Masa J F, Rubio M, Findley L J
Pulmonary Division, San Pedro de Alcántara Hospital, Cáceres, Spain.
Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1407-12. doi: 10.1164/ajrccm.162.4.9907019.
Sleepiness is a common cause of traffic crashes with a cost of billions of dollars per year. A recent study has found that 2 to 3% of drivers are habitually sleepy while driving. However, there has not been a controlled study to define the characteristics, driving performance, or automobile crash rate of habitually sleepy drivers. The prevalence of respiratory disorders during sleep, and whether these respiratory disorders contribute to the increased automobile crash frequency, is unknown in habitually sleepy drivers. We interviewed 4,002 randomly selected drivers to define the prevalence of drivers who are habitually sleepy while driving. We studied the habitually sleepy drivers and an age- and sex-matched control group of drivers. These studies included reporting of daytime sleepiness, automobile crashes, driving performance and sleep studies. Of the 4, 002 drivers interviewed, 145 (3.6%, confidence interval [CI] = 3.1 to 4.3) were habitually sleepy while driving. The habitually sleepy drivers reported a significantly higher frequency of auto crashes than control subjects (the adjusted odds ratio [OR] was 13.3, CI = 4. 1 to 43). The habitually sleepy drivers had a significantly higher prevalence of respiratory sleep disorders than control subjects. For a total respiratory events index (apneas, hypopneas, and other respiratory effort-related arousals) >/= 15 the adjusted OR was 6.0, CI = 1.1 to 32. In the habitually sleepy drivers group, the frequency of sleep apnea (apnea-hypopnea index) between subjects with or without auto crashes was not statistically different. However, if we consider total respiratory events index, this frequency of respiratory sleep disorders was significantly higher in subjects with automobile crashes (the adjusted OR for a total respiratory event index >/= 15 was 8.5, CI = 1.2 to 59). Habitually sleepy drivers are a large group of drivers (1 of 30 drivers) who are involved in several fold more automobile crashes than control subjects. As these excess auto crashes can be explained in part by the presence of respiratory disorders during sleep, which are treatable, many automobile crashes in these sleepy drivers may be preventable. Our findings suggest that asking about excessive sleepiness while driving may better predict which subjects with breathing disorders during sleep have crashes than asking about overall sleepiness.
困倦是交通事故的常见原因，每年造成的损失达数十亿美元。最近一项研究发现，2%至3%的驾驶员在开车时习惯性困倦。然而，尚未有对照研究来界定习惯性困倦驾驶员的特征、驾驶表现或车祸发生率。习惯性困倦驾驶员睡眠期间呼吸障碍的患病率，以及这些呼吸障碍是否导致车祸频率增加尚不清楚。我们对4002名随机挑选的驾驶员进行了访谈，以确定开车时习惯性困倦的驾驶员的患病率。我们研究了习惯性困倦驾驶员以及年龄和性别匹配的驾驶员对照组。这些研究包括白天困倦情况、车祸、驾驶表现及睡眠研究的报告。在接受访谈的4002名驾驶员中，145名（3.6%，置信区间[CI]=3.1%至4.3%）开车时习惯性困倦。习惯性困倦驾驶员报告的车祸频率显著高于对照组（校正优势比[OR]为13.3，CI=4.1至43）。习惯性困倦驾驶员呼吸睡眠障碍的患病率显著高于对照组。对于总呼吸事件指数（呼吸暂停、低通气及其他与呼吸努力相关的觉醒）≥15，校正OR为6.0，CI=1.1至32。在习惯性困倦驾驶员组中，有或没有车祸的受试者之间睡眠呼吸暂停（呼吸暂停低通气指数）频率无统计学差异。然而，如果我们考虑总呼吸事件指数，有车祸的受试者中这种呼吸睡眠障碍频率显著更高（总呼吸事件指数≥15的校正OR为8.5，CI=1.2至59）。习惯性困倦驾驶员是一个庞大的驾驶员群体（每30名驾驶员中有1名），他们发生车祸的次数是对照组的几倍。由于这些额外的车祸部分可归因于睡眠期间存在可治疗的呼吸障碍，这些困倦驾驶员中的许多车祸可能是可预防的。我们的研究结果表明，询问驾驶时是否过度困倦可能比询问总体困倦情况能更好地预测哪些睡眠期间有呼吸障碍的受试者会发生车祸。
