Self-reported sleepiness and not the apnoea hypopnoea index is the best predictor of sleepiness-related accidents in obstructive sleep apnoea

P Philip,J A Micoulaud-Franchi,S Bailly,M Joyeux-Faure,Y Grillet,I Jullian-Desayes,J L Pépin,R Tamisier,M Benmerad,M Sapène

doi:10.1038/s41598-020-72430-8

Abstract

To evaluate the value of apnoea + hypopnoea index versus self-reported sleepiness at the wheel in anticipating the risk of sleepiness-related accidents in patients referred for obstructive sleep apnoea. A cross-sectional analysis of the French national obstructive sleep apnoea registry. 58,815 subjects referred for a suspicion of obstructive sleep apnoea were investigated by specific items addressing sleepiness at the wheel and sleepiness-related accidents. Apnoea + hypopnoea index was evaluated with a respiratory polygraphy or full polysomnography. Subjects had a median age of 55.6 years [45.3; 64.6], 65% were men, with a median apnoea + hypopnoea index of 22 [8; 39] events/h. Median Epworth sleepiness scale score was 9 [6; 13], 35% of the patients reported sleepiness at the wheel (n = 20,310), 8% (n = 4,588) reported a near-miss accident and 2% (n = 1,313) reported a sleepiness-related accident. Patients reporting sleepiness at the wheel whatever their obstructive sleep apnoea status and severity exhibited a tenfold higher risk of sleepiness-related accidents. In multivariate analysis, other predictors for sleepiness-related accidents were: male gender, ESS, history of previous near-miss accidents, restless leg syndrome/periodic leg movements, complaints of memory dysfunction and nocturnal sweating. Sleep apnoea per se was not an independent contributor. Self-reported sleepiness at the wheel is a better predictor of sleepiness-related traffic accidents than apnoea + hypopnoea index.

Highlights

Subjects included in the study (n = 58,712) had a median age of 55.6 years [interquartile range: 45.3; 64.6], 65% of them were men, with a median apnoea + hypopnoea index of 22.0 [8.4; 38.8] events/h
(> 50,000) assessed the value of apnoea + hypopnoea index versus self-reported sleepiness at the wheel regarding the risk of sleepiness-related traffic accidents
We clearly showed that a relatively limited percentage of patients presenting with an obstructive sleep apnoea reported sleepiness at the wheel

Summary

Objectives

The Observatoire Sommeil de la Fédération de Pneumologie is collecting data in a prospective cohort of patients suspected of having obstructive sleep a pnoea[12]. Each patient is evaluated during a structured interview associated with an electronic medical record and is assessed by respiratory polygraphy or polysomnography to confirm the diagnosis of obstructive sleep apnoea and treat it. Apart from the classical symptoms and comorbidities characterizing obstructive sleep apnoea (in particular excessive daytime sleepiness), this national registry includes questions concerning sleepiness at the wheel, the occurrence of near-miss accidents and self-reports of sleepiness-related accidents. The main goal of the current study was to quantify the true value of apnoea + hypopnoea index versus sleepiness at the wheel in order to better identify obstructive sleep apnoea patients at risk for sleepiness-related accidents

Methods

Results

Discussion

Conclusion