Severe obstructive sleep apnea and long distance truck driving: A case report

Lisa N. Sharwood, Jane Elkington, Mark Stevenson, Soufiane Boufous, Keith K. Wong

Accident Research Centre, Monash University, Melbourne, Australia.
Respiratory and Sleep Medicine Unit, Royal Prince Alfred Hospital, Sydney, Australia.
The George Institute for Global Health, Sydney, Australia.

DOI: 10.4236/ojpm.2012.22023                

Abstract

Introduction: Untreated sleep disorders can increase driver crash risk by up to 7 fold, and truck drivers have a variety of risk factors for sleep disorders. Measures currently used to identify drivers at risk depend predominantly on the ability of the driver to identify and report themselves as sleepy. Methods: This case report presents a 54 year old long distance truck driver who participated in a case-control study, underwent at home breathing monitoring and was followed up with an in-depth interview. Results: Self-reported measures did not identify this driver as at risk of sleepiness or sleep apnea; yet he was subsequently diagnosed with severe sleep apnea using an at home monitor and polysomnography. Conclusions: Self-assessment of risk factors is insufficient as a screen for sleep apnea. General practitioners are in an ideal position to identify potential sleep apnea sufferers and can initiate the enquiry process that leads to diagnostic testing.

Keywords

Sleepiness; Obstructive Sleep Apnea; Truck Driver; Licensing; Risk

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Young, T., Blustein, J. and Finn, L. (1997) Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep, 20, 608-613.
[2]	Austroads. (2006) Assessing fitness to drive for comercial and private vehicle drivers. Austroads and NTC.
[3]	Bailes, S., Baltzan, M., Rizzo, D., Fichten, C., Grad, R., Wolkove, N., et al. (2009) Sleep disorder symptoms are common and unspoken in Canadian general practice. Family Practice, 26, 294-300. doi:10.1093/fampra/cmp031
[4]	Punjabi, N. (2008) The Epidemiology of adult obstructive sleep apnea. Proceedings American Thoracic Society, 5, 136-143. doi:10.1513/pats.200709-155MG
[5]	Howard, M., Desai, A., Grunstein, R., Hukins, C., Armstrong, J., Joffe, D., et al. (2004) Sleepiness, sleep-disordered breathing, and accident risk factors in comercial vehicle drivers. American Journal of Respiratory & Critical Care Medicine, 170, 1014-1021. doi:10.1164/rccm.200312-1782OC
[6]	Chung, S., Jairam, S., Hussain, M. and Shapiro, C. (2001) Knowledge of sleep apnea in a sample grouping of primary care physicians. Sleep and Breathing, 5, 115-121. doi:10.1055/s-2001-17429
[7]	Papp, K., Penrod, C. and Strohl, K. (2002) Knowledge and attitudes of primary care physicians toward sleep and sleep disorders. Sleep and Breath-ing, 6, 103-109. doi:10.1055/s-2002-34317
[8]	Young, T., Evans, L., Finn, L. and Palta, M. (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep, 20, 705-706.
[9]	Bearpark, H., Elliott, L., Grunstein, R., Schneider, H., Al- thaus, W. and Sullivan, C. (1995) Snoring and sleep apnea: A population study in Australian men. Respiratory and Critical Care Medicine, 151, 1459-65.
[10]	Pack, A., Dinges, D. and Maislin, G. (2002) A study of prevalence of sleep apnea among commercial truck drivers. Federal Motor Carrier Safety Administration, Washington DC.
[11]	Johns, M. (1991) A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14, 540-545.
[12]	Stevenson, M, Sharwood, L.N., Wong, K., El-kington, J., Meuleners, L., Ivers, R.Q., et al. (2010) The Heavy Vehicle Study: A case-control study investigating risk factors for crash in long distance heavy vehicle drivers in Australia. BMC Public Health, 10, 162. doi:10.1186/1471-2458-10-162
[13]	Maislin, G, Pack, A.I., Kribbs, N., Smith, P., Schwartz, A., Kline, L., et al. (1995) A Survey Screen for Prediction of Apnea. Sleep, 18, 158-166.
[14]	Rofail, L., Wong, K., Unger, G., Marks, G. and Grunstein, R. (2010) The utility of single-channel nasal airflow pressure transducer in the diagnosis of OSA at home. Sleep, 33, 1097-1105.
[15]	Rofail, L., Wong, K., Unger, G., Marks, G. and Grunstein, R. (2010) Comparison between a single-channel nasal airflow device and oximetry for the diagnosis of obstructtive sleep apnea. Sleep, 33, 1106-1114.
[16]	Rofail, L., Wong, K., Unger, G., Marks, G. and Grunstein, R. (2010) The role of single-channel nasal airflow pressure transducer in the diagnosis of OSA in the sleep laboratory. Journal of Clinical Sleep Medicine, 6, 349-356.
[17]	Wong, K., Jankelson, D., Reid, A., Jankelson, D., Unger, G, Dungan, G., et al. (2008) Diagnostic test evaluation of a nasal flow monitor for obstructive sleep apnea detection in sleep apnea research. Behavior Research Methods, 40, 360-366. doi:10.3758/BRM.40.1.360
[18]	Moreno, C.R.C., Carvalho, F.A., Matuzaki, L.S., Prezotti, S., Bighetti, P., Louzada, F.M., et al. (2004) High risk for obstructive sleep apnea in truck drivers estimated by the Berlin Questionnaire: Prevalence and associated factors. Chronobiology International, 21, 871-879. doi:10.1081/CBI-200036880
[19]	Gurubhagavatula, I., Maislin, G. and Pack, A. (2001) An algorithm to stratify sleep apnea risk in a sleep disorders clinic population. American Journal of Respiratory & Critical Care Medicine, 164, 1904-1909.
[20]	Talmage, J., Hudson, T., Hegmann, K. and Thiese, M. (2008) Consensus Criteria for screening commercial drivers for obstructive sleep apnea: Evidence of efficacy. Journal of Occupational and Environmental Medicine, 50, 324-349. doi:10.1097/JOM.0b013e3181617ab8
[21]	Pack, A., Maislin, G., George, C., Pack, F. and Dinges, D. (2001) Factors associated with daytime sleepiness and performance in a sample of commercial drivers. Sleep, 24, A427.
[22]	George, C. (2001) Reduction in motor vehicle collisions following treatment of sleep apnea with nasal CPAP. Thorax, 56, 508-512. doi:10.1136/thorax.56.7.508
[23]	Sullivan, C., Issa, F., Berthon-Jones, M. and Eves, L. (1982) Reversal of obstructive sleep apnea by continuous positive airways pressure applied through the nares. Lancet, 1, 862-865.
[24]	Gurubhagavatula, I., Nkwuo, J.E., Maislin, G. and Pack, A.I. (2008) Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea. Accident Analysis and Prevention, 40, 104-115. doi:10.1016/j.aap.2007.04.011
[25]	Kapur, N., Hunt, I., Lunt, M., McBeth, J., Creed, F. and MacFarlane, G. (2004) Psychosocial and illness related predictors of consultation rates in primary care. Psychological Medicine, 34, 719-728. doi:10.1017/S0033291703001223
[26]	Thorogood, M., Coulter, A., Jones, L., Yudkin, P., Muir, J. and Mant, D. (1993) Factors affecting response to an invitation to attend general health check. Journal of Epidemiology and Community Health, 47, 224-228. doi:10.1136/jech.47.3.224
[27]	Gijspbers van Wijk, C., Huisman, H. and Kolk, A. (1999) Gender differences in physical symptoms and illness behaviour: A health diary study. Social Science and Medicine, 49, 1061-1074.