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

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

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

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

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

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

8. 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,…

11. Therapy

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

13. 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

14. 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

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

16. Sleep lab: Polysomnography

17. 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

18. 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

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

20. 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

21. 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

22. 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.

23. 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

24. Thank you for your attention