Abstract
Objectives: Automobile accidents related to obstructive sleep apnea (OSA) represent an important public health concern. Frequent arousal response during sleep is responsible for the symptoms of daytime sleepiness and an increased risk of automobile accidents in patients with OSA. We therefore investigated the potential relationships between the intensity of arousal and occurrence of automobile accidents in OSA. Methods: We determined the incidence of automobile accidents in the past 5 years among 51 men with OSA (age, 58.5 ± 10.4 years) using a questionnaire. Daytime sleepiness was rated with the Epworth Sleepiness Scale (ESS). We calculated an automobile accident score, with two points per automobile accident causing damage and one point per near miss. Standard polysomnography was performed for all patients, and arousals were classified as electroencephalographic (EEG) arousal of an abrupt shift in EEG frequency alone and Movement arousal, which was defined as EEG arousal with increased electromyographic activity persisting for ≥3 s. The number of EEG or Movement arousals per hour (arousal index) was determined. Results: The Movement arousal index was significantly greater in the 27 patients who experienced at least one automobile accident causing damage than in the resting 24 patients who had no history of automobile accidents. Multiple regression analysis including age, body mass index, and sleep parameters revealed that the Movement arousal index was the most significant factor of risk for automobile accidents (β = 0.563, P = 0.017) as well as the ESS score (β = 0.417, P = 0.022). Conclusion: Movement arousal during sleep contributes to daytime sleepiness and the resulting frequent involvement of OSA patients in automobile accidents.
Highlights
In the United States, sleepiness is presumed to be a principal cause of 15% - 20% of traffic accidents [1]
Automobile accidents resulting in damage or near misses in the past 5 years were reported by 52.9% and 45.1% of obstructive sleep apnea (OSA) patients, respectively
Movement arousal index was significantly greater in the 27 OSA patients who experienced at least one automobile accident resulting in damage than in the 24 patients without automobile accidents (Table 2)
Summary
In the United States, sleepiness is presumed to be a principal cause of 15% - 20% of traffic accidents [1]. Obstructive sleep apnea (OSA) is one of the major medical causes of excessive daytime sleepiness [5] [6] [7]. Individuals with OSA show poor driving performance, as indicated by lapses of attention and increase in drifting in lane position in driving simulators [11]. Sleep fragmentation is caused by repeated episodes of arousal on termination of apnea or hypopnea, and consequent poor sleep quality during nighttime adversely affects daytime alertness [6] [7] [8]. Frequent arousals during sleep likely contribute to the increased risk of automobile accidents in OSA. To our knowledge, the impact of transient arousal from sleep on both the daytime sleepiness and automobile accidents in patients with OSA has not been systematically analyzed
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