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. 2004 Sep;59(9):804–807. doi: 10.1136/thx.2003.007187

Sleep · 5: Driving and automobile crashes in patients with obstructive sleep apnoea/hypopnoea syndrome

C George 1
PMCID: PMC1747140  PMID: 15333860

Abstract

Driving is a complex task involving distinct cognitive, perceptual, motor, and decision making skills. After placing the vehicle on the road, the driver must constantly survey the ever changing roadway environment to keep the vehicle in the lane and moving at an appropriate safe speed. This surveillance involves two distinct visual tasks: estimating and responding to the oncoming curvature and controlling lane position. Driving is therefore a divided attention task involving speed and lane control as well as monitoring. To do this in a safe manner requires careful attention and alertness which can be problematic for patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS) or other sleep disorders.

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Selected References

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  1. Aldrich M. S. Automobile accidents in patients with sleep disorders. Sleep. 1989 Dec;12(6):487–494. doi: 10.1093/sleep/12.6.487. [DOI] [PubMed] [Google Scholar]
  2. Arbus L., Tiberge M., Serres A., Rouge D. Somnolence et accidents de la circulation routière. Importance du diagnostic. Neurophysiol Clin. 1991 Mar;21(1):39–43. doi: 10.1016/s0987-7053(05)80354-5. [DOI] [PubMed] [Google Scholar]
  3. Arnedt J. T., Wilde G. J., Munt P. W., MacLean A. W. How do prolonged wakefulness and alcohol compare in the decrements they produce on a simulated driving task? Accid Anal Prev. 2001 May;33(3):337–344. doi: 10.1016/s0001-4575(00)00047-6. [DOI] [PubMed] [Google Scholar]
  4. Arnedt J. T., Wilde G. J., Munt P. W., MacLean A. W. Simulated driving performance following prolonged wakefulness and alcohol consumption: separate and combined contributions to impairment. J Sleep Res. 2000 Sep;9(3):233–241. doi: 10.1046/j.1365-2869.2000.00216.x. [DOI] [PubMed] [Google Scholar]
  5. Barbé, Pericás J., Muñoz A., Findley L., Antó J. M., Agustí A. G. Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. Am J Respir Crit Care Med. 1998 Jul;158(1):18–22. doi: 10.1164/ajrccm.158.1.9709135. [DOI] [PubMed] [Google Scholar]
  6. Cassel W., Ploch T., Becker C., Dugnus D., Peter J. H., von Wichert P. Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP. Eur Respir J. 1996 Dec;9(12):2606–2611. doi: 10.1183/09031936.96.09122606. [DOI] [PubMed] [Google Scholar]
  7. Connor J., Whitlock G., Norton R., Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies. Accid Anal Prev. 2001 Jan;33(1):31–41. doi: 10.1016/s0001-4575(00)00013-0. [DOI] [PubMed] [Google Scholar]
  8. Engleman H. M., Hirst W. S., Douglas N. J. Under reporting of sleepiness and driving impairment in patients with sleep apnoea/hypopnoea syndrome. J Sleep Res. 1997 Dec;6(4):272–275. doi: 10.1111/j.1365-2869.1997.00272.x. [DOI] [PubMed] [Google Scholar]
  9. Findley L. J., Fabrizio M. J., Knight H., Norcross B. B., LaForte A. J., Suratt P. M. Driving simulator performance in patients with sleep apnea. Am Rev Respir Dis. 1989 Aug;140(2):529–530. doi: 10.1164/ajrccm/140.2.529. [DOI] [PubMed] [Google Scholar]
  10. Findley L. J., Suratt P. M., Dinges D. F. Time-on-task decrements in "steer clear" performance of patients with sleep apnea and narcolepsy. Sleep. 1999 Sep 15;22(6):804–809. doi: 10.1093/sleep/22.6.804. [DOI] [PubMed] [Google Scholar]
  11. Findley L. J., Unverzagt M. E., Suratt P. M. Automobile accidents involving patients with obstructive sleep apnea. Am Rev Respir Dis. 1988 Aug;138(2):337–340. doi: 10.1164/ajrccm/138.2.337. [DOI] [PubMed] [Google Scholar]
