Published ahead of print on May 11, 2006, doi:10.1164/rccm.200408-1146OC Am. J. Respir. Crit. Care Med., Volume 174, Number 4, August 2006, 446-454 A more recent version of this article appeared on August 15, 2006
Submitted on August 31, 2004 Impaired Performance in Commercial Drivers: Role of Sleep Apnea and Short Sleep DurationAllan I Pack1*,1 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA; Pulmonary Allergy and Critical Care Division, University of Pennsylvania, Philadelphia, PA, USA, 2 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA; Division of Sleep Medicine, University of Pennsylvania, Philadelphia, PA, USA, 3 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA, 4 Federal Aviation Administration, USA, 5 London Health Sciences Center, University of Western Ontario, Canada, 6 Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, PA, USA; Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA * To whom correspondence should be addressed. E-mail: pack{at}mail.med.upenn.edu.
Sleepiness plays an important role in major crashes of commercial vehicles. Since determinants are likely to include inadequate sleep and sleep apnea, we evaluated the role of short sleep durations over one week at home and sleep apnea on subjective sleepiness (Epworth Sleepiness Scale), objective sleepiness (reduced sleep latency as determined through the Multiple Sleep Latency Test), and neurobehavioral functioning (lapses in performance, tracking error in divided attention task) in commercial drivers. Studies were conducted in 247 of 551 drivers at higher risk for apnea and 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 (AHI Key words: Obstructive sleep apnea, Obesity, Sleep duration, Commercial drivers, Excessive sleepiness, Driving simulators
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30 episodes/hour), which occurred in 4.7%, and sleep duration of less than 5 hours/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.
