Dwarakanath Akshay, Palissery Vinod, Ghosh Dipansu, Jamson Samantha, Elliott Mark
St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Mid Yorkshire Teaching Hospitals NHS Trust, Wakefield, UK.
ERJ Open Res. 2024 Jan 22;10(1). doi: 10.1183/23120541.00638-2023. eCollection 2024 Jan.
Sleepiness while driving is potentially fatal, and it is recommended that a driver who starts to feel tired should stop and have a rest. However, some may use various countermeasures to try to stay alert. We devised a questionnaire that assessed various potential coping strategies that might be used against fatigue and compared them between obstructive sleep apnoea syndrome (OSAS) patients and controls and with sleepiness in general (Epworth Sleepiness Scale (ESS)), specifically while driving (Driving Sleepiness Scale (DSS)) and driving incidents.
119 untreated OSAS patients (male 82%, body mass index (BMI) 37±8 kg·m, ESS 14±5, DSS 3±2, oxygen desaturation index (ODI) 39±15) and 105 controls (male 70%, BMI 28±6 kg·m, ESS 4±3, DSS 7±6) matched for age and driving experience were recruited. All completed a questionnaire relating to their experience over the last year, which included sleepiness in general, sleepiness specifically while driving, 10 questions about various coping strategies they might adopt in order to avoid sleepiness and their history of incidents while driving.
As compared to controls, nearly a third of OSAS patients (29.4%) used more than three coping strategies "frequently". OSAS patients who used more than three such strategies had worse ESS (17±4 12±5, p<0.0001); were more likely to feel sleepy while driving (10±8 5±7, p=0.0002) and had more reported accidents (22.85% 2.38%, p=0.0002) as compared to OSAS patients who used less than three strategies. There was no difference in patient demographics, severity of OSAS, driving experience or episodes of nodding at the wheel and reported near miss events.
Untreated OSAS patients frequently use certain strategies which could be surrogate markers of sleepiness. Enquiring about such strategies in clinical practice may aid the clinician in identifying the patients who are at risk of driving incidents and to advise appropriately.
驾车时困倦可能会致命，建议感到疲劳的驾驶员停车休息。然而，有些人可能会采取各种应对措施来试图保持警觉。我们设计了一份问卷，评估了各种可能用于对抗疲劳的潜在应对策略，并在阻塞性睡眠呼吸暂停综合征（OSAS）患者和对照组之间进行了比较，同时还与一般困倦程度（爱泼华嗜睡量表（ESS））进行了比较，特别是在驾车时（驾车嗜睡量表（DSS））以及驾车事故情况。
招募了119名未经治疗的OSAS患者（男性占82%，体重指数（BMI）为37±8 kg·m，ESS为14±5，DSS为3±2，氧饱和度下降指数（ODI）为39±15）和105名对照组（男性占70%，BMI为28±6 kg·m，ESS为4±3，DSS为7±6），两组在年龄和驾驶经验方面相匹配。所有人都完成了一份关于他们过去一年经历的问卷，其中包括一般困倦程度、驾车时的困倦程度、10个关于他们为避免困倦可能采取的各种应对策略的问题以及他们的驾车事故史。
与对照组相比，近三分之一的OSAS患者（29.4%）“经常”使用三种以上的应对策略。使用三种以上此类策略的OSAS患者的ESS更差（17±4对12±5，p<0.0001）；与使用少于三种策略的OSAS患者相比，他们在驾车时更易感到困倦（10±8对5±7，p=0.0002），且报告的事故更多（22.85%对2.38%，p=0.0002）。患者的人口统计学特征、OSAS严重程度、驾驶经验或驾车时点头发作情况以及报告的险些发生事故事件方面没有差异。
未经治疗的OSAS患者经常使用某些可能是困倦替代指标的策略。在临床实践中询问此类策略可能有助于临床医生识别有驾车事故风险的患者并给予适当建议。
