Sleep apnea: also a safe driving problem

Curated by Luigi Ferritto (1), Walter Ferritto (2), Giuseppe Fiorentino (3)

Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterized by repeated episodes of partial or complete obstruction of the upper airways that occur during the inspiratory phase. This obstruction manifests itself as a reduction (hypopnea) or complete cessation (apnea) of the flow of air, with persistence of thoraco-diaphragmatic respiratory movements. The lack of adequate alveolar ventilation usually results in a reduction in the oxygen saturation of arterial blood (SaO2) and, in the case of prolonged efforts, in a gradual increase in arterial pressure and carbon dioxide (PaCO2). These respiratory events often end in an arousal. The result is poor quality sleep and little restorative, with both nighttime symptoms (intense snoring, need to urinate, etc.) and daytime (excessive sleepiness, irritability, decreased attention and neuro-behavioral disorders, etc.). It is estimated that over 1, 600, 000 people are affected in Italy. Among the clinical and symptomatic consequences of OSAS there is one that may constitute a public health problem: sleepiness. In addition to the obvious repercussions on daily activities such as poor performance and reduced productivity on the job, it entails an increase in the risk of road accidents due to capacity reduction

attentive, with a consequent reduction in the ability to drive a motor vehicle. Accidents due to driver drowsiness occur more easily in the early afternoon and at the end of the night / early morning and have the characteristic of being particularly serious due to the lack of a defensive reaction from the driver. There is now ample literature confirming the association between OSAS and increased risk of driving accidents, with a risk 2 to 7 times greater than incurring in a car accident. It has been shown that, even in the absence of documented drowsiness, in OSAS patients there is an increase in reaction times, with consequent risk of impact with an obstacle. On the basis of the delay in reaction times between OSAS patients and normal subjects, we have seen that the first run on average at 130 km / h (maximum speed allowed on Italian motorways) 22 meters more before starting to brake. It is also shown that in some professional fields, particularly among professional drivers, the addition of more risk factors leads to a greater prevalence of respiratory disorders in sleep than in the general population. Furthermore, the sedentary and monotonous nature of this activity, the fact that the guide is often prolonged for many hours in uninspiring situations, such as driving on motorways and at night, more easily expose this professional category to a greater risk of drowsiness at driving, increasing reaction times and consequently road accidents. An Italian study published in 2001 (Sleep 2001; 24: 203-206), analyzing the total number of incidents that occurred in the 1993-1997 period on the Italian motorway network, led to the identification of drowsiness as a cause or cause of 21.9% of the accidents that occurred, against the ISTAT survey which, in the same period, was around 3.2%. Referring to the year 2002 according to the Ministry of Health the extra-urban accidents would be 15% of the total and among these, the OSAS would account for a 50% (estimated CREMS) with a total of 9551 events, equal to 3.99% of all road accidents occurred in Italy, with a number of victims equal to 367. If for the OSAS, in the population there is no doubt that there is an increase in accidents, in the individual it is impossible to predict whether this risk can occur, even in the case of transport professionals. The indication is that of an accurate information in this sense to all patients, in particular to those who drive a high number of kilometers a year is to start the diagnosis and treatment provided, now fully effective.

Obstructive Apnea Diagnosis »