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Truckers Drive Their Own Assessment for Obstructive Sleep Apnea: A Collaborative Approach to Online Self-Assessment for Obstructive Sleep Apnea: Difference between revisions

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== 4. Results ==
== 4. Results ==
{| class="wikitable" style="text-align: left; width: 100%;"
|+ Table 1. Descriptive statistics and variable types
! Question or Variables
! Scale Type
! Mean, Median, or Mode°
|-
| ''Height''
| Continuous
| 70.29 in.
|-
| ''Weight''
| Continuous
| 240.1 lbs.
|-
| ''BMI''
| Continuous
| 33.94 kg/m<sup>2</sup>
|-
| ''Gender''
| Binary
| 91.8% Male
|-
| ''Overall Berlin Score''
| Binary
| 55.9% Positive
|-
| Have you ever nodded off or fallen asleep while driving a vehicle?
| Binary
| 20.5% Yes
|-
| Do you have high blood pressure?
| Binary
| 39.5% Yes
|-
| Do you snore?
| Categorical
| 66.2% Yes
|-
| Does your snoring bother other people?
| Categorical
| 43.4% Yes
|-
| How often do you snore?
| Ordinal&dagger;
| Median: 1-2 times a week
|-
| How often has someone noticed that you quit breathing during your sleep?
| Ordinal
| Median: Never or nearly never
|-
| How often do you feel tired or fatigued after your sleep?
| Ordinal
| Median: 1-2 times a month
|-
| During your waking time, how often do you feel fatigued, or not up to par?
| Ordinal
| Median: 1-2 times a month
|-
| How loud is your snoring?
| Ordinal
| Median: Slightly louder than breathing
|-
| colspan=3 style="font-size: 8pt" | &dagger;In our logistic regression analyses, ordinal variables were treated as univariate continuous variables ranging from 0-4 where 0 was the lowest response and 4 was the highest response.
&deg; The descriptive statistic was chosen based on the scale type of the variable in question. Continuous data, such as GPA or weight, is best described by its mean. Ordinal data, such as great, good, or bad, is best described by its median. Categorical data, such as gender or race, is best described by the mode<sup>[19]</sup>.
|}


Over the nine months of data collection, a total 595 individuals took the survey. Of these, 55.9% scored positive on the overall Berlin survey, and 78.3% were positive on objective (BMI, hypertension) section. We have no way to determine the non-completion rate of the study. We did not collect data on participants' age. The type and treatment of variable in our data set as well as descriptive statistics can be found in Table 1.  
Over the nine months of data collection, a total 595 individuals took the survey. Of these, 55.9% scored positive on the overall Berlin survey, and 78.3% were positive on objective (BMI, hypertension) section. We have no way to determine the non-completion rate of the study. We did not collect data on participants' age. The type and treatment of variable in our data set as well as descriptive statistics can be found in Table 1.  


=== 4.1. Obesity and Hypertension ===
=== 4.1. Obesity and Hypertension ===
<center>[[File:JSCM-Figure1.png]]<br />
'''Figure 1. Histogram of Body Mass Indices of 595 Self-Selected Commercial Drivers'''</center>


More than two-thirds of the respondents were obese; 69.6% had a BMI > 30 kg/m<sup>2</sup>, and 47.6% had a BMI > 33 kg/m<sup>2</sup>. 35.6% of CMVDs surveyed had a BMI > 35 kg/m<sup>2</sup>. Figure 1 presents a frequency histogram of BMIs of the respondents. Obesity correlated with snoring loudness (the louder the snoring, the greater likelihood of obesity) (p<0.05) and with hypertension (p<0.05). More than a third (39.5%) of participants reported hypertension, which correlated with feeling tired/fatigued after sleep (p<0.05)
More than two-thirds of the respondents were obese; 69.6% had a BMI > 30 kg/m<sup>2</sup>, and 47.6% had a BMI > 33 kg/m<sup>2</sup>. 35.6% of CMVDs surveyed had a BMI > 35 kg/m<sup>2</sup>. Figure 1 presents a frequency histogram of BMIs of the respondents. Obesity correlated with snoring loudness (the louder the snoring, the greater likelihood of obesity) (p<0.05) and with hypertension (p<0.05). More than a third (39.5%) of participants reported hypertension, which correlated with feeling tired/fatigued after sleep (p<0.05)


