Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes
Nonadherence with Employer-Mandated Sleep Apnea Treatment and Increased Risk of Serious Truck Crashes
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DOI：
10.5665/sleep.5734
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发表时间：
2016-05-01
期刊：
影响因子：
5.6
通讯作者：
Kales, Stefanos N.
中科院分区：
文献类型：
--
作者：
Burks, Stephen V.;Anderson, Jon E.;Kales, Stefanos N.
研究目的：为了评估雇主授权的阻塞性睡眠呼吸暂停（OSA）程序的严重可预防的truck crashes.Methods的风险的影响：数据是从第一个大规模的，雇主授权的程序来筛选，诊断和监测OSA治疗依从性在美国卡车运输业。队列的回顾性分析：多导睡眠图诊断的司机（OSA阳性n = 1，613，OSA阴性n = 403）匹配控制司机不太可能有OSA（n = 2，016）的两个因素影响碰撞风险，经验在雇用和工作任期的长度;任期匹配的日期，每个诊断司机的多导睡眠图。对所有病例（即OSA阳性驱动者）提供自动调节气道正压通气（APAP）治疗;客观监测治疗依从性。病例按治疗依从性分组：“完全依从”（n = 682）、“部分依从”（n = 571）或“无依从”（n = 360）。在研究亚组之间比较了交通部可报告的撞车事故/10万英里。对稳健性进行了评估。在匹配日期之后，“无依从性”病例的可预防交通部可报告事故率是匹配对照组的5倍（发生率比= 4.97，95%置信区间：2.09，10.63）（每10万英里0.070对0.014）。“完全依从”病例的撞车率在统计学上与对照组相似（发病率比= 1.02，95%置信区间：0.48，2.04; 0.014/100，000英里）。未坚持治疗的OSA阳性司机发生严重可预防车祸的风险增加了5倍，但很快就出院或戒烟，保留时间仅为其他科目的三分之一。因此，强制性计划删除了风险非治疗依从性驱动程序，并保留了研究公司的依从性驱动程序。目前的规定允许非遵守OSA病例驾驶在另一家公司保持他们的诊断私人。评论：关于这篇文章的评论见本期第961页。
Study Objectives: To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) program on the risk of serious preventable truck crashes.Methods: Data are from the first large-scale, employer-mandated program to screen, diagnose, and monitor OSA treatment adherence in the US trucking industry. A retrospective analysis of cohorts was constructed: polysomnogram-diagnosed drivers (OSA positive n = 1,613, OSA negative n = 403) were matched to control drivers unlikely to have OSA (n = 2,016) on two factors affecting crash risk, experience-at-hire and length of job tenure; tenure was matched on the date of each diagnosed driver's polysomnogram. Auto-adjusting positive airway pressure (APAP) treatment was provided to all cases (i.e. OSA positive drivers); treatment adherence was objectively monitored. Cases were grouped by treatment adherence: "Full Adherence" (n = 682), "Partial Adherence" (n = 571), or "No Adherence" (n = 360). Preventable Department-of-Transportation-reportable crashes/100,000 miles were compared across study subgroups. Robustness was assessed.Results: After the matching date, "No Adherence" cases had a preventable Department of Transportation-reportable crash rate that was fivefold greater (incidence rate ratio = 4.97, 95% confidence interval: 2.09, 10.63) than that of matched controls (0.070 versus 0.014 per 100,000 miles). The crash rate of "Full Adherence" cases was statistically similar to controls (incidence rate ratio = 1.02, 95% confidence interval: 0.48, 2.04; 0.014 per 100,000 miles).Conclusions: Nontreatment-adherent OSA-positive drivers had a fivefold greater risk of serious preventable crashes, but were discharged or quit rapidly, being retained only one-third as long as other subjects. Thus, the mandated program removed risky nontreatment-adherent drivers and retained adherent drivers at the study firm. Current regulations allow nonadherent OSA cases to drive at another firm by keeping their diagnosis private. Commentary: A commentary on this article appears in this issue on page 961.