Obstructive sleep apnoea syndrome as a cause of road traffic accidents
Síndroma de apneia obstrutiva do sono como causa de acidentes de viação
M. Aguiar1,
, J. Valença1, M. Felizardo1, F. Caeiro1, S. Moreira1, R. Staats1, A.A. Bugalho de Almeida1
Corresponding author
m_aguiar@netcabo.pt
Correspondence to/Correspondência: Hospital de Santa Maria, Av. Egas Moniz, 1500 Lisboa.
Correspondence to/Correspondência: Hospital de Santa Maria, Av. Egas Moniz, 1500 Lisboa.
1 Serviço de Pneumologia I, Hospital de Santa Maria, CHLN, EPE, Lisboa / Pulmonology Unit I, Hospital de Santa Maria, CHLN, EPE, Lisboa
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Aguiar, J. Valença, M. Felizardo, F. Caeiro, S. Moreira, R. Staats, A.A. Bugalho de Almeida" "autores" => array:7 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Aguiar" "email" => array:1 [ 0 => "m_aguiar@netcabo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Valença" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Felizardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "F." "apellidos" => "Caeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Moreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Staats" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "A.A." "apellidos" => "Bugalho de Almeida" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Serviço de Pneumologia I, Hospital de Santa Maria, CHLN, EPE, Lisboa / <span class="elsevierStyleItalic">Pulmonology Unit I, Hospital de Santa Maria, CHLN, EPE, Lisboa</span>" "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondence to/Correspondência: Hospital de Santa Maria, Av. Egas Moniz, 1500 Lisboa." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Síndroma de apneia obstrutiva do sono como causa de acidentes de viação" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2008-11-12" "fechaAceptado" => "2008-12-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key-words" "identificador" => "xpalclavsec160083" "palabras" => array:3 [ 0 => "OSAS" 1 => "road traffic accidents" 2 => "FOSQ test" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec160082" "palabras" => array:3 [ 0 => "SAOS" 1 => "acidentes" 2 => "FOSQ test" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Several studies have demonstrated that obstructive sleep apnoea syndrome (OSAS) patients have a higher rate of road traffic accidents. Our study aimed to analyse any differences in OSAS patients between those who reported having had road traffic accidents and/or near misses and those who did not.</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We studied 163 patients with OSAS (apnoea- hypopnoea index (AHI)<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10/h) diagnosed using nocturnal polysomnography (NPSG), all drivers, 18.4% of whom drove for a living. Patients were asked at their first clinical interview to self-report road traffic accidents and/or near misses over the past 3 years which had been caused by abnormal daytime drowsiness. This allowed patients to be divided into two groups, those who had had road traffic accidents and/or near misses and those who had not. Both were compared as to age, body mass index (BMI), Epworth Sleepiness Scale (ESS), daytime PaO<span class="elsevierStyleInf">2</span> and PaCO<span class="elsevierStyleInf">2</span>, Functional Outcomes of Sleep Questionnaire (FOSQ) test and NPSG data. This latter was total sleep time (TTS), sleep efficiency, sleep stages, arousal index (ARI), AHI, minimal and average SaO<span class="elsevierStyleInf">2</span>, % of time with SaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90% (T90), desaturation index (ODI), total duration of apnoea-hypopnoea (TDAH) (T test).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Group I (no road traffic accidents) No<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>89 patients; group II (road traffic accidents) No<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>74 patients. Age (years) was 57.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.8 vs. 54.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.9 (ns); male gender, 75% vs. 78.4%; ESS, 12.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.4 vs. 17.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.3 (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001); BMI, (Kg/m<span class="elsevierStyleSup">2</span>) 36.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.1 vs. 35.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.3 (ns); PaO<span class="elsevierStyleInf">2</span> (mmHg), 76.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.4 vs. 78.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.6 (ns); PaCO<span class="elsevierStyleInf">2</span> (mmHg), 42.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.1 vs. 42.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.7 (ns); FOSQ, 15.1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1 vs. 12.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.4 (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). NPSG data revealed differences only in AHI: 45.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21.6 vs. 56.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.7 (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and in TDAH (minutes), 98.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>63.7 <span class="elsevierStyleItalic">vs</span>. 133.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>83.2 (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In our experience patients who had road traffic accidents and/or near misses had a more severe OSAS, with higher AHI, excessive daytime sleepiness and lower quality of life.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vários estudos demonstram que os doentes com síndroma de apneia obstrutiva do sono (SAOS) têm um risco aumentado de acidentes de viação. O objectivo do presente trabalho consistiu em analisar, nestes doentes, se há diferenças nos que referem acidentes e//ou quase acidentes e aqueles que o não fazem.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Material e métodos: Estudaram-se prospectivamente 163 doentes com SAOS (índice apneia/hipopneia (IAH)<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10/h) diagnosticados por polissonografia nocturna (PSG), todos condutores de veículos, 18,4% do quais profissionais. Na altura da entrevista clínica foi inquirido se tinham tido, nos três anos antes acidentes e/ou quase acidentes devido a hipersonia diurna (Grupo II<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>74) ou não (Grupo I<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>89).</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Estes dois grupos foram comparados quanto a: idade, índice de massa corporal (IMC), escala de sonolência de Epworth (ESE), PaO<span class="elsevierStyleInf">2</span> e PaCO2 diurnas, avaliação da qualidade de vida pelo inquérito <span class="elsevierStyleItalic">Functional Outcomes of Sleep Questionnaire</span> (FOSQ teste) e dados da polissonografia – tempo total de sono (TTS), eficiência do sono, estádios do sono, índice de microdespertares (IMD), índice de apneia/hipopneia (IAH), SaO<span class="elsevierStyleInf">2</span> mínima e média, % tempo SaO<span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>90% (T90), índice de dessaturação (IDS), tempo total em apneia/hipopneia (TTOT) (teste <span class="elsevierStyleItalic">t</span> de <span class="elsevierStyleItalic">Student</span>).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Resultados: (Grupo I / Grupo II) idade (anos) – 57,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11,8 / 54,7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10,9 (ns); sexo masculino – 75%/78,4%; ESE – 12,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5,4 / 17,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,3 (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001); IMC (kg/m<span class="elsevierStyleSup">2</span>) – 36,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8,1 / 35,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6,3 (ns); PaO<span class="elsevierStyleInf">2</span> (mmHg) – 76,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11,4 / 78,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12,6 (ns); PaCO<span class="elsevierStyleInf">2</span> (mmHg) – 42,6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5,1 / 42,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,7 (ns); <span class="elsevierStyleItalic">FOSQ test</span> – 15,1<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3,1/12,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3,4 (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001).</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Dos dados da PSG só se encontraram diferenças no IAH – 45,0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>21,6 / 56,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29.7 (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,01) e no TTOT (minutos) – 98,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>63,7 / 133,3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>83,2 (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Conclusões: Nesta experiência, os doentes com acidentes e/ou quase acidentes tinham uma SAOS mais grave, nomeadamente com maiores IAH e hipersonia diurna, e menor qualidade de vida.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography/Bibliografia" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
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