The Car and Truck Fleet and Leasing Management Magazine

Diagnosing Sleep Apnea in Drivers Is Becoming Easier

February 08, 2007

NEW YORK --- Researchers have developed a new method for diagnosing sleep apnea that doesn't require patients to be electronically monitored in a special sleep laboratory. Sleep apnea is a leading cause of driver fatigue. Instead of spending two nights in a laboratory, some patients can stay home and be tested using portable equipment, according to a New York Times article summing up the research project. The researchers revealed their findings in the current issue of Annals of Internal Medicine. The new method can quicken diagnoses and treatment for sleep apnea, a disorder that causes people to wake up repeatedly when they stop breathing. Typically, patients thought to have sleep apnea are sent to sleep centers for evaluation. If they are diagnosed with the disorder, they are given machines, known as C-PAPs, that send air into the lungs while they sleep. But the price tag for such overnight testing sessions is high, and waiting lists are long. What's more, many people don't live anywhere near a sleep disorder laboratory. For their study, researchers formed a group composed of patients with a 90 percent probability of having sleep apnea. These patients either received a standard evaluation at a laboratory or an in-home test. C-PAP use began immediately. When the patients were re-examined, those who went to the lab fared no better than those tested at home. The study was authored by Dr. C. Frank Ryan of the University of British Columbia and Alan T. Mulgrew of the Vancouver Public Health System in Canada. A major research study by the University of Pennsylvania School of Medicine concluded that truck drivers who routinely get too little sleep or suffer from sleep apnea show signs of fatigue and impaired performance that can make them a hazard on the road. These study results were published in the August 15 issue of the American Journal of Respiratory and Critical Care Medicine. This study is among the largest and most comprehensive studies of truck drivers and fatigue ever done. Penn researchers examined 406 truck drivers and found that those who routinely slept less than five hours a night were likely to fare poorly on tests designed to measure sleepiness, attention and reaction time, and steering ability. Drivers with severe sleep apnea also were sleepy and had performance impairment. Dr. Allan Pack, who headed the study, said the tired truck drivers had impaired performance similar to that of drivers who are legally drunk. "We identified some very impaired people," said Pack, a sleep expert who directs Penn's Center for Sleep and Respiratory Neurobiology. Nearly 5 percent of the truckers had severe sleep apnea, and about 13 percent of the drivers got fewer than five hours of sleep a night on a regular basis. "There are daytime neurobehavioral performance impairments that are found commonly in commercial drivers, and these are more likely among those who get an average of five or less hours of sleep a night and those who suffer from severe obstructive sleep apnea," the researchers concluded. To measure the impact of fatigue on driver performance and safety, Penn researchers sent questionnaires to 4,826 truck drivers who had commercial licenses and lived within 50 miles of the Penn sleep centers. After getting complete responses from 1,329 drivers, they focused on 247 drivers at high risk for sleep apnea and 159 drivers at low risk. The truck drivers, almost all men and on average 45 years old, were given wrist motion detection devices to measure how much they slept during a week. They then were put through a battery of tests at the sleep center. The drivers were monitored in the sleep lab while they slept to see if they had sleep apnea. About 28 percent of the drivers were found to have some degree of sleep apnea, with nearly five percent of them having a severe case. Three tests were then given to measure daytime sleepiness and performance. The drivers were put in a dark room and observed to see how long it took them to doze off. Drivers who logged less than five hours of sleep dozed off more quickly than those who got seven to eight hours of sleep. Drivers with severe sleep apnea also dozed off more rapidly. A lab test to analyze attention and reaction time and another to gauge "lane tracking ability" also turned up performance impairment among the sleep-deprived. When the results were compiled, investigators discovered: **Just over 5 percent of drivers showed impairment on all three performance-related tests. ** Nearly 60 percent did not fare well by at least one measure. ** About half of the drivers who got less than five hours of sleep had two or three impairments. That's compared to 10 percent of drivers who got more than eight hours of sleep regularly. ** About 60 percent of the drivers with severe sleep apnea had two or three impairments. According to the journal article, about 5,600 people are killed each year in the U.S. in crashes involving commercial trucks. Many of the crashes happen when the driver falls asleep at the wheel. Penn researchers are now suggesting specific steps for the Federal Motor Carrier Safety Administration to take to improve road safety: ** Develop strategies to identify impaired drivers through objective testing. ** Implement programs to identify and test drivers with severe sleep apnea and monitor that they stick to their treatment. ** Introduce programs to assess and promote longer durations of sleep among commercial drivers. The results of this study are published in the August 15th issue of the American Journal of Respiratory and Critical Care Medicine. The article is titled, "Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration." Other Penn researchers who worked on the study were: Greg Maislin, Bethany Staley, Frances Pack and David Dinges. William Rogers, formerly of the Trucking Research Institute, American Trucking Associations as well as Charles F. P. George of the University of Western Ontario were also involved. The research was funded through a contract from the Trucking Research Institute, American Trucking Associations -- that was funded by the Federal Motor Carrier Safety Administration. The National Institutes of Health also provided funding.
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