Prevalence and Predictors of Sleep related Accidents in Egyptian Commercial Drivers with Sleep Disordered Breathing Ahmad Yonis Badawy PROFESSOR Pulmonaty Medicine Department Sleep disorderd breathing unit Mansoura University - EGYPT

AUTHORS Nesreen Elsayed Morsy: Assistant lecturer of Chest Medicine, Faculty of Medicine, Mansoura University-EGYPT Ahmad Yonis Badawy: Professor of Chest Medicine, Faculty of Medicine, Mansoura University-EGYPT Sayed Ahmad abdelhafeez: Professor of Chest Medicine, Faculty of Medicine, Mansoura University-EGYPT Abd Elhady Elgilany: Professor of Public Health and Preventive Medicine, Faculty of Medicine, Mansoura University-EGYPT Mohsen Mohammed Elshafey: Professor of Chest Medicine, Faculty of Medicine, Mansoura University-EGYPT

Acknowledgement This study was supported by a grant of Egyptian Academy of Scientific Research and Technology (Ministry of Scientific Research) in collaboration with Mansoura University.

INTRODUCTION

INTRODUCTION Unfortunately Egypt is ranked the 3rd country in the world with highest mortality rates (41.6 deaths/100.000 population) due to road traffic accidents (RTA) based on a revision of the 2007 statistics done by WHO and WHO Global Status Report on Road Safety, 2009

INTRODUCTION According to the Central Authority for Public Mobilization and Statistics the commonest cause of accidents was inattention of the driver (18%) which is failure to pay attention to a particular task (due to distracting influences or to an inability related to a physiologic factor such as sleepiness)

INTRODUCTION Several risk factors for the occurrence of sleepiness at the wheel exist, including: long periods of wakefulness time of day while driving alcohol and drug consumption work hours reduced sleep time sleep disorders resulting in excessive daytime sleepiness, such as obstructive sleep apnea syndrome (OSAS)

INTRODUCTION Untreated sleep disordered breathing is common in commercial drivers and associated with 2 to 7 folds increased risk of motor vehicle crashes.

REVIEW OF LITERATURES

Sleep Disordered Breathing

Sleep Related Breathing Disorders The sleep related breathing disorders are characterized by abnormalities of respiration during sleep. In some of these disorders, respiration is also abnormal during wakefulness.

Sleep Related Breathing Disorders Classification according to ICSD-3

Sleep Related Breathing Disorders Classification according to ICSD-3 Isolated Symptoms and Normal Variants Snoring Catathrenia

SBD and COGNITION

Patients with OSAS show deficits across a wide range of cognitive functions including: attention memory psychomotor speed visuospatial abilities constructional abilities executive functions language abilities (Andreou & Agapitou, 2007)

Why sleepy drivers risky for accidents Slower reaction time Reduced vigilance Deficits in information processing Impairs coordination Impairs judgment

AIM OF THE WORK

AIM OF THE WORK Estimate the prevalence and the predictors of sleep related road traffic accidents in commercial drivers attending Mansoura Sleep Disordered Breathing Unit (EGYPT).

METHODOLOGY

METHODOLOGY Cross-sectional descriptive study including 110 commercial drivers attending to sleep disordered breathing unit clinic (pulmonology department - faculty of medicine - mansoura university – EGYPT) during the period of November 2013 to October 2014 where they had diagnostic in lab attended full night PSG . we assess history of sleep related accident or near accidents followed by a nested case-control study where case is those with history of accidents and control without history of accidents

Sleep lab

METHODOLOGY The following data was collected: The behavioral history of driving including: mean daily driving hours; mean daily sleep duration, Shift work, Tea/coffee while driving was taken. The clinical examination was done using: Epworth sleepiness scale (ESS), Functional outcome of sleep questionnaire (FOSQ), Berlin questionnaire, STOP Bang questionnaire, OSAS score and wake erect Pulse oximetry (SPO2).

