Dagan Yaron, Doljansky Julia T, Green Amit, Weiner Ada
The Institute for Sleep and Fatigue Medicine, Sheba Medical Center, Tel Hashomer, Israel.
Traffic Inj Prev. 2006 Mar;7(1):44-8. doi: 10.1080/15389580500412994.
Obstructive sleep apnea (OSA) is the main predisposing factor of excessive daytime sleepiness (EDS), and, therefore, increases the risk of road crashes. However, it is difficult to rely on medical intake for OSA or fatigue since drivers' symptoms reports are not reliable. On the other hand, direct measurement of EDS among large numbers of drivers carries serious practical drawbacks. Obstructive sleep apnea, in turn, is strongly related to obesity, and elevated body mass index (BMI) is considered one of the major risk factors for OSA. Thus, it could be postulated that BMI may carry predictive value for EDS proneness.
The present study examined the interrelation between BMI, degree of OSA, as measured with Respiratory Distress Index (RDI), and the degree of EDS, as measured with the mean sleep onset latency in the Multiple Sleep Latency Test (MSLT) among obese (BMI = 32) professional drivers. The drivers went through polysomnography followed by the five sessions of MSLT in the next day.
In accordance with prior studies, we have found strong correlation between BMI and the degree of OSA on the one hand, and between the degree of OSA and EDS on the other hand. OSA was detected among 77.7% of the drivers, 47.1% were sleepy, 19% had severe sleepiness [mean sleep latency [MSL < or = 5 min.], 28.1% had moderate sleepiness [MSL < or = 10 min.]. None of the drivers complained about any sleep problem, including snoring, and all reported that they do not experience excessive daytime sleepiness. Thus, there was no correlation between their subjective report and objective findings.
Obese drivers with BMI above 32 are highly prone to be sleepy during the day. Their subjective reports of OSA or fatigue symptoms are not reliable. Therefore it is highly recommended to screen them easily by weight and height measure for further sleep study and decision about their driving abilities.
阻塞性睡眠呼吸暂停（OSA）是白天过度嗜睡（EDS）的主要诱发因素，因此会增加道路交通事故风险。然而，由于驾驶员的症状报告不可靠，很难依靠医疗问诊来诊断OSA或疲劳。另一方面，对大量驾驶员直接测量EDS存在严重的实际缺陷。反过来，阻塞性睡眠呼吸暂停与肥胖密切相关，体重指数（BMI）升高被认为是OSA的主要危险因素之一。因此，可以推测BMI可能对EDS倾向具有预测价值。
本研究调查了肥胖（BMI = 32）职业驾驶员的BMI、用呼吸窘迫指数（RDI）测量的OSA程度以及用多次睡眠潜伏期试验（MSLT）中的平均睡眠开始潜伏期测量的EDS程度之间的相互关系。驾驶员先进行多导睡眠图监测，第二天再进行五组MSLT。
与先前的研究一致，我们发现一方面BMI与OSA程度之间存在强相关性，另一方面OSA程度与EDS程度之间也存在强相关性。77.7%的驾驶员检测出患有OSA，47.1%的驾驶员嗜睡，19%的驾驶员有严重嗜睡[平均睡眠潜伏期（MSL）≤5分钟]，28.1%的驾驶员有中度嗜睡[MSL≤10分钟]。没有驾驶员抱怨任何睡眠问题，包括打鼾，并且所有人都报告他们没有白天过度嗜睡的情况。因此，他们的主观报告与客观结果之间没有相关性。
BMI高于32的肥胖驾驶员白天极易嗜睡。他们对OSA或疲劳症状的主观报告不可靠。因此，强烈建议通过体重和身高测量对他们进行简单筛查，以便进一步进行睡眠研究并决定他们的驾驶能力。
