Risk Of Car Crashes Research Articles

Postal Code Diagnosis and Treatment of Sleep Apnea

The Lung Centre, Vancouver, British Columbia Correspondence: Dr John A Fleetham, The Lung Centre, 7th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9. Telephone 604-875-5653, fax 604-875-5587, e-mail john.fleetham@vch.ca In the current issue of the Canadian Respiratory Journal, Rotenberg et al (1) (pages 170-174) report data from a crosssectional survey sent to otolaryngologists, respirologists and family physicians in Ontario, to characterize wait times for obstructive sleep apnea (OSA) care. The major finding was that patients with suspected OSA in Ontario waited a mean of 11.6 months to initiate continuous positive airway pressure (CPAP) treatment and 16.2 months to initiate surgical therapy. This is much longer than the wait time in the Canadian Thoracic Society (CTS) guidelines, which recommend a maximum wait time of two to four weeks for urgent patients with comorbid disease or daytime sleepiness and a critical safety occupation, and six months for all patients with suspected OSA (2,3). Excessive diagnostic wait times frequently lead to inappropriate or incorrect therapy. Wait times for the diagnosis of sleep apnea in Canada have not improved much since Flemons et al (4) reviewed wait times for the diagnosis of OSA in five countries, including Canada, 16 years previously. To paraphrase what Pack (5) wrote in an associated editorial: “It seems inconceivable that we should tell a patient the following: You are highly likely to have severe sleep apnea, a disorder associated with an increased risk of car crashes, high blood pressure, and probably heart attack and stroke. We have an effective treatment for this disorder. We will arrange a study for you in 11.6 months’ time to assess this”. The even longer wait time for surgical treatment of OSA reported by Rotenberg et al also merits comment. The role of corrective upper airway surgery in the treatment of OSA is controversial. The current CTS guidelines conclude that laser-assisted uvulopalatoplasty is not recommended for the treatment of OSA, but that uvulopalatopharyngoplasty may be considered in selected patients with OSA who have failed CPAP and/or oral appliance therapy. The delay in the diagnosis and treatment of OSA in Ontario needs to be put in the context of the rest of Canada, where the diagnosis and treatment of sleep apnea is provided in a very different manner. Ontario has the highest number of sleep laboratories in Canada and most other parts of the world apart from the United States (4). Moreover, Ontario is one of the few provinces, along with Manitoba and Saskatchewan, in which the provincial medical plan funds CPAP treatment. The majority of centres in Canada outside of Ontario use ambulatory sleep monitoring – in addition to polysomnography – to diagnose OSA. After OSA has been diagnosed, there is no additional delay in the provision of CPAP therapy because this is funded by the patient and does not require approval by a funding agency. The majority of respondents to the survey in the article by Rotenberg et al (1) identified ‘not enough sleep laboratories’ as the reason for long wait times. Many would argue that more sleep laboratories are not what is required – what is necessary is a more appropriate diagnostic strategy that uses clinical prediction equations and ambulatory sleep monitoring (6) in conjunction with polysomnography for patients with comorbid disease or who fail to improve with CPAP treatment. Furthermore, if resources for the management of OSA are to be rationed, a higher priority should be given to treatment than to diagnosis. Patients with OSA use health care services at approximately twice the rate of control subjects for up to 10 years before the diagnosis of OSA (7). CPAP treatment has an incremental cost-effectiveness ratio of $2,618 per quality-adjusted life year over no treatment (8). A ratio of less than $10,000 per qualityadjusted life year is generally considered to be extremely cost effective. While CPAP treatment for OSA is funded in many other countries including the United Kingdom (9) and the United States (10), it is not funded in the majority of Canadian provinces. In 2008, The Lung Association and the CTS jointly recommended funding of CPAP treatment under all provincial and federal health insurance plans for adults and children appropriately diagnosed with OSA; however, little progress has been made over the past two years. It is now time to end the postal code differences that currently exist in Canada with regard to access to the diagnosis and treatment of OSA. editorial

Comparative optimism among drivers: An intergenerational portrait

We describe a large cross-sectional study examining comparative optimism (CO) regarding the risk of car crash in three age cohorts (17–26, 27–64, 65 and older). The participants completed a questionnaire in which they were asked to indicate their personal risk of being in an at-fault crash over nine driving related events in comparison to young drivers, mid-aged drivers, and older drivers. The results indicated that all three age groups exhibited CO, but that the level varied according to the age group on which they had to base their comparative judgment. Interestingly, greater CO was constantly observed when the three age groups compared themselves to older drivers. Also, young males exhibited greater CO than female of the same age group.

