Original ArticleSnoring men with daytime sleepiness drive more than others: A population-based study
Introduction
Motor vehicle accidents are a leading cause of death and severe injuries worldwide. Many accidents, especially single-vehicle accidents, are associated with sleepiness and falling asleep while driving [1], [2]. Obstructive sleep apnea is a prevalent disorder related to age, obesity and male gender. Snoring and excessive daytime sleepiness are the most common symptoms of sleep apnea. The treatment of obstructive sleep apnea using continuous positive airway pressure reduces daytime sleepiness, improves driving performance and reduces the risk of motor vehicle accidents [3], [4], [5], [6].
It is against the law in many countries, including Sweden, to drive when experiencing daytime sleepiness and snoring or obstructive sleep apnea, unless treated successfully [7]. Both obstructive sleep apnea and snoring have been recognized as strong risk factors for traffic accidents. Case-control studies report that subjects with obstructive sleep apnea run a 3- to 10-fold higher risk of traffic accidents [8], [9], [10]. Moreover, snoring men without sleep apnea run a more than 3-fold higher risk of traffic accidents, which is of the same magnitude as men with sleep apnea [11]. A recent study from Argentina also reports similar results among snoring truck drivers [12].
No previous study was found that systematically explored the driving distance among subjects with daytime sleepiness, snoring or sleep apnea, despite the fact that these subjects are recognized risks in traffic. We aimed to investigate whether subjects with daytime sleepiness who snore or report witnessed sleep apneas drive more than others.
Section snippets
Methods
Questions on sleep-disordered breathing were included in the northern Sweden component of the WHO “Multinational monitoring of trends and determinants in cardiovascular disease” (MONICA) study in 1999 and 2004 [13]. Participants were randomly selected from the population register in the two northernmost counties of Sweden and stratified for age into 10-year groups, between 25 and 79 years of age. A total of 10756 men and women were invited to participate, 8256 in 1999 and 2500 in 2004. The
Results
Of 10756 subjects, 7905 (3858 men and 4047 women) (73%) answered the questionnaires and attended visits for physical examinations. The number of missing answers in the questionnaires was low. The characteristics of the study population and the number of subjects with missing data are presented in Table 1. Men snored habitually more frequently than women (25.8% vs. 14.1%, respectively, p < 0.001), they reported witnessed sleep apneas more frequently (21.0% vs. 6.2%, respectively, p < 0.001) and
Discussion
In this population-based sample, we observed that men reporting excessive daytime sleepiness and habitual snoring or witnessed sleep apnea drove significantly more than other men, independent of age, obesity, smoking and physical activity. Men accounted for 74% of the total driving distance. Of men, 5.7% reported excessive daytime sleepiness and habitual snoring or witnessed apnea, and they drove 7.1% of the total distance driven by men. These are new findings and deserve attention, as subjects
Acknowledgements
This work was supported by grants from the Swedish Road Administration Skyltfonden, the Swedish Heart–Lung Foundation, the Swedish Research Council, the King Gustaf V 80th Anniversary and the King Gustaf V and Queen Victoria Foundations and the Västerbotten and Norrbotten County Councils.
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2016, Sleep MedicineCitation Excerpt :Although strongly associated with OSA, habitual snoring and daytime sleepiness are far more prevalent than OSA, and the underlying mechanisms behind them need further explanation [1]. Epidemiological studies have shown that males more commonly report snoring while daytime sleepiness is more common among females [1,3]. This may indicate different underlying mechanisms behind these two outcomes; however, there is a lack of thorough investigations in the existing literature.
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