Obstructive sleep apnea among commercial vehicle drivers in Malaysia: Issues and initiatives

Ameer Batcha Wahida, Othman Ilhamah, Ahmad Mohamad Suffian, Mohd Fahmi Aimi, Mohamed Norlen, Shaw Voon Wong

Director General Office, Malaysian Institute of Road Safety Research, Selangor, Malaysia.
Vehicle Safety and Biomechanics Research Centre, Malaysian Institute of Road Safety Research, Selangor, Malaysia;.

DOI: 10.4236/health.2013.58A2012                

Abstract

Obstructive Sleep Apnea (OSA) has been identified by many studies as one of the significant contributing factors for motor vehicle accidents. However, only a small number of studies have been conducted in Malaysia. Objective: This paper aims to highlight the prevalence of OSA among truck drivers and express bus drivers in Malaysia and efforts being undertaken to address issues related to OSA among commercial vehicle drivers. Methodology: Two separate studies were conducted: a cross sectional study among truck drivers and secondly among express bus drivers. The screening process for identifying the high risk group for OSA was done using Berlin questionnaire. Meanwhile, among express bus drivers, OSA was confirmed with sleep study using polysomnography test. Result: Screening of risk group of OSA among truck drivers revealed that 14.6% (19) of drivers were categorized as having high risk of OSA while 85.4% (111) having low risk of OSA. While, in another study, polysomnography test among express bus drivers showed that 83 (28.7%) had mild OSA, 26 (9.0%) had AHI moderate OSA, and 19 drivers (6.6%) severe OSA. Conclusion: This paper highlighted the issues of OSA among commercial vehicle drivers in Malaysia. With an alarming high prevalence, OSA should be a major road safety concern in this country. A special study focusing on sleep and fatigue related crashes may need to be conducted to complement the current studies and full implementation of existing efforts and initiatives to address OSA in road crashes should be realized by the relevant authorities.

