||Whilst Sleep Deprivation due to excessive driving hours is probably
the single most important cause of driver sleepiness, sleep disorders
are thought to account for a significant number of sleep-related accidents
due to excessive daytime sleepiness.
Sleep Disorders account for a significant burden to the economy
and disrupt the daily lives of millions of people worldwide. In
the USA, more than 30 million people were referred to sleep disorder
centres last year. In the United Kingdom, the prevalence of sleep
disorders and medically related sleep disorders is increasing.
The Common Causes of Excessive Daytime Sleepiness (EDS)
||Insufficient Sleep Quantity or Sleep Deprivation
||Insufficient Sleep Quality: Obstructive Sleep
||Neurological Disorders: Narcolepsy; Idiopathic
Hypersomnia; Head Injury
||Disorders of our Sleep-Wake Cycle e.g. Shift Work
||Drug and Alcohol use
Insufficient Sleep Quantity (Insomnia) and Sleep Deprivation
The inability to initiate and/or maintain sleep at the
appropriate (nocturnal) time is highly prevalent in all populations.
The accepted prevalence of Insomnia is between 5-12% of the general
population and significantly higher for the medical and psychiatrically
ill. Conservative estimates of prevalence estimate that about 5
million people suffer from short-term insomnia and approximately
2-3 million people in the UK have chronic sleep initiation and/or
maintenance disorders. Excessive working hours, Economic demands
and ambitions all lead to a problem of chronic sleep deprivation,
subsequent sleepiness and a higher proven risk of fatal road accidents.
Insufficient Sleep Quality – Obstructive Sleep Apnoea
||A condition of interruptions or pauses in
breathing whilst asleep – signs of this disorder include
obesity, snoring, sleep interrupted by intermittent gasping
for breath, and excessive daytime sleepiness.
Obstructive Sleep Apnoea (OSA) and other sleep related breathing
disorders constitute a significant health and economic burden. OSA
is commoner in men and has a prevalence of about 4% in men below
40years of age. The prevalence increases with age and about 8% of
men above 50 years have a clinically diagnosable OSA syndrome. OSA
is usually treated with Continuous Positive Airway Pressure (CPAP).
The relationship between OSA and cardiac disease is only now emerging
as significant. Recent international peer reviewed publications
cite a possible causative role of OSA in the genesis of Essential
Hypertension, Diabetes Mellitus and Ischaemic Heart Disease and
How common is OSA in Commercial Drivers
Allan Pack and his colleagues at the University of Pennsylvania,
USA, recently published the first comprehensive epidemiological
study on the prevalence of OSA in commercial drivers. They found
that 28% of Commercial Drivers have OSA i.e. 7 times more than the
normal population. They calculated from these results that a comprehensive
screening and treatment programme can prevent up to 60% of HGV related
accidents. They have strongly recommended the implementation of
sleepiness and OSA screening as an essential part of driver employment
What is the Risk of people with OSA in causing road accidents?
Drivers with OSA have been thoroughly researched as a group
with regard to their risk of increased motor vehicle collisions
(MVC). As a group, untreated patients with OSA have a 6 –
13 fold increased risk of causing a fatal road accident when compared
to the normal population (Teran-Santos, NEJM 1999; 340: 847; Masa
A J. Resp Crit Care Med 2000; 162: 1407) These studies have involved
large groups of patients and are internationally recognised to reflect
the degree of risk of fatal accidents by patients with OSA.
The Evidence for Removal of Risk with Treatment
Charles FP George and his team at The University of Western
Ontario, Canada, published a seminal article in the world renowned
journal Thorax in 2001. They have shown quite clearly a Reduction
in Motor Vehicle Collisions following treatment of OSA. They studied
210 patients with OSA who were treated for at least 3 years. MVC
rates were compared for 3 years before and after therapy for patients
and for a control group. Untreated patients with OSA had more MVCs
than controls and following treatment the number of MVCs/driver/year
fell to same level as the control group i.e. normalised. They concluded
that ‘’the risk of MVCs due to OSA is removed when patients
are treated. As such, any restrictions on driving because of OSA
could be safely removed after treatment’’.
Cost benefits of a Screening Programme and Treating Sleep
Alex Sassani and colleagues from the University of California
have for the first time calculated the cost of fatalities and the
cost benefit of treating sleep apnoea. Writing in the May 2004 edition
of the international journal SLEEP, they conclude that: ‘’More
than 800,000 drivers were involved in OSA-related motor-vehicle
collisions in the USA in the year 2000.These collisions cost $15.9
billion and 3,400 lives in the year 2000. In the United States,
treating all drivers suffering from OSA would cost $3.18 billion,
saving $11.1 billion in collision costs, and 2000 lives annually.
Annually, a significant portion of motor-vehicle collisions, costs,
and deaths are related to OSA. With appropriate treatment, most
of these collisions, costs, and deaths can be prevented. Treatment
of OSA benefits both the patient and the public’’.