title: Evaluation of candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers.
abstract: BACKGROUND
  Sleepiness-at-the-wheel has been identified as a major cause of highway accidents. The aim of our study is identifying the candidate measures for home-based screening of sleep disordered breathing in Taiwanese bus drivers, instead of polysomnography.
  
  
  METHODS
  Overnight polysomnography accompanied with simultaneous measurements of alternative screening devices (pulse oximetry, ApneaLink, and Actigraphy), heart rate variability, wake-up systolic blood pressure and questionnaires were completed by 151 eligible participants who were long-haul bus drivers with a duty period of more than 12 h a day and duty shifting.
  
  
  RESULTS
  63.6% of professional bus drivers were diagnosed as having sleep disordered breathing and had a higher body mass index, neck circumference, systolic blood pressure, arousal index and desaturation index than those professional bus drivers without evidence of sleep disordered breathing. Simple home-based candidate measures: (1) Pulse oximetry, oxygen-desaturation indices by ≥3% and 4% (r = 0.87~0.92); (2) Pulse oximetry, pulse-rising indices by ≥7% and 8% from a baseline (r = 0.61~0.89); and (3) ApneaLink airflow detection, apnea-hypopnea indices (r = 0.70~0.70), based on recording-time or Actigraphy-corrected total sleep time were all significantly correlated with, and had high agreement with, corresponding polysomnographic apnea-hypopnea indices [(1) 94.5%~96.6%, (2) 93.8%~97.2%, (3) 91.1%~91.3%, respectively]. Conversely, no validities of SDB screening were found in the multi-variables apnea prediction questionnaire, Epworth Sleepiness Scale, night-sleep heart rate variability, wake-up systolic blood pressure and anthropometric variables.
  
  
  CONCLUSIONS
  The indices of pulse oximetry and apnea flow detection are eligible criteria for home-based screening of sleep disordered breathing, specifically for professional drivers.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40201, Taiwan. huating@csmu.edu.tw.
authors.forename: Hua
authors.initials: H
authors.lastname: Ting
authors.affiliation: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40245, Taiwan. huangrenjing@yahoo.com.tw.
authors.forename: Ren-Jing
authors.initials: RJ
authors.lastname: Huang
authors.affiliation: Department of Medical Informatics, Chung Shan Medical University, Taichung 40201, Taiwan. liay@csmu.edu.tw.
authors.forename: Ching-Hsiang
authors.initials: CH
authors.lastname: Lai
authors.affiliation: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40245, Taiwan. csha499@csh.org.tw.
authors.forename: Shen-Wen
authors.initials: SW
authors.lastname: Chang
authors.affiliation: Center of Sleep Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40245, Taiwan. csha368@csh.org.tw.
authors.forename: Ai-Hui
authors.initials: AH
authors.lastname: Chung
authors.affiliation: PhD Program of Mechanical and Aeronautical Engineering, Feng Chia University, Taichung 40724, Taiwan. troyguo@yahoo.com.tw.
authors.forename: Teng-Yao
authors.initials: TY
authors.lastname: Kuo
authors.affiliation: Department of Photonics and Communication Engineering, Asia University, Taichung 41354, Taiwan. chchang@asia.edu.tw.
authors.forename: Ching-Haur
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Institute of Labor Policy and Occupational Safety and Health, Ministry of Labor Affairs, Executive Yuan, Taipei 22143, Taiwan. shih.tone@gmail.com.
authors.forename: Tung-Sheng
authors.initials: TS
authors.lastname: Shih
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung 40201, Taiwan. shinda@mail.cmu.edu.tw.
authors.forename: Shin-Da
authors.initials: SD
authors.lastname: Lee
mesh_terms: D056044:Actigraphy / Q000379:methods*; D000328:Adult; D001333:Automobile Driver Examination; D001334:Automobile Driving; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D018986:Motor Vehicles; D010092:Oximetry / Q000379:methods*; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000379:methods*; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D013624:Taiwan