title: Utility of overnight pulse oximeter as a screening tool for sleep apnea to assess the 8-year risk of cardiovascular disease: Data from a large-scale bus driver cohort study.
abstract: BACKGROUND
  Professional drivers' work under conditions predisposes them for development of sleep-disordered breathing (SDB) and cardiovascular disease (CVD). However, the effect of SDB on CVD risk among professional drivers has never been investigated. A cohort study was used to evaluate the effectiveness of overnight pulse oximeter as a sleep apnea screening tool to assess the 8-year risk of CVD events.
  
  
  METHODS
  The Taiwan Bus Driver Cohort Study (TBDCS) recruited 1014 professional drivers in Taiwan since 2005. The subjects completed questionnaire interview and overnight pulse oximeter survey. This cohort was linked to the National Health Insurance Research Dataset (NHIRD). Researchers found 192 CVD cases from 2005 to 2012. Cox proportional hazards model was performed to estimate the hazard ratio for CVD. The statistical analysis was performed using SAS software in 2015.
  
  
  RESULTS
  ODI4 and ODI3 levels increased the 8-year CVD risk, even adjusting for CVD risk factors (HR: 1.36, 95% CI: 1.05 to 1.78; p=0.022, and HR: 1.40, 95% CI: 1.03 to 1.90; p=0.033). ODI4 and ODI3 thresholds of 6.5 and 10events/h revealed differences of CVD risks (HR: 1.72, 95% CI: 1.00 to 2.95; p=0.048, and HR: 1.76, 95% CI: 1.03 to 3.03; p=0.041). Moreover, the ODI levels had an increased risk for hypertensive disease (not including essential hypertension).
  
  
  CONCLUSIONS
  This study concludes that ODI for a sign of SDB is an independent predictor of elevated risk of CVD. Further research should be conducted regarding measures to prevent against SDB in order to reduce CVD risk in professional drivers.
authors.affiliation: National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors.forename: Wei-Te
authors.initials: WT
authors.lastname: Wu
authors.affiliation: Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Su-Shan
authors.initials: SS
authors.lastname: Tsai
authors.affiliation: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Lin
authors.affiliation: Institute of Labor, Occupational Safety and Health, Ministry of Labor, Taipei, Taiwan.
authors.forename: Ming-Hsiu
authors.initials: MH
authors.lastname: Lin
authors.affiliation: National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Healthcare Administration, Asia University, Taichung, Taiwan.
authors.forename: Trong-Neng
authors.initials: TN
authors.lastname: Wu
authors.affiliation: Institute of Labor, Occupational Safety and Health, Ministry of Labor, Taipei, Taiwan.
authors.forename: Tung-Sheng
authors.initials: TS
authors.lastname: Shih
authors.affiliation: National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Occupational Safety and Health, China Medical University, Taichung, Taiwan; Department of Public Health, National Defense Medical Center, Taipei, Taiwan. Electronic address: shliou@nhri.org.tw.
authors.forename: Saou-Hsing
authors.initials: SH
authors.lastname: Liou
mesh_terms: D000328:Adult; D001334:Automobile Driving; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D016208:Databases, Factual / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D016273:Occupational Exposure / Q000009:adverse effects / Q000517:prevention & control; D010092:Oximetry / Q000379:methods* / Q000639:trends; D017286:Polysomnography / Q000379:methods / Q000639:trends; D011446:Prospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D020178:Sleep Disorders, Circadian Rhythm / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: Cardiovascular disease; Nocturnal intermittent hypoxia; Oxygen desaturation index; Portable pulse oximeter; Professional drivers; Sleep-disordered breathing