Original Article

Assessment of Elements of STOP-BANG Questionnaire in Screening Obstructive Sleep Apnea (OSA) in Iranian Commercial Drivers

Abstract

Background and Objective: Sleepiness is one of the important factors in motor vehicle accidents, especially in commercial drivers (CDs). Obstructive sleep apnea (OSA) has an important role in developing sleepiness. The STOP-BANG questionnaire is used in medical examinations of commercial drivers in Iran by law. This study aimed to investigate the judgment that drivers prefer not to report their symptoms honestly leading to underestimation of their STOP-BANG scores.
Materials and Methods: In a cross-sectional study, two groups of commercial drivers were compared; A: 52 drivers referred from Occupational Medicine Clinic to Baharloo Sleep Clinic, Tehran, Iran, because of detecting high scores in the STOP-BANG questionnaire with confirmed obstructive sleep apnea in the polysomnography, B: 87 volunteer commercial drivers referred to Baharloo Sleep Clinic because of sleep related complaints and obstructive sleep apnea was confirmed via polysomnography. The score of Epworth Sleepiness Scale (ESS) and the subjective items including snoring, tiredness, and observed apnea (STO) and objective items including blood pressure, body mass index (BMI), neck circumference, age, and gender (P-BANG) were compared between the groups and the correlations with Apnea/Hypopnea Index (AHI) were assessed.
Results: Statistical analysis showed that STO scores were different between the two groups (P < 0.0001). Mean STO score was 0.80 for Group A and 1.75 for Group B. The STO of group A showed a negative correlation with Ap-nea/Hypopnea Index (Correlation Coefficient = -0.1240). On the contrary, the STO score for group B was correlated with Apnea/Hypopnea Index (Correlation Coefficient = 0.4432).
Conclusion: Subjective items of STOP-BANG questionnaire in commercial drivers requesting health license require reevaluation. New cut-off criterion or combination with more objective methods is recommended to be considered for screening of obstructive sleep apnea in commercial drivers.

World Health Organization. Global status report on road safety 2015 (Accessed 2015, at http://www.who.int/violence_injury_prevention/road_s afety_status/2015/en/)

Toroyan T, Peden MM, Iaych K. WHO launch- es second global status report on road safety. Inj Prev 2013; 19: 150.

Iranian Legal Medicine Organization. Statistics of mortality due to motor vehicle crashes during 2013-2014. Tehran, 2014. (Accessed, 2015, athttp://lmo.ir/uploads/mtas9312p.pdf)

Hartenbaum N, Collop N, Rosen I, et al. Truck- ers with OSA, should they be driving? J Occup Envi- ron Med 2006; 48: 871-2.

Hartenbaum N, Collop N, Rosen IM, et al. Sleep apnea and commercial motor vehicle operators:Statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest 2006; 130: 902-5.

Kales SN, Straubel MG. Obstructive sleep ap- nea in North American commercial drivers. Ind Health 2014; 52: 13-24.

George CF. Sleep. 5: Driving and automobile crashes in patients with obstructive sleep ap- noea/hypopnoea syndrome. Thorax 2004; 59: 804-7.

Herman J, Kafoa B, Wainiqolo I, et al. Driver sleepiness and risk of motor vehicle crash injuries: a population-based case control study in Fiji (TRIP 12). Injury 2014; 45: 586-91.

Rabelo Guimaraes Mde L, Hermont AP. Sleep apnea and occupational accidents: Are oral appliances the solution? Indian J Occup Environ Med 2014; 18:39-47.

Tregear S, Reston J, Schoelles K, et al. Contin- uous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis. Sleep 2010; 33: 1373-80.

George CF. Reduction in motor vehicle colli- sions following treatment of sleep apnoea with nasal CPAP. Thorax 2001; 56: 508-12.

Chung F, Subramanyam R, Liao P, et al. High STOP-Bang score indicates a high probability of obstruc- tive sleep apnoea. Br J Anaesth 2012; 108: 768-75.

Sadeghniiat-Haghighi K, Montazeri A, Khajeh- Mehrizi A, et al. The STOP-BANG questionnaire: reli- ability and validity of the Persian version in sleep clin- ic population. Qual Life Res 2015; 24: 2025-30.

Iber C. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 2007. Darien, IL: American Academy of Sleep Medicine, 2007.

Dagan Y, Doljansky JT, Green A, et al. Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among pro- fessional drivers. Traffic Inj Prev 2006; 7: 44-8.

Gurubhagavatula I, Maislin G, Pack AI. An al- gorithm to stratify sleep apnea risk in a sleep disorders clinic population. Am J Respir Crit Care Med 2001;164: 1904-9.

US. Department of Transportation. Obstructive sleep apnea and commercial motor vehicle driver safe- ty-executive summary. Washington, DC: Federal Motor Carrier Safety Administration, 2008.

Vakulin A, Baulk SD, Catcheside PG, et al. Ef- fects of alcohol and sleep restriction on simulated driv- ing performance in untreated patients with obstructive sleep apnea. Ann Intern Med 2009; 151: 447-55.

Johns MW. A new method for measuring day- time sleepiness: the Epworth sleepiness scale. Sleep 1991; 14: 540-5.

Stutts JC, Wilkins JW, Scott OJ, et al. Driver risk factors for sleep-related crashes. Accid Anal Prev

; 35: 321-31.

Teran-Santos J, Jimenez-Gomez A, Cordero- Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Bur- gos-Santander. N Engl J Med 1999; 340: 847-51.

Shiomi T, Arita AT, Sasanabe R, et al. Falling asleep while driving and automobile accidents among patients with obstructive sleep apnea-hypopnea syn- drome. Psychiatry Clin Neurosci 2002; 56: 333-4.

Tzischinsky O, Cohen A, Doveh E, et al. Screening for sleep disordered breathing among appli-cants for a professional driver's license. J Occup Envi- ron Med 2012; 54: 1275-80.

Platt AB, Wick LC, Hurley S, et al. Hits and misses: screening commercial drivers for obstructive sleep apnea using guidelines recommended by a joint task force. J Occup Environ Med 2013; 55: 1035-40.

Sharwood LN, Elkington J, Stevenson M, et al. Assessing sleepiness and sleep disorders in Australian long-distance commercial vehicle drivers: self-report versus an "at home" monitoring device. Sleep 2012;35: 469-75.

Talmage JB, Hudson TB, Hegmann KT, et al. Consensus criteria for screening commercial drivers for obstructive sleep apnea: evidence of efficacy. J Occup Environ Med 2008; 50: 324-9.

Xie W, Chakrabarty S, Levine R, et al. Factors associated with obstructive sleep apnea among com-

mercial motor vehicle drivers. J Occup Environ Med 2011; 53: 169-73.

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IssueVol 1 No 3 (2016): Summer QRcode
SectionOriginal Article(s)
Keywords
Commercial drivers Motor vehicle accident Obstructive sleep apnea (OSA) Polysomnography STOP-BANG questionnaire

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How to Cite
1.
Nasootifard S, Sadeghniiat- Haghighi K, Aminian O, Salmani Nodoushan M, Karimi K. Assessment of Elements of STOP-BANG Questionnaire in Screening Obstructive Sleep Apnea (OSA) in Iranian Commercial Drivers. J Sleep Sci. 2016;1(3):109-114.