Self-reported sleepiness in the context of fitness-to-drive

Adaptation and validity of the Sleep Quality Scale among Chinese drivers

Purpose

Poor sleep quality is closed related with driving accidents. However, due to the lack of a valid instrument for assessing drivers’ sleep quality, few studies have examined drivers’ sleep quality and its associations with driving behaviours and traffic accidents in China. The aim of this paper is to revise the Sleep Quality Scale (SQS) and assess its reliability and validity in Chinese drivers.

Methods

522 Chinese drivers aged from 18 to 56 years old agreed to complete the SQS, Daytime Sleepiness Perception Scale version 4 (DSPS-4), Self-report of Risky Driving Behavior (RD-SR) and Self-assessment of the Likelihood of Being Involved in a Risky Driving Situation (RD-SA).

Results

The final Chinese version of the SQS contained 23 items across four factors: difficulty in getting up, difficulty in falling asleep, sleep recovery and daytime dysfunction. Second, man scored lower on the difficulty in falling asleep factor but higher on the sleep recovery factor than women. Third, low to moderate correlations were found between the SQS factors and the DSPS-4, RD-SA and RD-SR, indicating that the validity of the revised scale was satisfactory. More importantly, daytime dysfunction factor is an effective predictor of violation involvement and accident involvement.

Conclusion

The revised SQS has acceptable reliability and validity and can be used as a tool to measure the sleep quality of Chinese drivers.

Residual excessive daytime sleepiness in patients treated for obstructive sleep apnea: guidance for assessment, diagnosis, and management

Excessive daytime sleepiness (EDS) affects approximately half of patients with obstructive sleep apnea (OSA) and can persist in some despite normalization of breathing, oxygenation, and sleep quality with primary OSA therapy, such as continuous positive airway pressure (CPAP). EDS is often overlooked and under discussed in the primary care setting and in the follow-up of CPAP-treated patients due to difficult assessment of such a multi-dimensional symptom. This review aims to provide suggestions for procedures that can be implemented into routine clinical practice to identify, evaluate, and manage EDS in patients treated for OSA, including how to appropriately use various self-report and objective assessments along the clinical pathway and options for pharmacotherapy. In addition, examples of when it is appropriate to refer a patient to a sleep specialist for evaluation are discussed.

Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses

PURPOSE

Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs). Obstructive sleep apnea (OSA) is the most frequent medical cause of EDS. Therefore, the European Union Directive 2014/85/EU determined that "untreated moderate to severe OSA coincident with EDS constitutes a medical disorder leading to unfitness to drive." The paper aims are to provide a brief review of sleepiness and its implications for driving safety, as well as to describe the subjective and objective methods to accurately evaluate EDS in order to assess fitness to drive in patients with OSA.

METHODS

We examined databases including PubMed, Medline, and EMBASE using the search terms "sleepiness at the wheel, excessive daytime sleepiness, sleepiness measure, sleep-wake cycle, obstructive sleep apnea, driving license, fitness to drive."

RESULTS

Significant interindividual variability in EDS exists in patients with comparable severity of OSA. Objective methods of measuring EDS are too expensive and time consuming to be suitable for the certification of driving licenses. The reliability of subjective methods depends upon the clinical setting and subjective tools assess only limited aspects of EDS. Objective measures, such as biochemical biomarkers, must, therefore, support subjective methods.

CONCLUSIONS

Extensive data have supported different subjective and objective methods for the appraisal of EDS in patients with OSA depending upon the clinical and experimental setting. Challenges remain to determine an appropriate tool for the evaluation of fitness to drive.