Published ahead of print on May 11, 2006, doi:10.1164/rccm.200408-1146OC
American Journal of Respiratory and Critical Care Medicine Vol 174. pp. 446-454, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200408-1146OC
Impaired Performance in Commercial Drivers
Role of Sleep Apnea and Short Sleep Duration
Allan I. Pack,
Greg Maislin,
Bethany Staley,
Frances M. Pack,
William C. Rogers*,
Charles F. P. George and
David F. Dinges
Center for Sleep and Respiratory Neurobiology; Division of Sleep Medicine; Division of Pulmonary Allergy and Critical Care, Department of Medicine; Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Federal Aviation Administration, Washington, DC; and London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Correspondence and requests for reprints should be addressed to Allan I. Pack, M.B., Ch.B., Ph.D., 125 South 31st Street, Suite 2100, Philadelphia, PA 19104-3403. E-mail: pack{at}mail.med.upenn.edu
Sleepiness plays an important role in major crashes of commercial vehicles. Because determinants are likely to include inadequate sleep and sleep apnea, we evaluated the role of short sleep durations over 1 wk at home and sleep apnea in subjective sleepiness (Epworth Sleepiness Scale), objective sleepiness (reduced sleep latency as determined by the Multiple Sleep Latency Test), and neurobehavioral functioning (lapses in performance, tracking error in Divided Attention Driving Task) in commercial drivers. Studies were conducted in 247 of 551 drivers at higher risk for apnea and in 159 of 778 drivers at lower risk. A multivariate linear association between the sets of outcomes and risk factors was confirmed (p < 0.0001). Increases in subjective sleepiness were associated with shorter sleep durations but not with increases in severity of apnea. Increases in objective sleepiness and performance lapses, as well as poorer lane tracking, were associated with shorter sleep durations. Associations with sleep apnea severity were not as robust and not strictly monotonic. A significant linear association with sleep apnea was demonstrated only for reduced sleep latency. The effects of severe apnea (apnea–hypopnea index, at least 30 episodes/h), which occurred in 4.7%, and of sleep duration less than 5 h/night, which occurred in 13.5%, were similar in terms of their impact on objective sleepiness. Thus, addressing impairment in commercial drivers requires addressing both insufficient sleep and sleep apnea, the former being more common.
Key Words: commercial drivers • excessive sleepiness • obesity • obstructive sleep apnea • sleep duration
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