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Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea

STUDY OBJECTIVES: Motor-vehicle crashes are frequent in untreated OSA patients but there is still uncertainty on prevalence as well as physiological or clinical determinants of sleepiness at the wheel (SW) in OSA patients. We assessed determinants of SW or sleepiness related near-miss car accident (...

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Autores principales: Fanfulla, Francesco, Pinna, Gian Domenico, Marrone, Oreste, D’Artavilla Lupo, Nadia, Arcovio, Simona, Bonsignore, Maria R., Morrone, Elisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076750/
https://www.ncbi.nlm.nih.gov/pubmed/33927591
http://dx.doi.org/10.3389/fnins.2021.656203
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author Fanfulla, Francesco
Pinna, Gian Domenico
Marrone, Oreste
D’Artavilla Lupo, Nadia
Arcovio, Simona
Bonsignore, Maria R.
Morrone, Elisa
author_facet Fanfulla, Francesco
Pinna, Gian Domenico
Marrone, Oreste
D’Artavilla Lupo, Nadia
Arcovio, Simona
Bonsignore, Maria R.
Morrone, Elisa
author_sort Fanfulla, Francesco
collection PubMed
description STUDY OBJECTIVES: Motor-vehicle crashes are frequent in untreated OSA patients but there is still uncertainty on prevalence as well as physiological or clinical determinants of sleepiness at the wheel (SW) in OSA patients. We assessed determinants of SW or sleepiness related near-miss car accident (NMA) in a group of non-professional drivers with OSA. METHODS: A 237 consecutive, treatment-naïve PSG-diagnosed OSA patients (161 males, 53.1 ± 12.6 years) were enrolled. Self-reported SW was assessed by positive answer to the question, “Have you had episodes of falling asleep while driving or episodes of drowsiness at wheel that could interfere with your driving skill in the last year?” Occurrence of NMA in the last 3 years was also individually recorded. Habitual self-reported average sleep time was collected. RESULTS: SW was found in 41.3% of patients but one-quarter of patients with SW did not report excessive daytime sleepiness. Predictors of SW were the following subjective factors: Epworth sleepiness scale score (ESS-OR 1.26; IC 1.1–1.4; p < 0.0001), depressive symptoms (BDI-OR 1.2; IC 1.06–1.18; p < 0.0001) and level of risk exposure (annual mileage-OR 1.9; IC 1.15–3.1; p = 0.007). NMAs were reported by 9.7% of patients, but more frequently by SW(+) than SW(–) (22.4% vs. 0.7%; χ(2) 31, p < 0.0001). The occurrence of NMAs was significantly associated to ESS, BDI, habitual sleep duration and ODI (R(2) = 0.41). CONCLUSION: SW is not predicted by severity of OSA. Evaluation of risk exposure, assessment of depressive symptoms, and reported NMA should be included in the clinical evaluation, particularly in patients with reduced habitual sleep time and severe nocturnal hypoxia.
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spelling pubmed-80767502021-04-28 Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea Fanfulla, Francesco Pinna, Gian Domenico Marrone, Oreste D’Artavilla Lupo, Nadia Arcovio, Simona Bonsignore, Maria R. Morrone, Elisa Front Neurosci Neuroscience STUDY OBJECTIVES: Motor-vehicle crashes are frequent in untreated OSA patients but there is still uncertainty on prevalence as well as physiological or clinical determinants of sleepiness at the wheel (SW) in OSA patients. We assessed determinants of SW or sleepiness related near-miss car accident (NMA) in a group of non-professional drivers with OSA. METHODS: A 237 consecutive, treatment-naïve PSG-diagnosed OSA patients (161 males, 53.1 ± 12.6 years) were enrolled. Self-reported SW was assessed by positive answer to the question, “Have you had episodes of falling asleep while driving or episodes of drowsiness at wheel that could interfere with your driving skill in the last year?” Occurrence of NMA in the last 3 years was also individually recorded. Habitual self-reported average sleep time was collected. RESULTS: SW was found in 41.3% of patients but one-quarter of patients with SW did not report excessive daytime sleepiness. Predictors of SW were the following subjective factors: Epworth sleepiness scale score (ESS-OR 1.26; IC 1.1–1.4; p < 0.0001), depressive symptoms (BDI-OR 1.2; IC 1.06–1.18; p < 0.0001) and level of risk exposure (annual mileage-OR 1.9; IC 1.15–3.1; p = 0.007). NMAs were reported by 9.7% of patients, but more frequently by SW(+) than SW(–) (22.4% vs. 0.7%; χ(2) 31, p < 0.0001). The occurrence of NMAs was significantly associated to ESS, BDI, habitual sleep duration and ODI (R(2) = 0.41). CONCLUSION: SW is not predicted by severity of OSA. Evaluation of risk exposure, assessment of depressive symptoms, and reported NMA should be included in the clinical evaluation, particularly in patients with reduced habitual sleep time and severe nocturnal hypoxia. Frontiers Media S.A. 2021-04-13 /pmc/articles/PMC8076750/ /pubmed/33927591 http://dx.doi.org/10.3389/fnins.2021.656203 Text en Copyright © 2021 Fanfulla, Pinna, Marrone, D’Artavilla Lupo, Arcovio, Bonsignore and Morrone. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Fanfulla, Francesco
Pinna, Gian Domenico
Marrone, Oreste
D’Artavilla Lupo, Nadia
Arcovio, Simona
Bonsignore, Maria R.
Morrone, Elisa
Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea
title Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea
title_full Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea
title_fullStr Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea
title_full_unstemmed Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea
title_short Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea
title_sort determinants of sleepiness at wheel and missing accidents in patients with obstructive sleep apnea
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076750/
https://www.ncbi.nlm.nih.gov/pubmed/33927591
http://dx.doi.org/10.3389/fnins.2021.656203
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