Morbidity and mortality of sleep-disordered breathing: obstructive sleep apnoea and car crash

Educational aimsTo review the results of USA Department of Transportation meta-analysis regarding obstructive sleep apnoea (OSA) and car crash risk.To discuss factors beyond OSA that increase the risk of crash.SummaryUntreated OSA increases the risk of having a car crash two-fold. In addition, the severity of sleep-disordered breathing, degree of oxygen desaturation, self-reported sleepiness and body mass index (BMI) increase the risk of crash in OSA patients. Continuous positive airway pressure (CPAP) reduces the risk of car crash. The data are insufficient for other forms of treatment to date. Sleep loss, medications and driving conditions have also been found to be factors affecting the risk of crash.

Driving styles among young novice drivers—The contribution of parental driving styles and personal characteristics

As part of the effort to ascertain why young drivers are more at risk for car crashes, attention has recently turned to the effects of family, including the intergenerational transmission of driving styles from parents to offspring. The current study sought to further understanding of the nature and aspects of the family influence with the help of Bowen's family systems theory. In Phase 1 of the prospective study, 130 young driving students completed questionnaires tapping personal and personality measures, and their parents completed driving-related instruments. In Phase 2, a year after the young drivers had obtained their driver's license, they were administered the same questionnaires their parents had previously completed. The results show significant correlations between the parents’ driving styles and those of their offspring a year after licensure. Furthermore, differentiation of self and self-efficacy in newly acquired driving skills were found to moderate or heighten the similarity between the driving styles of parents and their offspring. For young drivers reporting anxiety in Phase 1, this was associated with a reported anxious driving style a year later. Among young female drivers, anxiety was also associated with a reckless and careless style. Higher sensation seeking was related to higher reckless driving among young male drivers. The findings are discussed in the context of adolescence and the role of the study variables in the development and intergenerational transmission of driving styles. In addition to its theoretical contribution to the realms of intergenerational transmission in general, and young drivers in particular, the study may have practical implications for both family therapy and the design of driving interventions.

Reducing air-pollution: A new argument for getting drivers to abide by the speed limit?

Speeding is one of the main factors of car crash-risk, but it also contributes to increasing air-pollution. In two studies we attempted to lead drivers to abide by speed limits using “reducing air-pollution” as a new argument. We presented prevention messages that highlighted the role of speeding in increasing “crash-risk”, “air-pollution”, or both (Studies 1 and 2). The messages were also positively or negatively framed (Study 2). Given that women are more concerned with environmental issues than are men, we expected the following hypotheses to be validated for women. The message with the “air-pollution” argument was expected to be evaluated more positively than the “crash-risk” message (H1). The “air-pollution” and “crash-risk and air-pollution” messages were expected to be more effective than the “crash-risk” message on the behavioral intention to observe speed limits (H2a) and on the perceived efficacy of speed-limit observance in reducing air-pollution (H2b; Studies 1 and 2). Furthermore, positive framing was expected to be more effective than negative framing (H3), and presenting a message to be more effective than presenting no message (H4; Study 2). Broadly, our results argue in favor of our hypotheses. However in Study 2, the effects of message framing did not allow us to conclude that negative or positive framing was superior. All in all, messages with the “air-pollution” argument were more effective at leading drivers to observe speed limits. Thus, environmental protection may be a fruitful route to explore for increasing road safety.

Obstructive Sleep Apnea and Cardiovascular Disease: A Perspective and Future Directions

Data from animal and human studies provide a biological plausibility to the notion that obstructive sleep apnea activates pathways that lead to insulin resistance, atherosclerosis and hypertension. Sleep apnea thus activates the same pathways as does obesity. That obstructive sleep apnea is a risk factor for cardiovascular disease is supported by epidemiological association studies. Longitudinal cohort studies also provide evidence that patients with untreated severe sleep apnea have an increased rate of cardiovascular events. But these studies, while highly suggestive, do not provide the evidence needed to convince the skeptic. This would only be obtained by randomized treatment trials with hard cardiovascular endpoints such as cardiac events and deaths. While such studies are in the planning stages, they will be challenging. There are issues about randomizing individuals with severe sleep apnea and excessive sleepiness into no therapy, since they are at known increased risk for car crashes. Thus, lack of therapy puts others on the road at risk as well as the subject with sleep apnea. There is, moreover, the concern that treating obstructive sleep apnea in very obese individuals will have little impact, since any effect of therapy for OSA will be overwhelmed by the effects of obesity itself. Data from randomized treatment trials for cardiovascular endpoints will likely not be available for many years. In the interim, physicians need to consider how to treat such patients. It is proposed that given that CPAP treatment for obstructive sleep apnea is highly effective and essentially totally safe, and that the evidence is suggestive that sleep apnea is a risk factor for cardiovascular disease, then we propose all patients with severe sleep apnea should be treated to reduce cardiovascular risk.

