Gurubhagavatula Indira, Nkwuo Jonathan E, Maislin Greg, Pack Allan I
Center for Sleep and Respiratory Neurobiology, Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia, PA 19104, United States.
Accid Anal Prev. 2008 Jan;40(1):104-15. doi: 10.1016/j.aap.2007.04.011. Epub 2007 May 24.
Sleep apnea among commercial drivers may increase the risk of fall-asleep crashes, which incur large expenses. Drivers of passenger cars whose apnea is treated experience lower crash risk. Among community-based holders of commercial driver's licenses, we considered three methods for identifying sleep apnea syndrome: (1) in-lab polysomnography; (2) selective in-lab polysomnography for high-risk drivers, where high risk is first identified by body mass index, age and gender, followed by oximetry in a subset of drivers; (3) not screening. The costs for each of these three programs equaled the sum of the costs of testing, treatment of identified cases, and crashes. Assuming that treatment prevents apnea-related crashes, polysomnography is not cost-effective, because it was more expensive than the cost of crashes when no screening is done. Screening with BMI, age and gender, however, with confirmatory in-lab polysomnography only on high-risk drivers was cost-effective, as long as a high proportion (73.8%) of screened drivers accepts treatment. These findings indicate that strategies that reduce reliance on in-laboratory polysomnography may be more cost-effective than not screening, and that treatment acceptance may need to be a condition of employment for affected drivers.
商业司机中的睡眠呼吸暂停可能会增加入睡时撞车的风险，这会带来巨大的费用。接受呼吸暂停治疗的乘用车司机发生撞车的风险较低。在以社区为基础的商业驾驶执照持有者中，我们考虑了三种识别睡眠呼吸暂停综合征的方法：（1）实验室多导睡眠图；（2）对高危司机进行选择性实验室多导睡眠图检查，其中首先通过体重指数、年龄和性别确定高危人群，然后对一部分司机进行血氧测定；（3）不进行筛查。这三个项目中每个项目的成本等于检测成本、确诊病例的治疗成本和撞车成本的总和。假设治疗可预防与呼吸暂停相关的撞车事故，多导睡眠图检查不具有成本效益，因为它比不进行筛查时的撞车成本更高。然而，仅对高危司机进行实验室多导睡眠图检查以确认结果的情况下，通过体重指数、年龄和性别进行筛查是具有成本效益的，只要很大比例（73.8%）接受筛查的司机接受治疗。这些发现表明，减少对实验室多导睡眠图检查依赖的策略可能比不进行筛查更具成本效益，而且治疗接受度可能需要成为受影响司机就业的一个条件。
