Motor Vehicle Accidents in Patients with Excessive Daytime Sleepiness
Background and Objective: Excessive daytime sleepiness (EDS) is a common problem in patients referred to sleep clinics, which could result in adverse consequences in their personal and social activities including motor vehicle accidents (MVAs). Epworth Sleepiness Scale (ESS) and Multiple Sleep Latency Test (MSLT) are known methods for measuring EDS. In this study, we aimed to evaluate the relationship between EDS and MVAs. Materials and Methods: Medical records of 144 patients (106 men) with EDS referred to Baharloo Sleep Clinic, Tehran, Iran, were assessed in this cross-sectional study. All participants filled out a questionnaire including demographic characteristics, ESS, and history of MVAs due to sleepiness in the last five years and underwent full-night polysomnography (PSG) and MSLT. Sleepiness was categorized to normal, moderate, or severe according to mean sleep latency (MSL) in MSLT.
Results: Patients with history of MVAs had a significantly less MSL and higher ESS scores than those without MVAs (6.6 ± 3.9 vs. 9.3 ± 6.5, P = 0.038; and 17.9 ± 4.4 vs. 15.6 ± 5.5, P = 0.030, respectively). MVAs were reported in 41.9%, 31.0%, and 16.1% of patients with severe, moderate, and normal sleepiness, respectively. There was a significant relationship between severity of sleepiness and history of MVAs (P = 0.020). Regression analysis showed that after adjustment for age and sex, ESS and MSL remained significantly different between patients with and without MVAs.
Conclusion: ESS score and MSL would help sleep clinicians to find high-risk patients for safety-sensitive jobs, the issue which should not be overlooked by them during visits in sleep clinic.
Walsleben JA, Kapur VK, Newman AB, et al. Sleep and reported daytime sleepiness in normal subjects: the sleep heart health study. Sleep 2004;27 (2):293-8.
Kim H, Young T. Subjective daytime sleepiness: dimensions and correlates in the general population. Sleep 2005; 28(5): 625-634.
Haglow JT, Lindberg E, Janson C. What are the important risk factors for daytime sleepiness and fatigue in women? Sleep 2006; 29 (6): 751-757.
Drake C, Roehrs T, Breslau N, et al. The 10-year Risk of Verified Motor Vehicle Crashes in Relation to Physiologic Sleepiness. Sleep 2010; 33(6): 745-752.
Akerstedt T. Searching for the countermeasure of night-shift sleepiness. Sleep 2006; 29(1): 19-20
Leibowitz SM, Black JE. Differential diagnosis and treatment of excessive daytime sleepiness. Primary Psychiatry 2005; 12(8): 57-66.
Amra B, Dorali R, Mortazavi S, et al. Sleep apnea symptoms and accident risk factors in Persian commercial vehicle drivers. Sleep Breath 2012; 16: 187-191.
Sadeghniiat-Haghighi K, Labbafinejad Y. Sleepiness among lorry drivers. Acta Medica Iranica 2007; 45(2): 149-152.
Geremew D, Rahimi-Golkhandan A, Shakiba Y, et al. Association study of HLA-DQB1*0602 Allele in Iranian patients with Narcolepsy. Iran J Allergy Asthma Immunol 2017; 16(5):452-456.
Sadeghniiat-Haghighi K, Montazeri A, Khajeh Mehrizi, et al. The Epworth Sleepiness Scale: translation and validation study of the Iranian version. Sleep Breath. 2013;17:419–26.
Thorpy M, Westbrook P, Ferber R, et al. The clinical use of the multiple sleep latency test. Sleep. 1992; 15: 268-76
American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine, 2014.
Benbadis SR, Perry MC, Wolgamuth BR, et al. The Multiple Sleep Latency Test: comparison of sleep onset criteria. Sleep 1996; 19(8): 632-6.
Herman J, Kafoa B, Weiniqolo I, et al. Driver sleepiness and risk of motor vehicle crash injuries: A population-based case control study in Fiji. Injury 2014 Mar; 45(3): 586–591.
Sadeghniiat-Haghighi K, Moller HJ, Saraei M et al. The Epworth sleepiness scale for screening of the drowsy driving: comparison with the Maintenance of Wakefulness Test in an Iranian Sample of Commercial Drivers. Acta Medica Iranica 2014;52(2):125-129.
Cai SJ, Chen R, Zhang YL, et al. Correlation of Epworth sleeping scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea-hypopnea syndrome. Chin Med J 2013;126(17):3245-50.
Bausmer U, Gouveris H, Selivanova O, et al. Correlation of the Epworth sleeping scale with respiratory sleep parameters in patients with sleep-related breathing disorders and upper airway pathology. Eur Arch Otorhinilaryngol. 2010;267(10):1645-8.