Police patrols for alcohol-related crashes: more rigorous evaluation needed

Driving vehicles after drinking alcohol is common, and has been shown to increase the risk of car crashes.1 There is a strong community perception that increased police patrols are effective...

An investigation of the effect of sleepiness, drowsy driving, and lifestyle on vehicle crashes

Abstract Purpose The current study investigated the impact of lifestyle and sleep-related factors on the probability of car crash involvement in a country that lacks good crash and driver history data. This is considered to be one of the few research studies exploring crash risk on the basis of the driver’s lifestyle, using a holistic approach of lifestyle instead of individual lifestyle characteristics. Method A sample of 1366 non-professional drivers aged 19–65, from the broader Athens area as well as from other cities of Greece, was studied through personal interviews. The questionnaire included items about the drivers’ socio-demographic characteristics, their lifestyle, the incidents of fatigue and falling asleep while driving, the frequency of daytime sleepiness and the symptoms of sleep disorders. Data analysis was undertaken by principal components analysis and multinomial logistic regression. Results Among the five lifestyle patterns (Amusement, Culture, Religion, Sport, Work) that emerged through the principal component analysis, only the lifestyle of Religion was found to be negatively associated with the risk of causing car crashes. The frequency of fatigue and fall asleep incidents while driving was shown to increase the risk of causing car crashes. The symptoms of sleep disorders were also found to increase the car crash risk but only in the case of a single crash. On the contrary, the frequency of daytime sleepiness was found to reduce the likelihood of causing a car crash. Discussion Road safety campaigns should target drowsy-prone drivers. The role of lifestyle in driving behaviour should be further explored.

Extending parental mentoring using an event-triggered video intervention in rural teen drivers

Teen drivers are at high risk for car crashes, especially during their first years of licensure. Providing novice teen drivers and their parents with a means of identifying their risky driving maneuvers may help them learn from their mistakes, thereby reducing their crash propensity. During the initial phase of learning, adult or parental supervision often provides such guidance. However, once teens obtain their license, adult supervision is no longer mandated, and teens are left to themselves to continue the learning process. This study is the first of its type to enhance this continued learning process using an event-triggered video device. By pairing this new technology with parental feedback in the form of a weekly video review and graphical report card, we extend parents' ability to teach their teens even after they begin driving independently. Twenty-six 16- to 17-year-old drivers were recruited from a small U.S. Midwestern rural high school. We equipped their vehicles with an event-triggered video device, designed to capture 20-sec clips of the forward and cabin views whenever the vehicle exceeded lateral or forward threshold accelerations. Preliminary findings suggest that combining this emerging technology with parental weekly review of safety-relevant incidents resulted in a significant decrease in events for the more at-risk teen drivers. Implications for how such an intervention could be implemented within GDL are also discussed.

Cannabis increases the risk of car crashes

Cannabis increases the risk of car crashes

Does periodic vehicle inspection reduce car crash injury? Evidence from the Auckland Car Crash Injury Study

This paper examines the association between periodic motor vehicle inspection and frequent tire pressure checks, and the risk of car crash injury. Data were analysed from the Auckland Car Crash Injury Study, a population-based case-control study in Auckland, NZ, where vehicles are required to undergo six-monthly safety inspections. Cases were all cars involved in crashes in which at least one occupant was hospitalised or killed, which represented 571 drivers. Controls were randomly selected cars on Auckland roads (588 drivers). Participants completed a structured interview. Vehicles that did not have a current certificate of inspection had significantly greater odds of being involved in a crash where someone was injured or killed compared with cars that had a current certificate, after adjustment for age, sex, marijuana use, ethnicity and licence type (OR 3.08, 95% CI 1.87-5.05). Vehicles that had not had their tire pressure checked within the past three months also had significantly greater odds of being involved in a crash compared with those that had a tire pressure check, after adjustment for age, sex, ethnicity, seatbelt use, licence type, self-reported speed and hours per week of driving exposure (OR 1.89, 95% CI 1.16-3.08). This study provides new evidence, using rigorous epidemiological methods and controlling for multiple confounding variables, of an association between periodic vehicle inspections and three-monthly tire pressure checks and reduced risk of car crash injury. This research suggests that vehicle inspection programs should be continued where they already exist and contributes evidence in support of introducing such programs to other areas.