Commercial drivers could be understating sleep apnoea symptoms for fear of losing their licence
People who drive commercial vehicles, such as buses, taxis, trucks and aeroplanes, could be incorrectly reporting their symptoms of sleep apnoea due to their fears of endangering their employment, according to a new study.
The research will be presented on 1 September 2012 at the European Respiratory Society’s (ERS) Annual Congress in Vienna. All the abstracts from the ERS Congress will be publicly available online today (26 August 2012).
People with the sleep apnoea suffer frequent disruptions to their breathing during sleep, leaving them with headaches, drowsiness and sometimes depression during the day. Obstructive sleep apnoea is a well-established risk for traffic accidents and commercial vehicle drivers could lose their licence if their illness is perceived to be compromising safety while driving.
The regular treatment for sleep apnoea is continuous positive airway pressure (CPAP), which uses a mask and other equipment to generate a stream of air to keep the upper airway open during sleep. As commercial drivers regularly do shift work, they don’t follow regular patterns of sleep and also do not always sleep in one place; this makes adherence to CPAP treatment more difficult.
Researchers examined 37 commercial vehicle drivers with sleep apnoea and compared them with a control group of 74 patients. Both groups had similar characteristics of age, body mass index (BMI) and similar numbers of disturbances suffered on average during the night. Both groups also underwent treatment using CPAP.
Levels of sleepiness were then analysed using the Epworth Sleepiness Score; a well-established short questionnaire used to give levels of sleepiness during the day time. The survey provides a score, which is the sum of 8 items and can range between 0 and 24.The higher the score, the higher the person’s level of daytime sleepiness
At the start of the study, commercial drivers reported an average score of 8.1 on the sleepiness scale, compared with an average of 11.0 reported by non-commercial drivers, despite a similar number of disturbances at night between the two groups. The difference was also seen after 6 months of treatment using CPAP therapy with the drivers reporting an average sleepiness score of 4.8 and non-drivers reporting an average of 7.7.
Sleep apnea signs and symptoms
It can be tough to identify sleep apnea on your own, since the most prominent symptoms only occur when you’re asleep. But you can get around this difficulty by asking a bed partner to observe your sleep habits or recording yourself during sleep.
Major signs and symptoms of sleep apnea
- Loud and chronic snoring
- Choking, snorting, or gasping during sleep
- Long pauses in breathing
- Daytime sleepiness, no matter how much time you spend in bed
Other common signs and symptoms of sleep apnea include:
- Waking up with a dry mouth or sore throat
- Morning headaches
- Restless or fitful sleep
- Insomnia or nighttime awakenings
- Going to the bathroom frequently during the night
- Waking up feeling out of breath
- Forgetfulness and difficulty concentrating
- Moodiness, irritability, or depression
The results also showed that drivers received less treatment (only receiving CPAP for an average of 75% of days, compared with 83%) and also had more unscheduled visits to the clinic, which suggests they were struggling with their symptoms.
The authors speculate that the lower scores reported by the commercial drivers could be due to drivers under-scoring their sleepiness levels for fear of losing their licence permissions.
Lead author, Dr. Werner Strobel from University Hospital, Switzerland, said: “Our study suggests that commercial drivers are playing down their levels of sleepiness for fear of losing their jobs. Although this is very difficult to prove, both the group of drivers and the group of non-drivers began the study with a similar number of disturbances during the night. You would therefore expect their reports of sleepiness to be similar to begin with, however the drivers estimated their levels of sleepiness as lower than the non-drivers. This pattern continued throughout the course of the study, with drivers reporting lower symptoms, yet receiving less treatment and making more unscheduled visits to the clinic.
“We can assume from these results that commercial drivers with sleep apnoea symptoms could be under-reporting their sleepiness in order to protect their job. These results should be taken into account by healthcare professionals who are treating this group of people.”
Risk factors for obstructive sleep apnea
You have a higher risk for obstructive sleep apnea if you are:
- Overweight
- Male
- Related to someone who has sleep apnea
- Over the age of 65
- Black, Hispanic, or a Pacific Islander
- A smoker
Other risk factors for obstructive sleep apnea include certain physical attributes, such as having a thick neck, deviated septum, receding chin, or enlarged tonsils or adenoids (the most common cause of sleep apnea in children). Your airway may be blocked or narrowed during sleep simply because your throat muscles tend to relax more than normal. Allergies or other medical conditions that cause to nasal congestion and blockage can also contribute to sleep apnea.
Dan Smyth from the Irish Sleep Apnoea Trust, said: “We know that an above average number of people involved in commercial driving have sleep apnoea. It is also known that many of them, mainly through ignorance of the condition and fear of losing their livelihood, are afraid to report it to their employer or seek help. The findings of this study confirm the current situation and show further evidence that Relative Advocacy and Support Groups, with the support of our legislators, must deliver a positive message on the benefits of treating Sleep Apnoea to the Transport Industry.”
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Notes to editors:
Abstract: Differences between commercial vehicle drivers and other patients in symptoms of obstructive sleep apnoea and response to CPAP therapy
Session: 77
Date and time: Sunday, 2 September, 10:45-12:45
Room: C5
Press Office at ERS Congress in Vienna (Saturday 31st August - Wednesday 5th September 2012):
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David Sadler +43 6767502294 .(JavaScript must be enabled to view this email address)
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Lauren Anderson
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