=== 4.2. Sleepy Driving ===
=== 4.2. Sleepy Driving ===
With regard to drowsy driving, 20.5% answered positively to the Berlin Questionnaire query about falling asleep while driving. Correlates of sleepy driving are reported in Table 2. Sleepy driving was not associated with BMI, hypertension (p=0.07) or gender, but strongly correlated with severity and frequency of snoring and with witnessed apneas.  
{| class="wikitable" style="text-align: left; width: 100%;"
|+ Table 2. Correlates of drowsy driving and witnessed apnea
! Question
! colspan=2 | Significance (i.e. p-value)&#42;
|-
| &nbsp;
| '''Drowsy Driving'''
| '''Witnessed Apneas&ordf;'''
|-
| ''Overall Berin Score''
| < 0.0001
| < 0.0001
|-
| Do you snore?
| < 0.01
| < 0.001&deg;
|-
| How loud is your snoring?
| < 0.0001
| < 0.0001
|-
| Does your snoring bother other people?
| < 0.01
| < 0.01
|-
| How often do you snore?
| < 0.0001
| < 0.0001
|-
| How often has someone noticed that you quit breathing during your sleep?
| < 0.0001
| n/a&dagger;
|-
| How often do you feel tired or fatigued after your sleep?
| < 0.0001
| < 0.0001
|-
| During your waking time, how often do you feel fatigued, or not up to par?
| < 0.0001
| < 0.0001
|-
| style="font-size: 8pt" colspan=3| &dagger;This value has been omitted since the test described here would be correlating the variable with itself.
&deg;Respondents who answered "yes" had the stated p-value, respondents who answered "I don't know" were weakly correlated with p=0.10478
 
&#42;The significance value is taken from a univariate logistic regression model with the questions as univariate independent variables and the two responses as the dependent variables.
 
&ordf;This variable was transformed such that "Nearly every day" and "3-4 times/week" were a positive response and every other
response was a negative response.
|}
 
 
With regard to drowsy driving, 20.5% answered positively to the Berlin Questionnaire query about falling asleep while driving. Correlates of sleepy driving are reported in Table 2. Sleepy driving was not associated with BMI, hypertension (p=0.07) or gender, but strongly correlated with severity and frequency of snoring and with witnessed apneas.


=== 4.3. Witnessed Apneas ===
=== 4.3. Witnessed Apneas ===
Twenty-one percent of the commercial motor vehicle drivers endorsed the symptom of witnessed apneas; correlates of this symptom are also presented in Table 2. Witnessed apneas were not correlated with BMI, gender, or hypertension, but correlated with classic OSA symptoms.
Twenty-one percent of the commercial motor vehicle drivers endorsed the symptom of witnessed apneas; correlates of this symptom are also presented in Table 2. Witnessed apneas were not correlated with BMI, gender, or hypertension, but correlated with classic OSA symptoms.


