Severity of OSA and risk of accident
Most studies use the Apnea-Hypopnea Index (AHI) to measure the severity level of OSA. Seven of the 18 studies that have documented this relationship have shown a clear statistical link between the severity of sleep apnea and the risk of having an accident.8
Apnea-hypopnea index9
Mild OSA is characterized by five or more apneic episodes per hour and a 42% higher risk of high blood pressure.
Moderate OSA is characterized by fifteen or more apneic episodes per hour and doubles the risk of hypertension.
Severe OSA is characterized by thirty or more apneic episodes per hour and triples the risk of hypertension.
Predisposing Factor Screening Questionnaire10
Do you use or are you expected to use breathing assistance (positive pressure spontaneous ventilation or biphasic positive pressure ventilation) while you sleep? Yes No
In the past five years, has the person sharing your bed told you that you snore? Yes No
Does anyone in your biological family (and NOT someone married to someone in your family) suffer from OSA or use breathing assistance while sleeping? Yes No
Do you find that you are more drowsy during the day than other vehicle operators you know? Yes No
The Epworth Sleepiness Scale
Situation / Risk of drowsiness
TV viewing
Time spent in a seated position in a public place (e.g., movie theater, meeting room, etc.)
One-hour car journey without interruption as a passenger
Reclining rest position in the afternoon when circumstances permit
Rest period in a sitting position after a dinner in which you have not consumed alcohol
By car, during a stop of several minutes due to traffic jam
Risk of drowsiness: 0 = no risk, 1 = low risk, 2 = moderate risk, 3 = high risk
Rating: From 0 to 9 = normal, From 10 to 12 = critical threshold, From 13 to 24 = abnormal
Numerous studies using the ESS scale have demonstrated its validity and reliability.11 It is a subjective measure of sleepiness where a 10 (or more) is a propensity to sleepiness. A high SSE score also indicates a high likelihood of OSA.
It is important to note that although the ESS scale has the advantage of being easy and quick to use, it is limited by the subjectivity of the patient who may be over-marked or graded down.
1 “Obesity Linked To Dangerous Sleep Apnea in Truck Drivers,” Science Daily, www.sciencedaily.com (March 12, 2009).
2 Ellen, R. et al., “Systematic Review of Motor Vehicle Crash Risk in Persons with Sleep Apnea”, Journal of Clinical Sleep Medicine (volume 2, number 2, 2006).
3 Hartenbaum, Natalie et al., “Sleep Apnea and Commercial Vehicle Operators,” Statement by the Working Group of Members of the American College of Chest Physicians, American College of Occupational and Environmental Medicine and the National Sleep Foundation (Chest 2006; 130: 902-905).
4 Levy, S., “Obstructive Sleep Apnea and the Commercial Driver: Understanding the Controversy and Applying Screening Criteria” Western Occupational and Environmental Medical Association, Continuing Medical Education Webinars (June 16, 2011).
5 Ibid., Levy (2011).
6 Alvarez, Albert, “Tech Brief: Sleep Apnea Crash Risk Study” FMCSA, US Department of Transportation (September 2004).
7 "Sleep Apnea, Risk Factors" Mayo Clinic, www.mayoclinic.com (accessed August 9, 2011).
8 Op. Cit., Ellen.
9 Op. Cit., Levy.
10 Op. Cit., Talmage.
11 Smythe, Carole, “The Epworth Sleepiness Scale (ESS)”, The Hartford Institute for Geriatric Nursing (New York University, College of Nursing, Issue 6.2, 2007).
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