title: Driving habits and risk factors for traffic accidents among sleep apnea patients--a European multi-centre cohort study.
abstract: Obstructive sleep apnea is associated with increased motor vehicle accident risk, and improved detection of patients at risk is of importance. The present study addresses potential risk factors in the European Sleep Apnea Database and includes patients with suspected obstructive sleep apnea [n = 8476, age 51.5 (12.5) years, body mass index 31.0 (6.6) kg m(-2) , 82.4% driver's licence holders]. Driving distance (km year(-1) ), driver's licence type, sleep apnea severity, sleepiness and comorbidities were assessed. Previously validated risk factors for accident history: Epworth Sleepiness Scale ≥16; habitual sleep time ≤5 h; use of hypnotics; and driving ≥15 000 km year(-1) were analysed across European regions. At least one risk factor was identified in male and female drivers, 68.75 and 51.3%, respectively. The occurrence of the risk factors was similar across Europe, with only a lower rate in the eastern region (P = 0.001). The mean number of risk factors increased across classes of sleep apnea severity. Frequent driving was prevalent [14.0 (interquartile range 8.0-20.0) × 10(3)  km year(-1) ] and 32.7% of drivers had severe obstructive sleep apnea [apnea-hypopnea index 50.3 (38.8-66.0) n h(-1) ]. Obesity, shorter sleep time and younger age were associated with increased traffic exposure (P ≤ 0.03). In conclusion, the risk factors associated with accident history were common among European patients with suspected obstructive sleep apnea, but varied between geographical regions. There was a weak covariation between occurrence of risk factors and clinically determined apnea severity but frequent driving, a strong risk factor for accidents, was over-represented. Systematic evaluation of accident-related risk factors is important to detect sleep apnea patients at risk for motor vehicle accidents.
authors.affiliation: Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Mahssa
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hedner
authors.affiliation: Sleep Disorders Centre, Department of Cardiology, Istituto Auxologico Italiano IRCCS, Milan, Italy.
authors.forename: Carolina
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Pulmonary and Sleep Disorders Unit, University College Dublin, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Walter T
authors.initials: WT
authors.lastname: Mcnicholas
authors.affiliation: Charite-Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Thomas
authors.identifier: http://orcid.org/0000-0002-4304-0112
authors.initials: T
authors.lastname: Penzel
authors.affiliation: Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Renata L
authors.initials: RL
authors.lastname: Riha
authors.affiliation: Center for Sleep Medicine and Pneumology Department, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Rodenstein
authors.affiliation: Centre for Sleep and Vigilance Disorders, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001288:Attention; D001334:Automobile Driving / Q000523:psychology; D015331:Cohort Studies; D016208:Databases, Factual; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000523:psychology*; D055815:Young Adult
keywords: driving exposure; hypersomnia; motor vehicle crash; registry; sleepy driving; traffic risk