scholarly journals Obstructive Sleep Apnea and Driving: A Canadian Thoracic Society and Canadian Sleep Society Position Paper

2014 ◽  
Vol 21 (2) ◽  
pp. 114-123 ◽  
Author(s):  
Najib Ayas ◽  
Robert Skomro ◽  
Adam Blackman ◽  
Kristen Curren ◽  
Michael Fitzpatrick ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Working Group ◽  
Motor Vehicle ◽  
The United States ◽  
Commercial Vehicles ◽  
Fitness To Drive ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Renewal Period

Individuals with obstructive sleep apnea (OSA) experience sleep fragmentation and poor sleep quality that results in daytime sleepiness, which impairs performance during driving and leads to an increased risk for collisions. Not surprisingly, observational studies have shown that patients with OSA experience a two- to 10-fold higher risk for collision compared with healthy controls. Although treatment would clearly mitigate these risks, there is no current Canadian position on driving and OSA. This article, the first Canadian position statement addressing the issue, provides an overview of provincial regulations and proposes recommendations with regard to driving in patients with OSA.Untreated patients with obstructive sleep apnea (OSA) are at increased risk for motor vehicle collisions; however, it is unclear how this should be translated into fitness-to-drive recommendations. Accordingly, the Canadian Thoracic Society (CTS) Sleep Disordered Breathing Clinical Assembly and the Canadian Sleep Society (CSS) assembled a CTS-CSS working group to propose recommendations with regard to driving in patients with OSA.Recommendations for assessing fitness to drive in noncommercial drivers: 1. Severity of OSA alone is not a reliable predictor of collision risk and, therefore, should not be used in isolation to assess fitness to drive; 2. The severity of sleep apnea should be considered in the context of other factors to assess fitness to drive; 3. The decision to restrict driving is ultimately made by the motor vehicle licensing authority; however, they should take into account the information and recommendations provided by the sleep medicine physician and should follow provincial guidelines; 4. For patients prescribed continuous positive airway pressure (CPAP) therapy, objective CPAP compliance should be documented. Efficacy should also be documented in terms of reversing the symptoms and improvement in sleep apnea based on physiological monitoring; 5. For patients treated with surgery or an oral appliance, verification of adequate sleep apnea treatment should be obtained; and 6. A driver diagnosed with OSA may be recertified as fit to drive based on assessment of symptoms and demonstrating compliance with treatment. The assessment should be aligned with the provincial driver’s license renewal period.Commercial vehicles: Assessment of fitness to drive should be more stringent for patients operating commercial vehicles. In general, the CTS-CSS working group was in agreement with the Medical Expert Panel recommendations to the Federal Motor Carrier Safety Administration in the United States; these recommendations were adapted for Canadian practitioners.

Obstructive sleep apnea: personal, societal, public health, and legal implications

2019 ◽  
Vol 34 (2) ◽  
pp. 153-169 ◽  
Author(s):  
Nesreen E. Morsy ◽  
Nesrine S. Farrag ◽  
Nevin F.W. Zaki ◽  
Ahmad Y. Badawy ◽  
Sayed A. Abdelhafez ◽  
...  
Keyword(s):  
Public Health ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Motor Vehicle ◽  
Work Productivity ◽  
Legal Aspects ◽  
Occupational Accidents ◽  
Organ Systems ◽  
Obstructive Sleep ◽  
Increased Risk

Abstract Introduction Obstructive sleep apnea (OSA) is a widely prevalent sleep-related breathing disorder, which leads to several life-threatening diseases. OSA has systemic effects on various organ systems. Untreated OSA is associated with long-term health consequences including hypertension, heart disease, diabetes, depression, metabolic disorders, and stroke. In addition, untreated OSA is reported to be associated with cognitive dysfunction, impaired productivity at the workplace and in an increased risk of motor vehicle accidents (MVAs) resulting in injury and fatality. Other consequences of OSA include, but are not limited to, impaired vigilance, daytime somnolence, performance deficits, morning headaches, mood disturbances, neurobehavioral impairments, and general malaise. Additionally, OSA has become an economic burden on most health systems all over the world. Many driving license regulations have been developed to reduce MVAs among OSA patients. Methods Studies of the personal, societal, public health, and legal aspects of OSA are reviewed. Data were collected through the following databases: MEDLINE, Google Scholar, Scopus, SAGE Research Methods, and ScienceDirect. Conclusion OSA leads to worsening of patients’ personal relationships, decreasing work productivity, and increasing occupational accidents as well as MVAs. The costs of undiagnosed and untreated OSA to healthcare organizations are excessive. Thus, proper management of OSA will benefit not only the patient but will also provide widespread benefits to the society as a whole.

