help button home button
AJRCCM
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Published ahead of print on May 13, 2004, doi:10.1164/rccm.200307-968OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 371-376

A more recent version of this article appeared on August 15, 2004
This Article
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
200307-968OCv1
170/4/371    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gurubhagavatula, I.
Right arrow Articles by Pack, A. I
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gurubhagavatula, I.
Right arrow Articles by Pack, A. I

Submitted on July 20, 2003
Accepted on May 10, 2004

Occupational Screening for Obstructive Sleep Apnea in Commercial Drivers

Indira Gurubhagavatula1*, Greg Maislin2, Jonathan E Nkwuo2, and Allan I Pack2

1 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Pulmonary and Critical Care and Sleep Section, Philadelphia VA Medical Center, Philadelphia, PA, USA, 2 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania Medical Center, Philadelphia, PA, USA

* To whom correspondence should be addressed. E-mail: gurubhag{at}mail.med.upenn.edu.

Excluding the presence of obstructive sleep apnea in commercial drivers is valuable, as the syndrome may increase their risk of sleepiness-related accidents. Using polysomnography as the criterion standard, we prospectively compared accuracies of five strategies in excluding the presence of severe sleep apnea and secondarily, any sleep apnea among 406 commercial drivers. These were: 1) symptoms, 2) body mass index 3) symptoms plus body mass index, 4) a two-stage approach with symptoms plus body mass index in everyone, followed by oximetry in a subset, and 5) oximetry in all. For excluding severe apnea, the two-stage strategy was highly successful, with 91% sensitivity and specificity, and a negative likelihood ratio of 0.10. This strategy was comparable in accuracy to oximetry, which had a negative likelihood ratio of 0.12, and was 88% sensitive and 95% specific. If we avoided oximetry altogether, then symptoms together with body mass index were 81% sensitive and 73% specific, with a negative likelihood ratio of 0.26. On the other hand, excluding any apnea could not be done with reasonable accuracy unless oximetry was used. We conclude that two-stage screening is likely to be a viable means of excluding severe sleep apnea among commercial drivers.
Key words: polysomnography, nocturnal pulse oximetry, questionnaire




This article has been cited by other articles:


Home page
 Exp PhysiolHome page
J. Aittokallio, O. Polo, J. Hiissa, A. Virkki, J. Toikka, O. Raitakari, T. Saaresranta, and T. Aittokallio
Overnight variability in transcutaneous carbon dioxide predicts vascular impairment in women
Exp Physiol, July 1, 2008; 93(7): 880 - 891.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
J. Stradling
Driving and obstructive sleep apnoea
Thorax, June 1, 2008; 63(6): 481 - 483.
[Full Text] [PDF]

Home page
 ERRHome page
B. Buyse and the participants of working group 2
Treatment effects of sleep apnoea: where are we now?
Eur. Respir. Rev., December 1, 2007; 16(106): 146 - 168.
[Abstract] [Full Text] [PDF]

Home page
 ERRHome page
J. Krieger
Sleep apnoea and driving: how can this be dealt with?
Eur. Respir. Rev., December 1, 2007; 16(106): 189 - 195.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. I. Pack, G. Maislin, B. Staley, F. M. Pack, W. C. Rogers, C. F. P. George, and D. F. Dinges
Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep Duration
Am. J. Respir. Crit. Care Med., August 15, 2006; 174(4): 446 - 454.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
S. Ferreira, J. Winck, P. Bettencourt, and F. Rocha-Goncalves
Heart failure and sleep apnoea: To sleep perchance to dream
Eur J Heart Fail, May 1, 2006; 8(3): 227 - 236.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
A. I. Pack
Advances in Sleep-disordered Breathing
Am. J. Respir. Crit. Care Med., January 1, 2006; 173(1): 7 - 15.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
T. D. Bradley, Y. E. Miller, F. J. Martinez, D. C. Angus, W. MacNee, and E. Abraham
Interstitial Lung Disease, Lung Cancer, Lung Transplantation, Pulmonary Vascular Disorders, and Sleep-disordered Breathing in AJRCCM in 2004
Am. J. Respir. Crit. Care Med., April 1, 2005; 171(7): 675 - 685.
[Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
C. F. P. George
Sleepiness, Sleep Apnea, and Driving: Still Miles To Go Before We Safely Sleep
Am. J. Respir. Crit. Care Med., November 1, 2004; 170(9): 927 - 928.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH
Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2004 American Thoracic Society