8) were available and included scores on Item 2 of the PCL-5 (severity of repeated, disturbing dreams of the stressful event). Scores were also available on the Brief Pain Inventory (BPI), Morin’s Insomnia Severity Index (ISI), Rivermead Post-concussion Symptoms Questionnaire, Subjective Neuropsychological Symptoms Scale (SNPSS), Whiplash Disability Questionnaire, and on three questionnaire measures of driving anxiety (Steiner’s, Whetstone’s, and DAQ). The patients were assessed, on the average, 49.7 weeks (SD=36.3) after their MVA; all still experienced active post-MVA symptoms requiring therapy. Results: Clinically relevant levels of MVA nightmares were reported by 62.5% of post-MVA patients. Subjectively more aversive levels of MVA nightmares correlated with higher driving anxiety as measured by the Whetstone questionnaire and DAQ, with higher levels of average post-accident pain and insomnia, with post-accident neuropsychological symptoms as measured by the Rivermead and SNPSS, and with higher post-accident levels of depression, anger, and generalized anxiety. Discussion and Conclusions: Almost two-thirds of our post-MVA patients reported MVA nightmares and their level of subjectively aversive impact correlated with most variables within the typical polytraumatic symptom pattern of these patients.

Post-Traumatic Subfrontal with Orbital Extradural Hematoma and Proptosis (Unusual Presentation Managed with Needle Aspiration) A Case Report with Review of Literature

Extradural hematoma (EDH) is a common intracranial pathology following motor vehicle accidents, comprising approximately 0.2 to 6% of all head injuries. The association of EDH with subperiosteal intraorbital hematomas is rarely reported. We report a case of a traumatic subfrontal EDH with subperiosteal hematoma (orbital EDH) successfully treated with needle aspiration, demonstrating that in appropriate patients, needle aspiration can result in the resolution of symptoms without an invasive procedure.