Tonsils and Adenoids: An Update

1995 ◽  
Vol 16 (1) ◽  
pp. 17-21
Author(s):  
Ellen S. Deutsch ◽  
Glenn C. Isaacson
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disturbances ◽  
Recurrent Infection ◽  
The United States ◽  
Cor Pulmonale ◽  
Clinical Aspects ◽  
Adenotonsillar Hypertrophy ◽  
Obstructive Sleep ◽  
Increased Risk

Pediatricians frequently face the decision of whether to recommend that a child undergo a tonsillectomy, an adenoidectomy, or both. The reputation and the indications for these procedures have evolved over the years and continue to evoke controversy. The total number of tonsillectomies and adenoidectomies performed in the United States has decreased substantially over the past 30 to 40 years, although the proportion of procedures performed for obstructive sleep apnea (OSA) has increased. We will address the indications (Table), techniques, and complications of tonsillectomies and adenoidectomies, as well as current ideas concerning OSA. The palatine tonsils, adenoids, and lingual tonsils comprise a circle of lymphoid tissue in the nasopharynx and oropharynx, sometimes referred to as Waldeyer ring (Fig. 1). Although this tissue is immunologically active, no postoperative immune deficits generally have been acknowledged other than an increased risk of complications from polio1 prior to the availability of polio vaccines. Clinical Aspects The most common problems attributed to the tonsils and adenoids are recurrent infection and OSA, or its milder manifestation, adenotonsillar hypertrophy with obstruction. Chronic middle ear disease can be related to adenoid pathology. OBSTRUCTIVE SLEEP APNEA OSA either is becoming more common in children or is being recognized more frequently. Sleep disturbances, cor pulmonale, pulmonary hypertension, and congestive heart failure are potential complications of OSA.

scholarly journals A study on evaluation of pre and postoperative polysomnography for obstructive sleep apnea patients

2017 ◽  
Vol 3 (4) ◽  
pp. 861
Author(s):  
Venugopal Mohankumar ◽  
M. K. Rajasekar ◽  
Narendrakumar Veerasigamani ◽  
M. Sivaranjani
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Motor Vehicle ◽  
Significant Proportion ◽  
Dynamic Mri ◽  
Lifestyle Modifications ◽  
Vehicle Accidents ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Tongue Base Reduction

<p class="abstract"><strong>Background:</strong> Obstructive sleep apnea is the most common form of sleep-disordered breathing. However, obstructive sleep apnea has been associated with much more insidious conditions, including hypertension, diabetes, heart disease, stroke, and daytime somnolence can lead to a dramatically increased risk of motor vehicle accidents.</p><p class="abstract"><strong>Methods:</strong> This study was conducted in our institution in 34 OSA patients. After thorough evaluation with PSG, dynamic MRI, DISE patients were treated with various surgeries depending on the level of obstruction. Commonly UPPP, ESP, zetaplasty, tonsillectomy, tongue base reduction were done either alone or in combination.  </p><p class="abstract"><strong>Results:</strong> Pre and postoperative polysomnograhpy for obstructive sleep apnea was evaluated and statistically analyzed. Significant proportion of patients improved both subjectively and objectively as determined by reduction in AHI from 41.73±13.94 to 15.77±9.13, reduction in ESS from 16.41+3.09 to 5.14±3.41 and reduction in snoring.</p><p><strong>Conclusions:</strong> OSA can be easily treated with proper preoperative investigations, appropriate surgery, prevention of complications and continued lifestyle modifications. </p>

scholarly journals Effect of Obstructive Sleep Apnea on the Risk of Injuries—A Nationwide Population-Based Cohort Study

2021 ◽  
Vol 18 (24) ◽  
pp. 13416
Author(s):  
An-Che Cheng ◽  
Gwo-Jang Wu ◽  
Chi-Hsiang Chung ◽  
Kuo-Hsiang Wu ◽  
Chien-An Sun ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Motor Vehicle ◽  
Cox Proportional Hazards ◽  
Study Cohort ◽  
Research Database ◽  
Traffic Injury ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Study Results