  12. Findley L., Smith C., Hooper J., Dineen M., Suratt P. M. Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):857–859. doi: 10.1164/ajrccm.161.3.9812154. [DOI] [PubMed] [Google Scholar]
  13. Garbarino S., Nobili L., Beelke M., De Carli F., Ferrillo F. The contributing role of sleepiness in highway vehicle accidents. Sleep. 2001 Mar 15;24(2):203–206. [PubMed] [Google Scholar]
  14. George C. F., Boudreau A. C., Smiley A. Comparison of simulated driving performance in narcolepsy and sleep apnea patients. Sleep. 1996 Nov;19(9):711–717. doi: 10.1093/sleep/19.9.711. [DOI] [PubMed] [Google Scholar]
  15. George C. F., Boudreau A. C., Smiley A. Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea. Thorax. 1997 Jul;52(7):648–653. doi: 10.1136/thx.52.7.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. George C. F., Boudreau A. C., Smiley A. Simulated driving performance in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1996 Jul;154(1):175–181. doi: 10.1164/ajrccm.154.1.8680676. [DOI] [PubMed] [Google Scholar]
  17. George C. F., Nickerson P. W., Hanly P. J., Millar T. W., Kryger M. H. Sleep apnoea patients have more automobile accidents. Lancet. 1987 Aug 22;2(8556):447–447. doi: 10.1016/s0140-6736(87)90974-3. [DOI] [PubMed] [Google Scholar]
  18. George C. F. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001 Jul;56(7):508–512. doi: 10.1136/thorax.56.7.508. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. George C. F., Smiley A. Sleep apnea & automobile crashes. Sleep. 1999 Sep 15;22(6):790–795. [PubMed] [Google Scholar]
  20. George Charles F. P., Findley Larry J., Hack Melissa A., Douglas McEvoy R. Across-country viewpoints on sleepiness during driving. Am J Respir Crit Care Med. 2002 Mar 15;165(6):746–749. doi: 10.1164/ajrccm.165.6.2107112. [DOI] [PubMed] [Google Scholar]
  21. Hack M., Davies R. J., Mullins R., Choi S. J., Ramdassingh-Dow S., Jenkinson C., Stradling J. R. Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax. 2000 Mar;55(3):224–231. doi: 10.1136/thorax.55.3.224. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Haraldsson P. O., Carenfelt C., Diderichsen F., Nygren A., Tingvall C. Clinical symptoms of sleep apnea syndrome and automobile accidents. ORL J Otorhinolaryngol Relat Spec. 1990;52(1):57–62. doi: 10.1159/000276104. [DOI] [PubMed] [Google Scholar]
  23. Haraldsson P. O., Carenfelt C., Laurell H., Törnros J. Driving vigilance simulator test. Acta Otolaryngol. 1990 Jul-Aug;110(1-2):136–140. doi: 10.3109/00016489009122528. [DOI] [PubMed] [Google Scholar]
  24. Haraldsson P. O., Carenfelt C., Lysdahl M., Törnros J. Long-term effect of uvulopalatopharyngoplasty on driving performance. Arch Otolaryngol Head Neck Surg. 1995 Jan;121(1):90–94. doi: 10.1001/archotol.1995.01890010070012. [DOI] [PubMed] [Google Scholar]
  25. Haraldsson P. O., Carenfelt C., Persson H. E., Sachs C., Törnros J. Simulated long-term driving performance before and after uvulopalatopharyngoplasty. ORL J Otorhinolaryngol Relat Spec. 1991;53(2):106–110. doi: 10.1159/000276198. [DOI] [PubMed] [Google Scholar]
  26. Horne J. A., Reyner L. A. Sleep related vehicle accidents. BMJ. 1995 Mar 4;310(6979):565–567. doi: 10.1136/bmj.310.6979.565. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Horstmann S., Hess C. W., Bassetti C., Gugger M., Mathis J. Sleepiness-related accidents in sleep apnea patients. Sleep. 2000 May 1;23(3):383–389. [PubMed] [Google Scholar]
  28. Juniper M., Hack M. A., George C. F., Davies R. J., Stradling J. R. Steering simulation performance in patients with obstructive sleep apnoea and matched control subjects. Eur Respir J. 2000 Mar;15(3):590–595. doi: 10.1034/j.1399-3003.2000.15.27.x. [DOI] [PubMed] [Google Scholar]
