1. 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

2. 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

3. 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.

4. INTRODUCTION

5. INTRODUCTION
Unfortunately Egypt is ranked the 3rd country in the world with highest mortality rates (41.6 deaths/ 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

6. 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)

7. 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)

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

9. REVIEW OF LITERATURES

10. Sleep Disordered Breathing

11. 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.

12. Sleep Related Breathing Disorders Classification according to ICSD-3

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

15. SBD and COGNITION

16. 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)

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

21. AIM OF THE WORK

22. 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).

23. METHODOLOGY

24. 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

25. Sleep lab

26. 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).

27. 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).

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

29. RESULTS

30. 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)

31. 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

32. 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

33. 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

34. 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 ( )
Sleep efficiency % (continuous)
- 0.37
0.008
0.69 ( )
Slow wave sleep % (Continuous)
- 0.82
0.015
0.44 ( )
REM sleep% (Continuous)
- 1.1
0.001
0.35 ( )
Constant
Model 2
Percent correctly predicted
60.3
2= 89.9,P≤0.001
91.1%

35. CONCLUSION
RED SEA BOTTOM

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

37. 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.