Obstructive sleep apnea (OSA) has been reported to increase the risk of motor vehicle accidents. However, only few studies have investigated the effects of OSA on overall risk injury. The aim of study is to investigate whether OSA increases the risk of overall injury. The data were collected during 2000–2015 from Taiwan’s National Health Insurance Research Database. A total of 8901 individuals diagnosed with OSA were inpatients, or outpatients at least three times were enrolled. Finally, 6915 participants with OSA were included as the study cohort. We matched the study cohort with a comparison cohort, at a ratio of 1:4. Cox proportional hazards regression was used to analyse the association between OSA and overall injury. Patients with OSA had 83.1% increased risk of overall injury, compared to non-OSA individuals [adjusted hazards ratio (HR) = 1.831, confidence interval (CI) = 1.674–2.020, p < 0.001]. In the stratified age group, patients aged ≧65 years had the highest risk of injury (adjusted HR= 2.014; CI = 1.842–2.222, p < 0.001). Patients with OSA were at a higher risk of falls, traffic injury, poisoning, suffocation, suicide, and abuse or homicide than non-OSA individuals, with falls and traffic injury as the leading causes of injuries. The data demonstrated that patients with OSA have a higher risk of overall injury. The study results can be a reference for developing injury prevention strategies in the future. The general population and clinicians should have more awareness regarding OSA and its negative effects on injury development.

scholarly journals Obstructive Sleep Apnea and Risk of Motor Vehicle Accident

2021 ◽  
Author(s):  
Gaia S. Pocobelli ◽  
Mary A. Akosile ◽  
Ryan N. Hansen ◽  
Joanna Eavey ◽  
Robert D. Wellman ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Vehicle Accident ◽  
Obstructive Sleep

827 Central Sleep Apnea in a patient with Multiple Sclerosis

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A322-A323
Author(s):  
Rahul Dasgupta ◽  
Sonja Schütz ◽  
Tiffany Braley
Keyword(s):  
Multiple Sclerosis ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Central Sleep Apnea ◽  
Progressive Multiple Sclerosis ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Demyelinating Lesions ◽  
The Brain

Abstract Introduction Sleep-disordered breathing is common in persons with multiple sclerosis (PwMS), and may contribute to debilitating fatigue and other chronic MS symptoms. The majority of research to date on SDB in MS has focused on the prevalence and consequences of obstructive sleep apnea; however, PwMS may also be at increased risk for central sleep apnea (CSA), and the utility of methods to assess CSA in PwMS warrant further exploration. We present a patient with secondary progressive multiple sclerosis who was found to have severe central sleep apnea on WatchPAT testing. Report of case(s) A 61 year-old female with a past medical history of secondary progressive multiple sclerosis presented with complaints of fragmented sleep. MRI of the brain, cervical spine, and thoracic spine showed numerous demyelinating lesions in the brain, brainstem, cervical, and thoracic spinal cord. Upon presentation, the patient noted snoring, witnessed apneas, and daytime sleepiness. WatchPAT demonstrated severe sleep apnea, with a pAHI of 63.3, and a minimum oxygen saturation of 90%. The majority of the scored events were non-obstructive in nature (73.1% of all scored events), and occurred intermittently in a periodic fashion. Conclusion The differential diagnosis of fatigue in PwMS should include sleep-disordered breathing, including both obstructive and central forms of sleep apnea. Demyelinating lesions in the brainstem (which may contribute to impairment of motor and sensory networks that control airway patency and respiratory drive), and progressive forms of MS, have been linked to both OSA and CSA. The present data illustrate this relationship in a person with progressive MS, and offer support for the WatchPAT as a cost-effective means to evaluate for both OSA and CSA in PwMS, while reducing patient burden. PwMS may be at increased risk for CSA. Careful clinical consideration should be given to ordering appropriate sleep testing to differentiate central from obstructive sleep apnea in PwMS, particularly for patients with demyelinating lesions in the brainstem. Support (if any) 1. Braley TJ, Segal BM, Chervin RD. Obstructive sleep apnea and fatigue in patients with multiple sclerosis. J Clin Sleep Med. 2014 Feb 15;10(2):155–62. doi: 10.5664/jcsm.3442. PMID: 24532998; PMCID: PMC3899317.

scholarly journals Increased Risk of Parkinsonʼs Disease in Patients With Obstructive Sleep Apnea

Medicine ◽  
2016 ◽  
Vol 95 (2) ◽  
pp. e2293 ◽  
Author(s):  
Nai-Cheng Yeh ◽  
Kai-Jen Tien ◽  
Chun-Ming Yang ◽  
Jhi-Joung Wang ◽  
Shih-Feng Weng
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Obstructive Sleep ◽  
Increased Risk
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