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Communications to the Editor |

Sleep-Disordered Breathing in Middle-Aged Adults Predicts No Significantly Higher Rates of Traffic Violations FREE TO VIEW

Katharine M. Rex, BA; Daniel F. Kripke, MD; Melville R. Klauber, PhD; Sonia Ancoli-Israel, PhD
Author and Funding Information

University of California San Diego, CA

Correspondence to: Katharine M. Rex, University of California, San Diego, 9500 Gilman Dr, Dept 0667, La Jolla, CA 92093-0667; e-mail: krex@ucsd.edu



Chest. 2001;119(5):1623-1624. doi:10.1378/chest.119.5.1623
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The American Medical Association1has recommended that guidelines be developed for the driving licensure of persons who have sleep-related disorders that would be based on the extent to which those disorders contribute to traffic accidents and injuries. There is concern that regulators might attempt to restrict the driving privileges of apnea patients because of “lapses of consciousness” as defined by the “inability to respond rationally to the environment (excluding psychiatric conditions).”2

Kripke et al3 described a large population sample studied between 1990 and 1995, which may be the only randomly selected, ethnically representative objective survey of sleep-disordered breathing in a general US middle-aged population. Included were 190 women and 165 men between the ages of 40 and 64 years, and 65 women between the ages of 20 and 39 years. Home-based pulse oximetry data were collected to determine the incidence of 4% oxygen desaturation (ODI4) events each hour during sleep. More than half the male and almost half the female participants had at least five desaturation events per hour of sleep. The prevalence of > 20 events per hour was 9.3% for men and 5.2% for women.

Following the receipt of driving records, which spanned the previous 3 years in most cases, coded violation/accident data were calculated for each subject. Citations were scored from 1 to 3, according to the severity of the violation.

The 303 volunteer records had violation scores ranging from 0 to 7, with 51 scores of > 0. The mean adjusted violation scores for groups with increasing numbers of ODI4 events were not consistently related to increasing the number of ODI4 events. Logistic regression for any violation (ie, a score of ≥ 1) showed no significant effect of log10[ODI4], when age and gender were controlled. The results of a logistic regression analysis for violation scores of ≥ 3 (n = 20) were not significant, with no predictor meeting p < 0.05 criteria. This survey demonstrated that the relationship of desaturation incidents to sleepiness is very weak,3as other population samples have also shown.47 This study had 80% power to detect if the log10[ODI4] increases 0.3 log units or if the risk of accident increases 76% (risk ratio, 1.76). Thus, the possibility of any strong risk in our general population can be excluded.

Young et al8described an increased number of motor vehicle accidents in men with apnea-hypopnea index (AHI) scores of≥ 5 but also described an anomalous protective association of AHI scores of ≥ 5 in women. There was no significant overall relationship of the odds ratio to the AHI. Aldrich9found that there was no significantly higher self-reported accident rate among patients with sleep apnea, narcolepsy, or other disorders of excessive daytime sleepiness when compared to a control group. George et al10 found that men with a mean (± SD)> found that male subjects 49.3 ± 12.7 years old (SD) who had sleep apnea (AHI score, 73 ± 29) did significantly worse than control subjects on a divided attention driving test. However, there was no relationship between the level of the AHI and poor performance, and a large number of symptomatic volunteers were as good as, or better than, control subjects.

Neither this study nor the preponderance of previous studies supports a strong risk of accidents related to sleep apnea. Although the occurrence of five or more respiratory events per hour is exceptionally common in the population, it does not indicate a driving risk as great as that of single men under the age of 25 years, which we tolerate.

This research was supported by National Institutes of Health grants HL40930, AG12364, HL55983, ES08930, and AG02711, and the Sam and Rose Stein Institute for Research on Aging.

Deborah L. Wingard, Mary Anne Mowen, William J. Mason, Julian S. Smith, Robert L. Fell, Charles M. Senger, Raul S. Sepulveda, Matthew R. Marler, and Joseph D. Assmus assisted in this study.

. American Medical Association. (1996)Policy compendium of the American Medical Association. American Medical Association. Chicago, IL:
 
State of California Department of Motor Vehicles.. Lapse of consciousness disorders.Division of driver safety manual1995,22-18.50 California Department of Motor Vehicles. Sacramento, CA:
 
Kripke, DF, Ancoli-Israel, S, Klauber, MR, et al Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey.Sleep1997;20,65-76. [PubMed]
 
Young, T, Palta, M, Dempsey, J, et al The occurrence of sleep disordered breathing among middle-aged adults.N Engl J Med1993;328,1230-1235. [CrossRef] [PubMed]
 
Stradling, JR, Crosby, JH Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.Thorax1991;46,85-90. [CrossRef] [PubMed]
 
Ferini-Strambi, L, Zucconi, M, Palazzi, S, et al Snoring and nocturnal oxygen desaturations in an Italian middle-aged male population: epidemiologic study with an ambulatory device.Chest1994;105,1759-1764. [CrossRef] [PubMed]
 
Bearpark, H, Elliott, L, Grunstein, R, et al Snoring and sleep apnea: a population study in Australian men.Am J Respir Crit Care Med1995;151,1459-1465. [PubMed]
 
Young, T, Blustein, J, Finn, L, et al Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.Sleep1997;20,608-613. [PubMed]
 
Aldrich, MS Automobile accidents in patients with sleep disorders.Sleep1989;12,487-494. [PubMed]
 
George, CFP, Boudreau, AC, Smiley, A Comparison of simulated driving performance in narcolepsy and sleep apnea patients.Sleep1996;19,711-717. [PubMed]
 

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References

. American Medical Association. (1996)Policy compendium of the American Medical Association. American Medical Association. Chicago, IL:
 
State of California Department of Motor Vehicles.. Lapse of consciousness disorders.Division of driver safety manual1995,22-18.50 California Department of Motor Vehicles. Sacramento, CA:
 
Kripke, DF, Ancoli-Israel, S, Klauber, MR, et al Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey.Sleep1997;20,65-76. [PubMed]
 
Young, T, Palta, M, Dempsey, J, et al The occurrence of sleep disordered breathing among middle-aged adults.N Engl J Med1993;328,1230-1235. [CrossRef] [PubMed]
 
Stradling, JR, Crosby, JH Predictors and prevalence of obstructive sleep apnoea and snoring in 1001 middle aged men.Thorax1991;46,85-90. [CrossRef] [PubMed]
 
Ferini-Strambi, L, Zucconi, M, Palazzi, S, et al Snoring and nocturnal oxygen desaturations in an Italian middle-aged male population: epidemiologic study with an ambulatory device.Chest1994;105,1759-1764. [CrossRef] [PubMed]
 
Bearpark, H, Elliott, L, Grunstein, R, et al Snoring and sleep apnea: a population study in Australian men.Am J Respir Crit Care Med1995;151,1459-1465. [PubMed]
 
Young, T, Blustein, J, Finn, L, et al Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults.Sleep1997;20,608-613. [PubMed]
 
Aldrich, MS Automobile accidents in patients with sleep disorders.Sleep1989;12,487-494. [PubMed]
 
George, CFP, Boudreau, AC, Smiley, A Comparison of simulated driving performance in narcolepsy and sleep apnea patients.Sleep1996;19,711-717. [PubMed]
 
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