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Prevalence of risk factors for undiagnosed obstructive sleep apnoea is high in truck drivers on UK roadsA. J. Filtness1,2*, L.A. Reyner1, J.A. Horne11.Sleep Research Centre, Loughborough University, Leicestershire, LE11 3TU, UK2. Accident Research Centre, Injury Research Institute, Monash University, Clayton, 3800, AustraliaCorresponding author: ashleigh.filtness@monash.edu

  • Summary
  • Five risk factors of obstructive sleep apnoea are more prevalent in a UK truck driver population than the general population.
  • Day time sleepiness, snoring and witnessed apnoeas are more prevalent in a UK HGV driver population than the general population.
  • Truck drivers have heightened potential to suffer from obstructive sleep apnoea; compulsory screening should be considered.

Introduction

The consequences for potential damage if a truck driver falls asleep while driving is greater than for a car driver because of the vast difference in mass of the vehicle.

Obstructive sleep apnoea (OSA) is a sleep disorder where the sufferers airway collapses repeatedly, interrupting their sleep. These repeated awakenings often result in excessive daytime sleepiness (EDS). The NHS recognises five factors increasing the risk of OSA: Male gender, age >40y, obesity, large neck circumference and smoking.

OSA has been shown to be more prevalent in truck driver populations than in the general population (Carter et al. 2003, Canani et al. 2005). Although there is a growing international body of evidence demonstrating high prevalence of OSA in truck drivers this type of research has been lacking the UK.

Method

Participants: 148 truck drivers (mean age 47.3y, range 21-68)

Protocol: The study was conducted at a major truck stop in the UK on the M1.. Participants completed a short survey and anthropometric measurements designed to indentify prevalence of the five risk factors OSA identified by the NHS and three symptoms of OSA: EDS, snoring and witnessed apnoeas.

Measures: The survey included a demographics questions, about sleep and the Epworth sleepiness score (ESS) to measure EDS. Height, weight and neck circumference measurements were also taken.

Analysis: Results for each risk factor and symptom were compared with prevalence in the general population. Prevalence figures for the general population were obtained from various sources resulting from a review of relevant literature.

Figure 1: Comparison of HGV results and population statistics for OSA risk factors

Risk Factors

Figure 1 shows all risk factors to be more prevalent in HGV drivers than the general population.

Results

All risk factors were more prevalent in the truck driver sub population compared with the general population, see figure 1. Truck drivers were all men and 82% were aged over 40y. 24% more of the truck drivers were obese than the general population and average neck circumference was 4cm larger. Smoking was reported by 10% more truck drivers than the general population.

Symptoms were also more prevalent in truck drivers, see figure 2. Snoring was reported by 57% of HGV drivers , witnessed apnoeas by 7% and an ESS was on average 2.1 points higher than the general population.

Figure 2: Comparison of HGV and population statistics for OSA symptoms

Symptoms

Figure 2 shows all symptoms to be more prevalent in the HGV drivers than the general population.

Conclusion

Five risk factors and three key symptoms of OSA have been found in a sample of truck drivers on UK roads, to greater extent that for estimates in the general male population. The strongest indicator of undiagnosed OSA is bed partners reporting witnessed apnoeas, in the truck driver population this was reported by 7.4% suggesting a high potential for undiagnosed OSA in this population. This figure is lower than Swedish and Australian studies who used over night recording to find 17% and 15.8% respectively also in truck drivers (Carter et al. 2003, Howard et al. 2004). However, in the current study 20.3% of participants reported not having a bed partner, as such witnessed apnoeas may be under reported.

OSA sufferers are repeatedly reported to be at high risk of causing road traffic accidents. The increased chance of undiagnosed OSA coupled with the large size of trucks, leads to a potentially lethal situation. Truck drivers, especially those who are obese, ought to be a high priority population for OSA screening.

References

Canani, S., John, A., Raymundi, M., Schönwald, S. & MennaBarreto, S. 2005,"Prevalence of sleepiness in a group of Brazilian lorry drivers", Public health(London), vol. 119, no. 10, 925-929.

Carter, N., Ulfberg, J., Nyström, B. & Edling, C. 2003, "Sleep debt, sleepiness and accidents among males in the general population and male professional drivers", Accident Analysis & Prevention, vol. 35, no. 4, 613-617.

Howard, M.E., Desai, A.V., Grunstein, R.R., Hukins, C., Armstrong, J.G., Joffe, D., Swann, P., Campbell, D.A. & Pierce, R.J. 2004, "Sleepiness, sleep disordered breathing and accident risk factors in commercial vehicle drivers", American journal of respiratory and critical care medicine, 1014-1021

a. Office for National Statistics 2007, Age Structure of the UK and England and Wales

b. NHS Information Centre 2006, Statistics on Obesity, Physical Activity and Diet: England, 2006

c. Martin, S.E., Mathur, R., Marshall, I. & Douglas, N.J. 1997, "The effect of age, sex, obesity and posture on upper airway size", European Respiratory Journal, vol. 10, no. 9, pp. 2087-2090.

d. National Statistics Online 2009, “Smoking habits in Great Britain”

e. Johns, M. & Hocking, B. 1997, "Daytime sleepiness and sleep habits of Australian workers", Sleep, vol. 20, no. 10, 844-849.

f. Ohayon, M.M., Guilleminault, C., Priest, R.G. & Caulet, M. 1997, "Snoring and breathing pauses during sleep: telephone interview survey of a United Kingdom

population sample", British medical journal, vol. 314, no. 7084, 860.