  29. Kingshott R. N., Vennelle M., Hoy C. J., Engleman H. M., Deary I. J., Douglas N. J. Predictors of improvements in daytime function outcomes with CPAP therapy. Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):866–871. doi: 10.1164/ajrccm.161.3.9905053. [DOI] [PubMed] [Google Scholar]
  30. Krieger J., Meslier N., Lebrun T., Levy P., Phillip-Joet F., Sailly J. C., Racineux J. L. Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure: a prospective study. The Working Group ANTADIR, Paris and CRESGE, Lille, France. Association Nationale de Traitement à Domicile des Insuffisants Respiratoires. Chest. 1997 Dec;112(6):1561–1566. doi: 10.1378/chest.112.6.1561. [DOI] [PubMed] [Google Scholar]
  31. Land M., Horwood J. Which parts of the road guide steering? Nature. 1995 Sep 28;377(6547):339–340. doi: 10.1038/377339a0. [DOI] [PubMed] [Google Scholar]
  32. Lyznicki J. M., Doege T. C., Davis R. M., Williams M. A. Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association. JAMA. 1998 Jun 17;279(23):1908–1913. doi: 10.1001/jama.279.23.1908. [DOI] [PubMed] [Google Scholar]
  33. Masa J. F., Rubio M., Findley L. J. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. Am J Respir Crit Care Med. 2000 Oct;162(4 Pt 1):1407–1412. doi: 10.1164/ajrccm.162.4.9907019. [DOI] [PubMed] [Google Scholar]
  34. Maycock G. Sleepiness and driving: the experience of U.K. car drivers. Accid Anal Prev. 1997 Jul;29(4):453–462. doi: 10.1016/s0001-4575(97)00024-9. [DOI] [PubMed] [Google Scholar]
  35. Muñoz A., Mayoralas L. R., Barbé F., Pericás J., Agusti A. G. Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J. 2000 Apr;15(4):676–681. doi: 10.1034/j.1399-3003.2000.15d09.x. [DOI] [PubMed] [Google Scholar]
  36. Naughton M., Pierce R. Sleep apnoea's contribution to the road toll. Aust N Z J Med. 1991 Dec;21(6):833–834. doi: 10.1111/j.1445-5994.1991.tb01402.x. [DOI] [PubMed] [Google Scholar]
  37. Noda A., Yagi T., Yokota M., Kayukawa Y., Ohta T., Okada T. Daytime sleepiness and automobile accidents in patients with obstructive sleep apnea syndrome. Psychiatry Clin Neurosci. 1998 Apr;52(2):221–222. doi: 10.1111/j.1440-1819.1998.tb01041.x. [DOI] [PubMed] [Google Scholar]
  38. Richardson G. S., Miner J. D., Czeisler C. A. Impaired driving performance in shiftworkers: the role of the circadian system in a multifactorial model. Alcohol Drugs Driving. 1989 1990;5-6(4-1):265–273. [PubMed] [Google Scholar]
  39. Risser M. R., Ware J. C., Freeman F. G. Driving simulation with EEG monitoring in normal and obstructive sleep apnea patients. Sleep. 2000 May 1;23(3):393–398. [PubMed] [Google Scholar]
  40. Roehrs T., Roth T. Sleep, sleepiness, and alcohol use. Alcohol Res Health. 2001;25(2):101–109. [PMC free article] [PubMed] [Google Scholar]
  41. Terán-Santos J., Jiménez-Gómez A., Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med. 1999 Mar 18;340(11):847–851. doi: 10.1056/NEJM199903183401104. [DOI] [PubMed] [Google Scholar]
  42. Turkington P. M., Sircar M., Allgar V., Elliott M. W. Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax. 2001 Oct;56(10):800–805. doi: 10.1136/thorax.56.10.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Wu H., Yan-Go F. Self-reported automobile accidents involving patients with obstructive sleep apnea. Neurology. 1996 May;46(5):1254–1257. doi: 10.1212/wnl.46.5.1254. [DOI] [PubMed] [Google Scholar]
  44. Yamamoto H., Akashiba T., Kosaka N., Ito D., Horie T. Long-term effects nasal continuous positive airway pressure on daytime sleepiness, mood and traffic accidents in patients with obstructive sleep apnoea. Respir Med. 2000 Jan;94(1):87–90. doi: 10.1053/rmed.1999.0698. [DOI] [PubMed] [Google Scholar]
  45. Young T., Blustein J., Finn L., Palta M. Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. Sleep. 1997 Aug;20(8):608–613. doi: 10.1093/sleep/20.8.608. [DOI] [PubMed] [Google Scholar]

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