METHODOLOGY The polysomnographic results reviewed using: Apnea Hypopnea Index (AHI), Basal and lowest oxygen saturation oxygen desaturation index Sleep efficiency % slow wave sleep% REM % Arousal index Final diagnosis: obstructive sleep apnea syndrome (OSAS) or obesity hypoventilation syndrome (OHS).

METHODOLOGY Then variables analyzed by SPSS version 16. Bivariate analysis was done followed by multivariate logistic regression to detect independent variables of accidents.

RESULTS

RESULTS SDB (90) N(%) No SDB (20) Significance test Accident 42(46.7) Prevalence of accidents or near accidents in those with SDB versus those without SDB   SDB (90) N(%) No SDB (20) Significance test Accident 42(46.7) 2 (10) 2= 9.2 P=0.002 No accident 48(53.3) 18(90) Total 90(100) 20(100)

RESULTS Significance test Behavioral predictors of accidents or near accidents in those with SDB   Neither accident nor near accidents (48) Mean±SD Accident or near accidents (42) Significance test Driving hours 7.6±2.2 7.2±3.3 t=0.7, P=0.5 Daily sleep duration 7.7±1.3 6.9±1.8 t=2.5, P=0.02 Shift work (N,%) 14 (38.9) 22 (61.1) 2=5, P=0.03 Tea/coffee while driving (N,%) 14 (29.2) 19 (45.2) 2=2.5, P=0.1

RESULTS Significance test Accident or near accidents (42) Clinical predictors of accidents or near accidents in those with SDB   Neither accidents nor near accidents (48) Mean±SD Accident or near accidents (42) Significance test ESS 10.9±4.7 16.4±3.42 t=6.4, P≤0.001 FOSQ 30±7.9 22.4±7.7 t=4.9, P≤0.001 Freidman OSAS score 7.8±1.6 8.8±1.5 t=3.2, P= 0.002 STOP BANG 5.6±1.7 5.9±1.1 t=1.2, P=0.2 Berline score 2.5±0.8 2.8±0.4 t=2.7, P=0.009 Erect wake SPO2 94.7±2.7 90.4±5.1 t=5.08, P≤0.001

RESULTS Neither accidents nor near accidents (48) Polysomnographic Predictors of accidents or near accidentsin those with SDB   Neither accidents nor near accidents (48) Mean±SD Accidents or near accidents (42) Significance test AHI 34.9±21.3 65.6±22.6 Z=5.6, P≤0.001 Basal oxygen saturation 91.9±3.8 88.8±5.3 t=3.2, P=0.002 Lowest oxygen saturation 75.4±13.7 69.2±11.1 t=2.3, P=0.02 Oxygen desaturation index 38.9±26 63.9±24.4 Z=4.2, P≤0.001 Sleep efficiency % 88.7±5.3 82.5±5.1 t=6.0, P≤0.001 Slow wave sleep % 7.6±2.0 4.0±3.4 Z=4.6, P≤0.001 REM sleep% 19.4±2.7 11.3±4.7 t=10, P≤0.001 Arousal index 34±21.9 65.5±22.7

RESULTS β OR(95%CI) - 0.76 0.034 0.47 (0.23-0.94) - 0.37 0.008 Multiple logistic regression analysis of independent predictors of Accidents or near accidents in those with SDB   β P OR(95%CI) Daily sleep duration (Continuous) - 0.76 0.034 0.47 (0.23-0.94) Sleep efficiency % (continuous) - 0.37 0.008 0.69 (0.52-0.91) Slow wave sleep % (Continuous) - 0.82 0.015 0.44 (0.23-0.85) REM sleep% (Continuous) - 1.1 0.001 0.35 (0.19-0.66) Constant Model 2 Percent correctly predicted 60.3 2= 89.9,P≤0.001 91.1%

CONCLUSION RED SEA BOTTOM

CONCLUSION The prevalence of accidents or near accidents was found to be high (46.7%) in drivers with SDB .

CONCLUSION lower Sleep efficiency% lower mean daily sleep hours lower slow wave sleep% lower REM% could be of predictive importance in detection of SDB related accidents among commercial drivers.