title: A new approach for the assessment of sleepiness and predictivity of obstructive sleep apnea in drivers: A pilot study.
abstract: BACKGROUND
  Falling asleep behind the wheel is one of the most relevant consequences of obstructive sleep apnea (OSA). We created a new screening questionnaire, named the Driver Sleepiness Score (DSS), aiming to assess sleepiness in drivers with suspected OSA. The primary aim of our study was to evaluate sleepiness in drivers with a suspicion of OSA by the DSS in order to assess its correlation with the apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and total sleep time with oxyhemoglobin saturation below 90% (TST90). We also aimed to assess the diagnostic accuracy of DSS for three different cutoffs of AHI (AHI = 5, AHI = 15, AHI = 30), which allow stratification of the severity of OSA.
  
  
  METHODS
  Seventy-three driving patients at risk for OSA participated in the study. DSS and the Epworth Sleepiness Scale (ESS) were both administered in operator-dependent modality and in randomized sequence.
  
  
  RESULTS
  The DSS showed higher accuracy in screening patients with mild OSA [area under curve (AUC): 0.88 vs 0.74] and moderate OSA (AUC: 0.88 vs 0.79), whereas ESS showed higher accuracy in screening patients with severe OSA (AUC: 0.91 vs 0.78). A DSS score ≥ 7 is the optimal cutoff for distinguishing true positives from false positives for the presence of OSA and for its different severity levels. The administration of both questionnaires increases the accuracy for the detection of all OSA severity levels.
  
  
  CONCLUSIONS
  If validated, DSS may qualify as a new screening tool specifically for drivers with the suspicion of having OSA, in combination with the ESS.
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Vitaliano Nicola
authors.initials: VN
authors.lastname: Quaranta
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Dragonieri
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Carratù
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Vito Antonio
authors.initials: VA
authors.lastname: Falcone
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Carucci
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Ranieri
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Ventura
authors.affiliation: Department of Respiratory Diseases, University of Bari, Bari, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Resta
keywords: Obstructive sleep apnea (OSA); road accidents; screening questionnaires