== Discussion ==
== 5. Discussion ==


The primary findings of this report are that some commercial drivers willingly assess their OSA risk anonymously online, and a majority of those who do so are obese, have positive Berlin screening questionnaires, and would be required to undergo polysomnography (PSG) if suggested guidelines become regulation. Those who reported classic OSA symptoms (snoring, sleepiness) were more likely to report drowsy driving. Contrary to our hypothesis, however, objective data (BMI, hypertension history) did not predict sleepy driving better than did subjective data (sleepiness, snoring).  
The primary findings of this report are that some commercial drivers willingly assess their OSA risk anonymously online, and a majority of those who do so are obese, have positive Berlin screening questionnaires, and would be required to undergo polysomnography (PSG) if suggested guidelines become regulation. Those who reported classic OSA symptoms (snoring, sleepiness) were more likely to report drowsy driving. Contrary to our hypothesis, however, objective data (BMI, hypertension history) did not predict sleepy driving better than did subjective data (sleepiness, snoring).  
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In an interesting study of clinicians who likely have hands-on experience with screening for OSA in commercial drivers, Durand and Kales<sup>[18]</sup> surveyed American College of Occupational and Environmental Medicine (ACOEM) members regarding recent consensus guidelines for 0 screening commercial drivers for OSA.2 Fewer than half of these clinicians used consensus guidelines or another specific protocol to screen for OSA, citing as explanations that they were unaware of guidelines (36%), that such guidelines were too complicated (12%), that it would affect client retention (10%) or cause inconvenience to drivers (10%). Thus, many commercial driver medical examiners may avoid rigorous screening for OSA because it is complicated or may adversely affect drivers or their practice. In addition, drivers themselves who are suspected of having OSA by their medical examiner and who are referred for screening frequently fail to follow-up with sleep testing or with the examiner who recommended it<sup>[14]</sup>. So, despite the fact the untreated sleep apnea increases crash risk and has a high prevalence in commercial drivers, many medical examiners are not screening for it, and drivers are denying symptoms on their certifying examinations. As noted by the FMCSA’s Medical Expert Panel, cost, complexity, and delay probably contribute an inability to diagnose and expediently treat commercial drivers. Sleep health professionals need expedient, non-punitive tools to keep commercial motor vehicle drivers healthy and driving.
In an interesting study of clinicians who likely have hands-on experience with screening for OSA in commercial drivers, Durand and Kales<sup>[18]</sup> surveyed American College of Occupational and Environmental Medicine (ACOEM) members regarding recent consensus guidelines for 0 screening commercial drivers for OSA.2 Fewer than half of these clinicians used consensus guidelines or another specific protocol to screen for OSA, citing as explanations that they were unaware of guidelines (36%), that such guidelines were too complicated (12%), that it would affect client retention (10%) or cause inconvenience to drivers (10%). Thus, many commercial driver medical examiners may avoid rigorous screening for OSA because it is complicated or may adversely affect drivers or their practice. In addition, drivers themselves who are suspected of having OSA by their medical examiner and who are referred for screening frequently fail to follow-up with sleep testing or with the examiner who recommended it<sup>[14]</sup>. So, despite the fact the untreated sleep apnea increases crash risk and has a high prevalence in commercial drivers, many medical examiners are not screening for it, and drivers are denying symptoms on their certifying examinations. As noted by the FMCSA’s Medical Expert Panel, cost, complexity, and delay probably contribute an inability to diagnose and expediently treat commercial drivers. Sleep health professionals need expedient, non-punitive tools to keep commercial motor vehicle drivers healthy and driving.


== Acknowledgements ==
== 6. Acknowledgements ==


== References ==
Both authors had full access to the data and participated in writing this report. We gratefully acknowledge the help of Robert Stanton and Gary Hull, and Truckers for a Cause Chapter of Alert Well and Keeping Energetic of the American Sleep Apnea Association (TFAC-AWAKE), who initiated this project and hosted the survey on the TFAC-AWAKE website.
 
== 7. References ==
: <sup>[1]</sup> Tregear S, PhD; James Reston J, Schoelles K, Phillips B, Obstructive Sleep Apnea and Risk of Motor Vehicle Crash: Systematic Review and Meta-analysis, JCSM 2009; 5 (15) : 573-581.  
: <sup>[1]</sup> Tregear S, PhD; James Reston J, Schoelles K, Phillips B, Obstructive Sleep Apnea and Risk of Motor Vehicle Crash: Systematic Review and Meta-analysis, JCSM 2009; 5 (15) : 573-581.  
: <sup>[2]</sup> Hartenbaum N, Collop N, Rosen IM, Phillips B, et al. Sleep apnea and commercial motor vehicle operators: Statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest. 2006;130 (3):902-5.  
: <sup>[2]</sup> Hartenbaum N, Collop N, Rosen IM, Phillips B, et al. Sleep apnea and commercial motor vehicle operators: Statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest. 2006;130 (3):902-5.  
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Med. 2009;51(10):1220-6.  
Med. 2009;51(10):1220-6.  
: <sup>[19]</sup> Stevens, S.S. On the Theory of Scales of Measurement, Science 1946;103 :677-80.
: <sup>[19]</sup> Stevens, S.S. On the Theory of Scales of Measurement, Science 1946;103 :677-80.
[[Category:Journal Papers]]
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