title: Impaired vigilance and increased accident rate in public transport operators is associated with sleep disorders.
abstract: OBJECTIVE
  Sleep disturbances can impair alertness and neurocognitive performance and increase the risk of falling asleep at the wheel. We investigated the prevalence of sleep disorders among public transport operators (PTOs) and assessed the interventional effects on hypersomnolence and neurocognitive function in those diagnosed with obstructive sleep apnea (OSA).
  
  
  METHODS
  Overnight polygraphy and questionnaire data from 101 volunteers (72 males, median age 48 range [22-64] years, 87 PTOs) employed at the Gothenburg Public Transportation Company were assessed. Treatment was offered in cases with newly detected OSA. Daytime sleep episodes and neurocognitive function were assessed before and after intervention.
  
  
  RESULTS
  At baseline, symptoms of daytime hypersomnolence, insomnia, restless legs syndrome as well as objectively assessed OSA (apnea hypopnea index (AHI, determined by polygraphic recording)=17[5-46]n/h) were highly present in 26, 24, 10 and 22%, respectively. A history of work related traffic accident was more prevalent in patients with OSA (59%) compared to those without (37%, p<0.08). In the intervention group (n=12) OSA treatment reduced AHI by -23 [-81 to -5]n/h (p=0.002), determined by polysomnography. Reduction of OSA was associated with a significant reduction of subjective sleepiness and blood pressure. Measures of daytime sleep propensity (microsleep episodes from 9 [0-20.5] to 0 [0-12.5], p<0.01) and missed responses during performance tests were greatly reduced, indices of sustained attention improved.
  
  
  CONCLUSIONS
  PTOs had a high prevalence of sleep disorders, particularly OSA, which demonstrated a higher prevalence of work related accidents. Elimination of OSA led to significant subjective and objective improvements in daytime function. Our findings argue for greater awareness of sleep disorders and associated impacts on daytime function in public transport drivers.
authors.affiliation: Center for Sleep and Vigilance Disorders, Institution of Medicine, Department of Internal Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. mahssa.karimi@lungall.gu.se
authors.forename: Mahssa
authors.initials: M
authors.lastname: Karimi
authors.forename: Derek N
authors.initials: DN
authors.lastname: Eder
authors.forename: Davoud
authors.initials: D
authors.lastname: Eskandari
authors.forename: Ding
authors.initials: D
authors.lastname: Zou
authors.forename: Jan A
authors.initials: JA
authors.lastname: Hedner
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data; D000328:Adult; D001288:Attention; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D017286:Polysomnography; D015995:Prevalence; D011890:Railroads; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D020919:Sleep Disorders, Intrinsic / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D014851:Wakefulness