Tondo Pasquale, Pronzato Caterina, Risi Irene, Perretti Carlo, De Gennaro Luigi, Bonsignore Maria R, Malovini Alberto, Fanfulla Francesco
Respiratory Function and Sleep Medicine, Clinical and Scientific Institute "Maugeri" IRCCS, Pavia, Italy.
Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
J Clin Sleep Med. 2025 Feb 1;21(2):287-295. doi: 10.5664/jcsm.11376.
Obstructive sleep apnea is considered a risk factor for sleepiness at the wheel and near-miss accidents (NMA). To date, there are subjective and objective methods such as the Maintenance of Wakefulness Test (MWT) to investigate sleepiness. However, these methods have limitations. Therefore, a new analysis of the MWT was introduced based on the identification of microsleeps (MS). So, we tested MS analysis to improve the discriminative ability of MWT in recognizing individuals at risk for sleepiness at the wheel and NMA in a population with obstructive sleep apnea.
The study was conducted on 100 naïve patients with suspected obstructive sleep apnea referred to our Sleep Medicine Unit. All patients performed a full standard polysomnography and MWT. The MWT was analyzed according to standard criteria, and the presence of MS episodes, the mean MS latency, and the MS density (the mean absolute or relative number of MS) were assessed.
MS were observed in 100% of alert or sleepy patients and 47% of the fully alert patients ( < .0001). Almost 90% of patients reporting NMA showed episodes of MS during MWT. The occurrence of NMA was related to excessive daytime sleepiness, MS latency, and MS density ( < .001). The discriminative power for the NMA of MS density measures was higher than that derived from latency analysis, particularly in patients without excessive daytime sleepiness and with a simultaneous mean sleep latency > 33 minutes.
MS analysis provides objective evidence of sleepiness and, therefore, could improve the discriminative ability of the MWT in recognizing individuals at high risk for accidents.
Tondo P, Pronzato C, Risi I, et al. The role of microsleeps to estimate sleepiness at the wheel and near-miss accidents in obstructive sleep apnea. 2025;21(2):287-295.
阻塞性睡眠呼吸暂停被认为是导致驾车时困倦和险些发生事故（NMA）的一个风险因素。到目前为止，有主观和客观的方法，如清醒维持测试（MWT）来调查困倦情况。然而，这些方法存在局限性。因此，基于微睡眠（MS）的识别引入了对MWT的一种新分析。所以，我们测试了MS分析，以提高MWT在识别阻塞性睡眠呼吸暂停人群中存在驾车时困倦和NMA风险个体方面的辨别能力。
该研究对100名转诊至我们睡眠医学科的疑似阻塞性睡眠呼吸暂停的初诊患者进行。所有患者均进行了全面的标准多导睡眠图和MWT检查。根据标准标准对MWT进行分析，并评估MS发作的存在情况、平均MS潜伏期和MS密度（MS的平均绝对或相对数量）。
在100%的警觉或困倦患者以及47%的完全警觉患者中观察到了MS（P<0.0001）。几乎90%报告有NMA的患者在MWT期间出现了MS发作。NMA的发生与日间过度嗜睡、MS潜伏期和MS密度有关（P<0.001）。MS密度测量对NMA的辨别能力高于潜伏期分析，特别是在没有日间过度嗜睡且同时平均睡眠潜伏期>33分钟的患者中。
MS分析提供了困倦的客观证据，因此可以提高MWT在识别事故高风险个体方面的辨别能力。
Tondo P, Pronzato C, Risi I,等。微睡眠在评估阻塞性睡眠呼吸暂停患者驾车时困倦和险些发生事故中的作用。2025；21(2):287 - 295。
