Drivers who use more than three strategies to stay awake while driving could be experiencing poor sleep due to obstructive sleep apnoea, according to a study published in ERJ Open Research.
People with sleep apnea may wake up several times during the night and snore loudly. This is because their breathing starts and stops during the night. About one in five people have this condition, but many are unaware they have a problem. However, sleep apnoea causes excessive sleepiness, and these patients have a higher risk of being involved in a car accident.
To understand the scale of this problem, researchers from St James’ University Hospital, Leeds, UK, asked a group of people whether they use strategies to keep awake while driving, including opening the window, drinking tea or coffee, and turning up the radio. The aim of the study was to develop a way to spot those with sleep apnea and give them medical help.
“Up to one-fifth of collisions on the road may be caused by fatigue or sleepiness. Many OSA patients drive either for personal or for professional reasons, and there is good evidence to suggest that some patients are at increased risk of collisions on the road,” said Dr Akshay Dwarakanath.
The study included 119 people with sleep apnoea who were not receiving treatment and 105 people who did not have this condition. Participants answered questions about their sleeping habits in general, their sleepiness while driving, any strategies they used to stay awake while driving, and any history of car collisions or other driving accidents.
Results showed that people with sleep apnea were more likely to use multiple ways to stay alert while driving than those without one. About a third of people with sleep apnoea frequently used more than three coping strategies. In contrast, people who didn’t have sleep apnoea never used more than three coping strategies. In addition, people with sleep apnoea who used more than three strategies reported feeling sleepier while driving and were more likely to have experienced a crash.
The methods most frequently used by drivers included opening the window, drinking tea or coffee, and turning up the volume on the radio. Some participants reported singing or talking to themselves, frequently changing positions in the seat, chewing gum or eating, stopping for a walk, fidgeting, stopping for a nap, or washing their face with cold water.
“Doctors are often asked to make recommendations about their patient’s fitness to drive. This can be challenging as it can have major implications on a patient’s livelihood, particularly if they are a professional driver. However, there is a duty of care on doctors to discourage patients from driving if are at high risk of causing a collision,” said Dr Dwarakanath. “Our research suggests that untreated sleep apnoea patients often use coping strategies that could be surrogate markers of sleepiness. Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”
“Obstructive sleep apnoea is of high public health relevance due to its high prevalence, symptoms that impair quality of life, and potential cardiovascular consequences. In addition to choking, fragmented sleep and unrefreshing sleep, possible symptoms include difficulty concentrating, tiredness and a tendency to fall asleep during the day. Fortunately, awareness of OSA has increased somewhat in recent years. Today, treatment recommendations are based on the different risk factors, symptom groups, and cardiovascular consequences of certain OSA types. Various treatment approaches geared to different types of OSA can be offered to successfully treat the symptoms, including daytime sleepiness,” added Dr. Esther Schwarz, a member of the European Respiratory Society’s group on sleep-disordered breathing based at the University Hospital Zurich in Switzerland.
Dwarakanath A, Palissery V, Ghosh D, Jamson S, Elliott M. An exploratory study evaluating the use of coping strategies while driving in obstructive sleep apnoea syndrome patients and controls. ERJ Open Res. 2024 Jan 22;10(1):00638-2023. doi: 10.1183/23120541.00638-2023.