Sleep Apnea Treatment

Apnea and Accident Rate

Sleep breathing disorders are common entities and therefore a constant source of health problems and economic impacts. The impact on the health and quality of life of patients is compounded by problems based on poor quality of sleep that arise many situations of road accidents, work accidents and domestic mishaps. Most of these disorders enrole drowsiness in its description with clinical levels disabling for driving. Traffic accidents are a major problem for the social and economic consequences that entails human suffering and economic losses. Official figures are categorical. The latest report on global road safety situation published by the WHO, confirms the priority of traffic accidents as a public health problem, mentioning the diseases, mortality, health costs and socioeconomic impacts, that are involved. 1.2 million people die every year on the roads worldwide and between 20 and 50 million suffer nonfatal injuries. In all countries the pandemic death rate, that is represented by traffic accidents is increasing. According to WHO dates, road traffic accidents represent the fourth leading cause of death worldwide, and the first in men between 15 and 24. For every fatality, there are 7 major and 15 minor injuries.
To human life loss must be added the exorbitant economic costs that these situations generate regarding to hospitalization, rehabilitation, health, personal expenses, inability to work, compensation and costs of vehicle repair and road network. In the European Union, the costs caused by traffic accidents shuffled figures ranging between 180 303 and 240 404 000 euros, a figure equivalent to 2% of EU GDP. In Spain, this figure rises to 14,000 million euros, according to figures according to official ciphers of 2005. According to other information gathered by experts, each accident costs 400 euros to each Spanish, representing 42 million euros a day. Calculating the high prevalence of sleep apnea and the high percentage of accidents caused by this disease, a large part of the economic costs shall be directly related to this. The economic burden caused by untreated sleep apnea is measurable in billions of euros a year. Investment in diagnosis and treatment would save the economic costs and human lives.

Sleepiness is comparable to the consumption of alcohol, drugs and speeding in his disastrous invasion of driving. The lack of concentration and driver distraction is the second leading cause of the claims and the vast majority of cases are associated with insufficient rest. The statistics, although the oscillation in the range, show that the risk of an accident in traffic for drivers with a shortage of sleep is between 7 and 13 times greater than the normal. Driving under the influence of sleepiness in Spain each year causes an estimate of 40,000 traffic accidents according to dates collected in studies of SEPAR. The survey shows that 35% of drivers, who travel on our roads affirm driving under the influence of sleepiness. It is estimated that between 30 and 25% of traffic accidents in whom human factors are involved, drivers have fallen asleep at the wheel, a fact supported by the expert examinations, which in many cases demonstrate the absence of maneuvers avoidance.

Insomnia and sleep apnea sleep disorders are more prevalent in society and both entities enrolled excessive sleepiness in daytime symptom picture. Restless sleep resulting in sleepiness and fatigue, are mortal allies for drivers, who are dangerously involved in up to 40% of traffic accidents that occur in our country. Of all sleep disorders, sleep apnea is the most deadly and dangerous behind the wheel for a good reason. Patients who believe they have slept well, are not aware that their rest was interrupted by successive episodes of breathing pauses and arousals that contribute to a bad sleep time. These individuals report excessive daytime sleepiness and fatigue, unjustified after a night of sleep that they perceive as normal. Patients with apnea, the vast majority undiagnosed, rise with the feeling of having slept peacefully. However, symptoms of fatigue and persistent fatigue (as if they had not slept) cause real confusion in those, who can not find justifications for this state of constant drowsiness. The daytime symptoms are accompanied by a procession of dire consequences caused by lack of sleep, which due to neuropsychological dysfunction, poor work performance, decreased psychomotor ability, memory impairment, and even depression. This “non- awareness” of the disease is an aggravating factor in the case of apnea regarding to other sleep disorders. For insomniacs or narcolépsicos the debt of hours of sleep and rest and their sleep-related problems are awared. These patients affront the predisposition for drowsiness to safeguard them in the development of daytime, professional, labor and personal activity. They are may be more cautious, aware and act accordingly. A person with severe insomnia can quantify the extent of the symptoms and will think before getting behind the wheel or practicing risky professional activities after a sleepless night. If the diagnosis is narcolepsy, it is improbable to obtain the drivers license and such a person would be discarded to perform dangerous jobs or have positions of responsibility, which would involve to endanger themselves or others. By contrast, subjects with undiagnosed apnea, that are almost 90%, are unaware of not having slept, and the constant feeling of drowsiness, the wrongly blamed fatigue, tiredness or laziness enforce their vulnerability and these patients without diagnosis or treatment, tend much more to be involved in hazardous and accident scenarios of work and traffic.


Scientific studies on sleep apnea and accident rate

Studies on the association between accidents and sleep apnea go back to the 80s. Several articles began to appear marginally in journals suggesting this relationship between OSAHS and accident rate. One of the most concrete, was carried out by Findley et al. showing a high rate of accidents in a group of patients with OSAHS. After more than twenty years of research on the subject the dates show that the accident risk for apnea patients is 300% to 400% higher than for the healthy population. Although these studies already evidenced more than a decade the risk of traffic accidents in patients with OSAHS, the seriousness of the problem has not yet be taken for real. Barbé et al. in 1998, on a sample of 60 patients with OSAS and 60 healthy controled, matched for age and sex, quantified the number of motor vehicle mishaps in the last three years. Patients with OSA had more accidents than controled subjects, also increasing the likelihood that they had suffered more than an accident. They were also more sleepy, more anxious and more depressed than the controled group and had a lower level of vigilance while driving. For his part, Teran-Santos et al. selected 102 distressed drivers treated in the emergencyhospitals of Burgos and Santander. The sampling crossed controled selected with randomly selected health centers of these cities. The results were as follows: there is a strong association between sleep apnea, measured by the apnea-hypopnea index (AHI ≥ 10) and the risk of a traffic accident. This relationship was maintained after adjusting for potential confounders such as alcohol consumption, visual impairments, BMI, years of driving, age, history of accidents, and the use of medications, that can cause drowsiness and sleep schedules. In the light of these reports, OSAHS represents a major risk factor than the other classic complications involving an excess of accidents such as sight or hearing defects, rheumatic heart disease, diabetes, neurological diseases, alcoholism, the consumption of drugs or mental illness. Alcohol consumption and sleep apnea as a trigger, explain most of the accidents involving the human factor. The poor quality of sleep is the reason for the changes in behavior, irritability, cognitive impairment, decreased motor function and reduced sensory abilities and is also a direct result of a decline in perceptual abilities and reduced attention. All this comorbidity impedes activities that require full capacity of the most everyday driving. According to the DMV, up to 20% of accidents are related to drowsiness, being compared to alcohol and excessive speed as factors directly related to the accident rate on the roads.