IntroductionSleep 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.MethodsDrivers 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.ResultsBetween 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.ConclusionsThe 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.

IC was a median of 5 days . Logistic regression revealed two predictors of IC, presence of comorbidities (OR 5.4, p < 0.001) and 24-hour total transfused PRBC volume (OR 1.08, 95% CI 1.02 -1.15, p = 0.01). Findings from the Cox proportional hazards model revealed that injury severity (HR 1.41, 95% CI 1.03 -1.92, p = 0.03) and 24-hour total transfused PRBC volume (HR 1.01, 95% CI 1.00 -1.02, p = 0.001) were associated with development of IC. Conclusions: Enhanced understanding of the mechanisms that contribute to immune alterations after trauma and blood component transfusion may provide clinicians with the ability to individualize patient management and reduce complications to optimize patient outcomes.

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