Keywords

OSA; Obstructive Sleep Apnea; Commercial Vehicle Drivers

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Downey, R., Gold P.M. and Wickramasinghe, H (2009) Obstructive sleep apnoea. http://emedicine.medscape.com/article/295807-overview
[2]	Norlen, M., Fadhli, Y., Ilhamah, O., Rohayu, S. and Wong, S.V. (2008) Fatigue among commercial bus drivers in Malaysia: Role of driving hours and single versus twodriver approach. Malaysian Institute of Road Safety Research, Kuala Lumpur. doi:10.1183/09031936.02.00404502
[3]	McNicholas, W.T. and Krieger, J. (2002) Public health and medicolegal implications of sleep apnoea. European Respiratory Journal, 20, 1594-1609.
[4]	Moreno, C.R.C., Carvalho, F.A., Lorenzi, C., Matuzaki, L.S., Prezotti, S., Bighetti, P., Louzada, F.M. and LorenziFilho, G. (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
[5]	Sassani, A., Findley, L.J., Kryger, M., Goldlust, E., George, C. and Davidson, T.M. (2004) Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome, sleep disordered breathing. Sleep, 27, 453-458.
[6]	Pack, A.I., Dinges, D.F. and Maislin, G. (2002) A study of prevalence of sleep apnea among commercial truck drivers. FMCSA, Washington DC.
[7]	NRCME Training Online (2013) Obstructive Sleep Apnea (OSA): Its effects on commercial truck drivers. NRCME Training Online 2013.
[8]	Ellen, R.L.B., Marshall, S.C., Palayew, M., et al. (2006) Systematic review of motor vehicle crash risk in persons with sleep apnea. Journal of Clinical Sleep Medicine, 2, 193-200.
[9]	Tregear, S., Reston, J., Schoelles, K. and Phillips, B. (2009) Obstructive sleep apnea and risk of motor vehicle crash: Systematic review and meta-analysis. Journal of Clinical Sleep Medicine, 5, 573-581.
[10]	Findley, L.J., Unverzagt, M.E. and Suratt, P.M. (1988) Automobile accidents involving patients with obstructive sleep apnea. American Review of Respiratory Disease, 138, 337-340. doi:10.1164/ajrccm/138.2.337
[11]	Terán-Santos, A. Jiménez -Gómez, J., Ordero-Guevara, C. and the Cooperative Group Burgos-Santander (1999) The association between sleep apnea and the risk of traffic accidents. The New England Journal of Medicine, 340, 847-851. doi:10.1056/NEJM199903183401104
[12]	Horstmann, S., Hess, C.W., Bassetti, C., Gugger, M. and Mathis, J. (2000) Sleepiness-related accidents in sleep apnea patients. Sleep, 23, 383-389.
[13]	RTA (1987) Road traffic act. Malaysia Law, Act 333.
[14]	Ministry of Health (2011) Medical examination standards for vocational driver’s licensing.
[15]	Occupational Safety and Health of the Industry Code of Practice for Road Transport Activities 2010, Department of Occupational Safety and Health, Ministry of Human Resources Malaysia, JKKP DP(S) 127/379/3-5, pp. 3-4.
[16]	Netzer, N.C., Stoohs, R.A. and Netzer, C.M. (1999) Using the Berlin questionnaire to identify patients at risk for the sleep apnea syndrome. Annals of Internal Medicine, 131, 488. doi:10.7326/0003-4819-131-7-199910050-00002
[17]	Sharma, S.K., Vasudev, C., Sinha, S., Banga, A., Pandey, R.M. and Handa, K.K. (2006) Validation of the modified Berlin questionnaire to identify patients at risk for the obstructive sleep apnoe syndrome. Indian Journal of Medical Research, 124, 281-290.
[18]	Parks, P.D., Durand, G., Tsismenakis, A.J., Vela-Bueno, A. and Kales, S.N. (2009) Screening for obstructive sleep apnea during commercial driver medical examinations. JOEM, 51, 275-282.
[19]	Hui, D.S.C., Chan, J.K.W., Ko, F.W.S, Choy, D.K.L., Li, T.S.T., Chan, A.T., Wong, K.K. and Lai, C.K.W. (2002) Prevalence of snoring and sleep-disordered breathing in a group of commercial bus drivers in Hong Kong. Internal Medicine Journal, 32, 149-157. doi:10.1046/j.1444-0903.2001.00196.x
[20]	Gurubhagavatula, I., Maislin, G., Nkwuo, J.E. and Pack, A.I. (2004) Occupational screening for obstructive sleep apnoea in commercial drivers. American Journal of Respiratory and Critical Care Medicine, 170, 371-376. doi:10.1164/rccm.200307-968OC
[21]	Royal Malaysia Police (2012) Statistical Report Road Accident 2011. Traffic Branch, Bukit Aman, Kuala Lumpur.
[22]	Ahmad Noor Syukri, Z.A., Siti Atiqah, M.F., Fauziana, L. and Abdul Rahmat, A.M. (2012) MIROS crash investigation and reconstruction annual statistical report 2007-2011, MRR 05/2012 Malaysian Institute of Road Safety Research, Kuala Lumpur.
[23]	Aishah (2004) Tesis Sarjana Kesihatan Masyarakat, Universiti Kebangsaan Malaysia, Kajian kelesuan serta faktor-faktor berkaitan dikalangan pemandu bas ekspres. Universiti Kebangsaan Malaysia, Bangi.
[24]	Fadhli, Y., Norlen, M., Ilhamah, O., Rohayu, S. and Wong, S.V. (2008) Prevalence of fatigue among commercial bus drivers in Malaysia. Malaysian Institute of Road Safety Research, Kuala Lumpur.
[25]	Mills, P.J., Kim, J.-H., Bardwell, W., Hong, S. and Dimsdale, J.E. (2008) Predictors of fatigue in obstructive sleep apnea. Sleep and Breathing November, 12, 397-399.
[26]	Transport Statistics Malaysia, Ministry of Transport Malaysia 2011.
[27]	Hartenbaum, N., Collop, N., Rosen, I.M., Philips, B., George, C.F.P., Rowley, J.A., Freedman, N., Weaver, T.E., Gurubhagavatula, I., Strohl, K., Leaman, H.M., Moffitt, G.L. and Rosekind, M.R. (2006) Sleep apnoea and commercial motor vehicle operators: Statement from the joint task force of the American college of chest physicians, the American college of occupational and environmental medicine, and the national sleep foundation. Journal Occupational Environmental Medicine, 48, S5-S37.
[28]	Young, T., Blustein, J., Finn, L. and Palta, M. (1997) Sleep disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep, 20, 608-613.
[29]	Norlen, M., Wahida, A.B., Ilhamah, O., Aimi, M.F., Mohamad, S.A. and Wong, S.V. (2012) Sleep apnea test among commercial vehicle drivers: The need versus the challenges for the implementation. Malaysian Institute of Road Safety Research, Kuala Lumpur.