Expert Panel Recommendations
[Pages:37]Expert Panel Recommendations:
Obstructive Sleep Apnea and Commercial Motor Vehicle Driver
Safety
Medical Expert Panel Members: Sonia Ancoli-Israel PhD
Charles A Czeisler, MD, PhD Charles FP George, MD, FRCPC Christian Guilleminault, MD, BiolD
Allan I Pack, MB, ChB, PhD
SLEEP APNEA: Major Facts
? Symptomatic sleep apnea - 4% of middle-aged males, 2% of middle-aged females (Young et al, 1993)
? Recurrent pauses (apnea) or decrements in breathing (hypopneas)
? Breathing pauses lead to
Repeated episodic hypoxia
Sleep interruption (arousal)
Hypertension
Excessive sleepiness Neurocognitive abnormalities
Example of Obstructive Sleep Apnea:
Nocturnal O2 Saturation in a Patient with Sleep Apnea:
Risk Factors for Obstructive Sleep Apnea:
? Obesity
? Obesity ? Obesity ? Ethnic background ? Upper airway anatomy ? Endocrine abnormalities ? Menopausal status ? Genetic factors
Meta Analysis- Increased Risk of Car Crashes in Subjects with Obstructive
Sleep Apnea
(Sassani et al. Sleep, 27:453, 2004)
Distribution of Body Mass Index in Commercial Drivers
(Gurubhagavatula et al. AJRCCM, 170: 371, 2004)
Proportion Studied in Laboratory
50
45
40
38.4%
35
30.0%
30
25
20 15 11.3%
13.8%
10
6.4%
5
0 40
BMI Interval (kg/m2)
Pathological Sleepiness in Commercial Drivers with Different Degrees of Obstructive Sleep Apnea (OSA)
(Pack et al. AJRCCM, 174:446,2006)
100
80
% of Drivers
60
40
20
0 Severe Moderate Mild OSA No OSA
OSA
OSA
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