Mechanism of driving risk in sleep apnea patients

1. 我们对睡眠呼吸暂停综合征（SAS）患者的睡眠驾驶患病率进行了一系列研究，明确了SAS驾驶员睡眠驾驶高危人群的特点，以及我们应该在何种程度上改善SAS以避免驾驶风险。110例未经治疗的SAS患者的睡眠驾驶经历是154例对照组的5倍（28.2% Vs 5.3%, p<0.001）。由于缺乏警惕性而导致的交通事故中，有9名SAS患者（8.2%）和无对照组（0%）报告了这一经历。从多次睡眠潜伏期测试（MSLT）的结果来看，有睡眠驾驶经验的SAS驾驶员的睡眠潜伏期集中到小于10分钟的值。同时，呼吸暂停低通气指数（AHI）小于15/h的SAS驾驶员均无睡眠驾驶经历。开始治疗12个月后，AHI降低到预处理值的25%以下的患者，开车困倦及其问题完全消失。从这些结果中可以明显看出，与普通人群相比，SAS司机的睡眠驾驶和与睡眠相关的车祸发生率都要高得多。AHI值小于15/h， MSLT值大于10分钟，视为SAS驾驶员驾驶风险防范的切入点。此外，AHI降低到预处理值的25%或更低被认为是抑制驾驶风险的治疗标准。我们确定了碳水化合物抑制剂（乙酰唑胺）和牙科器械对SAS患者的治疗指征。关于乙酰唑胺，单药治疗被认为仅在轻度病例中有益，而乙酰唑胺联合治疗和上气道手术可能显著改善重症病例。对于SAS合并舌咽部梗阻的病例，推荐采用牙器械治疗。

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.