Epidemiology, Physiology and Clinical Approach to Sleepiness at the Wheel in OSA Patients: A Narrative Review

Abstract

Sleepiness at the wheel (SW) is recognized as an important factor contributing to road traffic accidents, since up to 30 percent of fatal accidents have been attributed to SW. Sleepiness-related motor vehicle accidents may occur both from falling asleep while driving and from behavior impairment attributable to sleepiness. SW can be caused by various sleep disorders but also by behavioral factors such as sleep deprivation, shift work and non-restorative sleep, as well as chronic disease or the treatment with drugs that negatively affect the level of vigilance. An association between obstructive sleep apnea (OSA) and motor vehicle accidents has been found, with an increasing risk in OSA patients up to sevenfold in comparison to the general population. Regular treatment with continuous positive airway pressure (CPAP) relieves excessive daytime sleepiness and reduces the crash risk. Open questions still remain about the physiological and clinical determinants of SW in OSA patients: the severity of OSA in terms of the frequency of respiratory events (apnea hypopnea index, AHI) or hypoxic load, the severity of daytime sleepiness, concomitant chronic sleep deprivation, comorbidities, the presence of depressive symptoms or chronic fatigue. Herein, we provide a review addressing the epidemiological, physiological and clinical aspects of SW, with a particular focus on the methods to recognize those patients at risk of SW.

Presenteeism and Traffic Accident Among Taxi Drivers: A Prospective Cohort Study in Japan

“…A previous study noted a link between presenteeism and near-misses among emergency personnel [ 15 ]. Delays in reaction time and impaired decision-making due to fatigue or drowsiness and decreased judgment can lead to reduced attention and increased traffic accident risk [ [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] ]. Sleep deprivation affects performance in a similar way to alcohol consumption [ [32] , [33] , [34] ].…”

Association of Visual-Based Signals with Electroencephalography Patterns in Enhancing the Drowsiness Detection in Drivers with Obstructive Sleep Apnea

“…OSA affects around 2% to 4% of women and 4% to 11% of men in the middle-aged population [ 4 ]. OSA patients face a notably higher risk of motor vehicle accidents, with rates two to seven times higher compared to the general population [ 5 , 6 ]. A specific study highlighted the increased accident risk in individuals with OSA compared to those without OSA (crash relative risk = 2.43, 95% CI: 1.21–4.89, p = 0.013) [ 7 ].…”

Utilization of the GOAL questionnaire as a standardized screening tool for obstructive sleep apnea

“…OSA is a danger factor for hemorrhagic and ischemic cerebrovascular disease 5 , hypertension 6 , arrhythmias 7 , ischemic heart disease and heart failure 8 , diabetes 9 , cognitive impairment 10 , and traffic accidents due to reduced alertness and attention 11 . Therefore, early diagnosis of OSA is important.…”