Mechanism of driving risk in sleep apnea patients

1.我们对睡眠呼吸暂停综合征(SAS)患者睡眠驾驶的发生率进行了一系列研究，确定了睡眠驾驶高危人群的特点以及我们应该在多大程度上改善SAS以避免驾驶风险。据报道，110名未经治疗的SAS患者睡眠驾驶的发生率是154名对照组的5倍(28.2%比5.3%，p&lt；0.001)。对于因缺乏警觉而导致的车祸，9名SAS患者(8.2%)和没有对照的受试者(0%)报告了这一经历。关于多重睡眠潜伏期测试(MSLT)的结果，有睡眠驾驶经验的SAS司机的睡眠潜伏期集中在10分钟以下。此外，没有睡眠呼吸暂停低通气指数(AHI)低于15/小时的SAS司机报告有过睡眠驾驶经历。治疗12个月以上，AHI降至治疗前25%或以下的患者驾驶困倦及相关问题完全消失。从这些结果可以看出，SAS司机的睡眠驾驶和睡眠相关车祸的发生率明显高于普通人群。以AHI<15次/小时和MSLT>10分钟为预防SAS驾驶员驾驶风险的临界点。此外，将AHI降至预处理值的25%或更低被认为是抑制驾驶风险的治疗标准。我们确定了无水碳水化合物抑制剂(乙酰唑胺)和牙科器械对SAS患者的治疗适应证。至于乙酰唑胺，单用该药被认为只对轻度病例有益，而与乙酰唑胺和上呼吸道手术联合治疗可能会显著改善重症病例。对于牙科器械，对于伴有舌咽阻塞的SAS患者，该疗法被认为是最好的选择。

1. We made a series of study regarding prevalence of sleep driving in patients with sleep apnea syndrome (SAS) and identified both the characteristies of SAS drivers who are high risk of sleep driving and to what extent we should improved SAS in order to avoid driving risk.Experience of sleep driving was reported 5 times higher in 110 untreated SAS patients than 154 control subjects (28.2% Vs 5.3%, p<0.001). With respect to car accidents due to lack of vigilance, nine SAS patients (8.2%) and no control subjects (0%) reported the experience. With respect to the findings of multiple sleep latency test (MSLT), sleep latencies of the SAS drivers with the experience of sleep driving concentrated to the value less than 10 minutes. And also, no SAS drivers with the value of apnea-hypopnea index (AHI) less than 15/hour reported the experience of sleep driving. More than 12 months after starting the treatment, sleepiness while driving and its problems completely disappeared in the patients whose AHI was reduced to 25% or less of the pretreatment value.From these results, it was apparent that the rate of both sleep driving and sleeping related car accidents are definitely higher in SAS drivers compared with general population. The value of AHI less than 15/hour and the value of MSLT more than 10 minutes were regarded to be the cut of point to prevent the driving risk of SAS drivers. Furthermore, reduction of AHI to 25% or less of the pretreatment value is thought to be the treatment standard for suppressing the driving risk.2. We identified the treatment indication of both carbonic anhydrate inhibitor (acetazolamide) and dental device on SAS patients. Regarding acetazolamide, monotherapy with the drug was thought to be beneficial only in mild cases whereas combination therapy with acetazolamide and upper airway surgery might remarkably improve severe cases. As for dental device, the therapy was thought to be best recommended to the SAS cases with glossopharyngeal obstruction.