Risk Factors for Sleepiness at the Wheel and Sleep-Related Car Accidents Among Patients with Obstructive Sleep Apnea: Data from the French Pays de la Loire Sleep Cohort

Abstract

Purpose: We aimed to determine the risk factors of sleepiness at the wheel among patients with obstructive sleep apnea (OSA) and to determine factors that were independently associated with reported sleep-related near-miss accidents or car accidents. Patients and Methods: This retrospective study was conducted on 843 OSA patients from the French Pays de la Loire sleep cohort database. Each patient completed surveys including anthropometric data, medical history, professional status, and data on alcohol and tobacco use. Epworth sleepiness scale (ESS) and sleep quality questionnaires were administered. Regarding driving, data were collected on occurrence of sleepiness-related near-misses or car accidents, and on distance driven per year. The primary dependent variable of interest was reported sleepiness at the wheel. Results: On multivariable regression analysis, reported sleepiness at the wheel (n=298) was independently associated with younger age (p=0.02), male gender (p=0.009), marked nocturnal hypoxemia (p=0.006), lower BMI (p=0.03), absence of cardiovascular disease (p=0.022), executives or high degree jobs (p=0.003) and reported difficulty-maintaining sleep (p=0.03). Only past experience of sleepiness at the wheel (OR 12.18,) and an ESS ≥11 ) were independently associated with reported car accidents (n=30) or near-miss accidents (n=137). Conclusion:In patients newly diagnosed with OSA, the risk of car accident seems multifactorial, and its evaluation should include multiple parameters such as patient self-reported sleepiness at the wheel, occurrence of sleepiness-related accidents, anthropometry, professional status, and insomnia complaints. Thus, it is possible to evaluate this risk and advise patients as early as the first visit at the sleep medicine clinic without waiting for the results of the sleep study.

Excessive Daytime Sleepiness and Associated Factors Among Women in Perinatal Period

“…The finding in this study was higher when compared with the other study conducted in Switzerland 5.1% [31], in Japan 2.5% [52], in Slovakia 10.2% [30], in Sweden 7.9% [28], in China 10.9% [53]. In contrast, this result was less than the other study conducted in France 28% [18], in Korea 19.1% [47], in Brazil 55.5% [21], in France 35.3% [22], in Belgium 50.8% [33] and 34.3% [27], in China 22.2% [24], in Greece 38.8% [54] and in Nigeria 44.8% [55]. The discrepancy might be a result of a difference in assessment tools, geographical areas, sample size, the nature and culture of the study subject, and the study setting.…”

“…Indirectly, the illness also leads other health problems like depression and/or anxiety, which can also cause EDS. Other study also reported that the association of EDS to younger age [20,52] male sex [49,52], smoking [18], high degree of job [22], insomnia [13,18], loud snoring [16,20,52], and multiple gestations [20]. Though, all the above factors were not independent predictors of EDS in our study, this might be due to variations in sample size, life style, health status, and sociocultural…”

“…Various study revealed that younger age [20][21][22][23], high school educational level [24] unemployment status [25], respiratory comorbidity [16], having depression symptoms [21,23,[26][27][28][29], low body mass index, high degree of workload [22], the presence chronic medical illness such as diabetes mellitus [24,30], being pregnant [25], use of selective serotonin reuptake inhibitors [23], having anxiety symptoms and substance use like smoking [28] were factors associated with EDS.…”

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

“…Near-miss accidents were reported by 22% of patients reporting SW and were associated with ESS, depression, habitual sleep duration and the oxygen desaturation index (ODI) [37]. Compared to AHI, the severity of nocturnal hypoxia seems to be a better marker of daytime sleepiness [37][38][39] or poor performance at psychomotor vigilance tests [40]. The lack of a relationship between AHI and the risk for car accidents could at least partly be explained by the finding that OSA is not always associated with daytime sleepiness, as shown by recent studies on clinical OSA phenotypes [29,[41][42][43].…”

Symptoms and Risk of Obstructive Sleep Apnea in Patients Attending Primary Health Care Clinics in Riyadh, Saudi Arabia

“…OSA is associated with significant health consequences, including hypertension, obesity, coronary artery disease, metabolic dysfunction, cognitive decline, and cancer progression [ 3 , 4 ]. Sleep-related accidents are also strongly associated with OSA [ 5 ].…”