Vesna Pekarović Džakulin Drowsy driving – Evaluation of professional drivers with Obstructive sleep apnea syndrome Vesna Pekarović Džakulin

Declaration on Disclosure I declare no conflicts of interest relevant to the presentation

Sleepiness while driving Recently identified important reason for fatal car crashes on motorways 20 % in Europe, up to 30 % in USA

Causes of sleepiness Lack of sleep Use of psychoactive medication Sleeping disorders

Obstructive sleep apnea (OSA) Disorder of normal breathing during sleep Reccurent collapse of the upper airway Chronic intermittent hypoxia Sleep fragmentation and arousals

Daytime symptoms Excessive daytime sleepiness, afternoon drowsiness (tiredness, fatigue) Forgetfulness, impaired concentration and attention Personality changes Morning headaches

Nocturnal signs and symptoms Snoring (extremely loud and disruptive) Observed apneas (intervals of silence) Awakening with a sensation of choking or gasping Unexplained tachycardia Restless sleep Sweating during sleep, nocturia, bruxism,…

Therapy

J Clin Sleep Med. 2008 June 15; 4(3): 261–272.

Obstructive sleep apnea in professional drivers Mentor: Prim. prof. dr. Marjan Bilban, dr. med., spec. medicine dela, prometa in športa Izr. prof. dr. Leja Dolenc Grošelj, dr. med., spec. nevrolog

Objectives of the research To identify professional drivers who suffer from OSA To propose guidelines for the detection of OSA in professional drivers during health checks by practitioners of occupational, traffic, and sports medicine

Patients and methods Professional bus drivers Workplace health promotion programme Screening test (questionnaire and objective measurements) Nocturnal polysomnography

Sleep lab: Polysomnography

Hypothesis High positive predictive value of screening test 5-10 % of professional bus drivers have OSA Workplace health promotion programme will improve cooperation in a research

Results 35 workers participated in the screening test (out of 565 drivers) 19 (54 %) displayed increased risk of OSA 11 were given a PSG (only 1 normal) 6 (5 professional drivers – 17,8 %) have OSA 5 (4 professional drivers – 14,3 %) have other sleeping disorders

Positive predictive value of the screening test 70 % for all sleepnig disorders causing daytime sleepiness 38 % for OSA alone

Limitation of the study Very small sample 4 drivers (positive on screening test) failed to do PSG Fear of loosing drivers licence or even job

Conclusion High frequency (54%) of excessive daytime sleepiness among screened professional bus drivers 5 (17,8%) professional drivers had non- identified OSA 4 (14,4%) professional drivers had non- identified other sleepnig disorders

Perspective Raise general and professional public awareness Screening Timely diagnoses Adequate further treatment Careful monitoring of patients Drivers, following efficient OSA treatment, should be permited to drive.

Legislation 2014: EU Directive on new standards and guidelines for drivers with obstructive sleep apnoea syndrome 2016 (Slovenia): New Rules on Health Conditions for Drivers of Motor Vehicles: Guidelines on screening and monitoring of such patients

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