The Connection between Sleep Apnea and Accidents on the Roadway

There seems to be a connection between sleep apnea and accidents on the highway. According to research conducted in Spain, sleepy drivers have a high frequency of automobile crashes and the sleepiness is often associated with respiratory disorders during sleep.

One survey showed that 2-3% of drivers are sleepy on a frequent basis.  In another, nearly 4% of survey respondents were habitually sleepy. 

The Spanish researchers interviewed 4000 drivers.  3.6% reported sleepiness while driving.  Those sleepy drivers had over 6 times as many car crashes as the non-sleepy ones during the previous five years. 

About 6% of the sleepy drivers had been diagnosed with some type of sleep-related respiratory disorder, primarily apneas.  The San Francisco CHEST 2000 study provides additional evidence.
According to the study, a “disproportionate” number of patients with OSA had crashes while they were waiting for polysomnography to confirm the diagnosis.  In other words, while they were waiting to be treated, they often had a car accident.

Doctors have suggested that the danger of driving while sleepy is as serious as driving while intoxicated.  In simulation studies, sleepy volunteers performed as poorly as those who were intoxicated.  So, it should be no surprise that sleep apnea and accidents are connected.
In stage 2 of the Spanish study, 134 of the 4000 drivers interviewed agreed to participate in polysomnography.  More commonly referred to as a sleep-study, polysomnography is used to diagnose a variety of sleep-related disorders, including the various kinds of apneas. 

The studies are performed in a clinical setting.  Technicians attach electrodes to the patient’s chest, head and legs.  The heart rate, blood pressure, blood oxygen levels, air flow and brain activity are monitored. 

What is particularly troubling about the connection between untreated sleep apnea and accidents is that the patients had to wait for polysomnography and treatment.  Although the number of technicians qualified to perform the studies is growing, there are apparently not enough to meet society’s needs.
Of the 134 drivers who participated in stage 2 of the study, 90 were sleepy.  They had not previously been diagnosed with any kind of sleep-related disorder.  44 were not habitually sleepy while driving.  They were used as control subjects to compare the results. 

Polysomnography revealed that 42% of the sleepy drivers had 15 or more respiratory episodes per hour.  Only six episodes are needed to make a diagnosis of clinically significant or requiring treatment.
What’s even more surprising is that 13% of the control group had clinically significant symptoms.  This indicates that there is probably a relationship between undiagnosed sleep apnea and accidents of all kinds. 

It also indicates that a lot of people have nighttime breathing difficulties and are not even aware of it.  They do not suffer from excessive daytime sleepiness, which is the most common reason that people seek treatment.  You might say they are tired of being tired.

The researchers concluded that many crashes may be preventable, because the respiratory disorders are treatable.  They also suggested that doctors ask their patients about excessive sleepiness while driving, rather than overall daytime sleepiness, because half of the sleepy drivers reported being wide awake during other daytime activities.

The CHEST 2000 study queried 124 people about the time spent waiting for diagnosis or treatment of sleep apnea and accidents that occurred during that time.  The volunteers were not only questioned about automobile crashes, but also about “near” crashes and other adverse events.

18% reported falling asleep while driving.  34% reported falling asleep at work.  12% were either demoted or fired because of daytime sleepiness. 

6% crashed their cars, while another 18% came close to crashing.  So there is a connection between sleep apnea and accidents on the road. 

There is a need for quicker evaluations and treatments if the issue of sleep apnea and accidents is to be resolved.  The participants in the CHEST study waiting an average of 36 days before their polysomnography could be performed.  Some waited as long as two months.  In the past, this type of delay has been considered acceptable. 

The delay was considered acceptable because it takes years for the heart complications to develop.  Damage to the heart and cardiovascular system are the primary risks of untreated apneas.

By establishing the connection between sleep apnea and accidents on the road, researchers have shown that there are other risks to be considered.  By delaying diagnosis and treatment for one to two months, there is a significant risk that the patient will die in an automobile accident.  There is also a risk that the patient will kill someone else. 

There is a significant risk that the patient will lose their job, which could delay treatment even longer if he or she loses their insurance.  That of course is only a factor in the US. 

In other words, the connection between sleep apnea and accidents is not the only thing to consider when scheduling treatment.  Whether you are the doctor or the patient, it is important to get the problem diagnosed and treated as soon as possible.

If you are the patient, it is important that you stick with the recommended treatment.  There are many patients who discontinue the use of CPAP machines without consulting their doctors.  Studies indicate that could be a dangerous thing to do.

The only solution for the people who struggle to stay awake while driving is to see their doctor.  There are still many people who are completely unaware of the condition.  So, increased public awareness is important, too. 

Perhaps billboards or radio commercials could be used to let sleepy drivers know that they could have a treatable condition.  Many drivers realize they are sleepy and blame it on some kind of insomnia. 

Middle-of-the-night insomnia is relatively common among middle aged and older individuals.  The reason the individuals awake during the middle of the night could be a respiratory episode. 

Tell everyone that you know about the connection between sleep apnea and accidents.  Remember that some of the non-sleepy drivers had apneas, too.  By spreading the word, you could save a life.