Abstract
Background: Sleepiness-at-the-wheel has been identified as a major cause of highway accidents. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography. Methods: Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy), heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting. Results: 63.6% of professional bus drivers were diagnosed as having sleep disordered breathing and had a higher body mass index, neck circumference, systolic blood pressure, arousal index and desaturation index than those professional bus drivers without evidence of sleep disordered breathing. Simple home-based candidate measures: (1) Pulse oximetry, oxygen-desaturation indices by ≥3% and 4% (r = 0.87∼0.92); (2) Pulse oximetry, pulse-rising indices by ≥7% and 8% from a baseline (r = 0.61∼0.89); and (3) ApneaLink airflow detection, apnea-hypopnea indices (r = 0.70∼0.70), based on recording-time or Actigraphy-corrected total sleep time were all significantly correlated with, and had high agreement with, corresponding polysomnographic apnea-hypopnea indices [(1) 94.5%∼96.6%, (2) 93.8%∼97.2%, (3) 91.1%∼91.3%, respectively]. Conversely, no validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables. Conclusions: The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, specifically for professional drivers.
Highlights
There is an increasing accumulation of evidence to indicate that sleepiness-at-the-wheel is a major cause of traffic accidents [1,2], a situation which places a huge monetary and personal cost on society [3].Professional long-haul bus drivers, compared with short-haul drivers, are the major group involved in this issue
The aim of this study is to evaluate candidate measures for a home-based screening of sleep disordered breathing in long-haul bus drivers by measuring various parameters from different devices or methods, such as pulse oximetry (PO), ALK, Actigraphy-corrected total-sleep-time (ACT), Multi-variables Apnea Prediction Questionnaire (MAP) Questionnaire, Epworth Sleepiness Scale (ESS), Heart Rate Variability Parameters (HRVp), and body mass index (BMI)
It might be noteworthy that the similarities of pulse oximetry measures with apnea hypopnea index by polysomnographic study (AHIpsg) would be improved if Actigraphy-corrected total-sleep-time (ACT) corrected for total sleep time
Summary
There is an increasing accumulation of evidence to indicate that sleepiness-at-the-wheel is a major cause of traffic accidents [1,2], a situation which places a huge monetary and personal cost on society [3].Professional long-haul bus drivers, compared with short-haul drivers, are the major group involved in this issue. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography. Methods: Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy), heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting. No validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables. Conclusions: The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, for professional drivers
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