Obstructive sleep apnoea among professional taxi drivers: a pilot study

Examining demographic, work, and sleep characteristics among older South Asian American yellow taxi drivers in New York City: A brief report

OBJECTIVES

This exploratory study examines workplace factors, sleep, sleep disorders, and safety among older (age 50 years and above) yellow taxi drivers in New York City (NYC) of South Asian descent.

METHODS

Using street intercept methods, quantitative data was collected among yellow taxi drivers in NYC (n = 27) from January-March 2020.

RESULTS

Among drivers, higher than normal sleepiness was identified in 33%, sleeping fewer than 7 hours on worknights work nights was reported by 52%, and 37% were at high risk for obstructive sleep apnea (OSA). Among drivers, 11% (n = 3) reported a motor vehicle accident in the past year and all drivers who reported an accident were at high risk for OSA.

CONCLUSIONS

Findings from this hard-to-reach and understudied population revealed that most drivers did not report sufficient sleep on work nights. Results found over one-third of drivers had high OSA risk and drivers at high risk for OSA contributed to all reports of motor vehicle crashes.

Sleep behavior of New York City taxi drivers compared to the general US population

Introduction

Taxi drivers are a low income population with long work hours, a high-stress sedentary occupation, and varied work shifts, augmenting their risk for sleep disorders. We evaluated sleep quality among New York City (NYC) taxi drivers, a predominantly immigrant/minority population, for associations with sleep outcomes and examined intervention development and policy implications.

Methods

A cross-sectional survey was conducted at driver-frequented locations with 211 consenting NYC taxi drivers and included the 12-item Medical Outcomes Study Sleep Scale and the Perceived Stress Scale-10. For five domains (sleep disturbance, snoring, shortness of breath, sleep adequacy, and somnolence) and Sleep Problems Index-II, self-reported scores were calculated and normed against a nationally representative 2009 US sample to obtain standardized t-test scores. Scores <47 were lower than US averages, indicating worse sleep quality. Results were explored in multivariable linear and logistic regression models.

Results

Almost one-half (47%) of drivers had scores indicating sleep quality below US averages for snoring, 36% for shortness of breath/obstruction, and 19% for somnolence. There were significant associations of perceived stress with Sleep Problems Index II (p<0.001), sleep disturbance (p<0.001), somnolence (p<0.001), and sleep adequacy (p<0.05). Stress was predictive of sleep adequacy (p<0.05, bivariate; p<0.05, multivariate) and shortness of breath/obstruction (p<0.01, bivariate; p<0.001, multivariate). Nightshift drivers had significantly worse sleep disturbance scores than dayshift drivers (p<0.05). Taxi drivers were more likely to get an inadequate amount of daily sleep (<7 hours) than the average US male (48.5% vs. 38.3%).

Conclusions

Sleep hygiene and stress management interventions could benefit the health of this population and improve driver and public safety. The associations of taxi driver sleep quality and stress indicate an opportunity for targeted intervention. Further research into sleep as an important determinant of taxi driver health is needed, especially in the burgeoning for-hire vehicle (Uber, Lyft, etc) sector.

Taxi drivers and modifiable health behaviors: Is stress associated?

BACKGROUND

Taxi drivers, an immigrant male population, may exhibit poor health behaviors and increased health risks.

OBJECTIVE

The current study examined stress and demographics as predictors of physical activity (PA), nutrition, sleep, and smoking, and the co-occurrence of these behaviors among taxi drivers.

METHODS

A cross-sectional needs assessment was conducted in New York City. The sample (n = 252) was comprised of male taxi drivers, 98%of whom were born outside of the U.S., with the majority from South Asian countries (62%), and 45 years old on average (SD = 11).

RESULTS

We found low rates of fruit/vegetable consumption and PA. Rates of stress, PA, and smoking varied by demographic factors. Stress was positively associated with sleep disturbances and negatively associated with smoking. Aside from a relationship between sugar consumption and smoking, other health behaviors were not associated.

CONCLUSIONS

While stress appears to impact some indicators of modifiable health behaviors, its lack of relationship with others points to more persistent health issues. Demographic differences found for PA and smoking also point to groups that may especially benefit from interventions. These findings suggest the need for targeted health interventions for taxi drivers in large metropolitan cities.

Temporal patterns of driving fatigue and driving performance among male taxi drivers in Hong Kong: A driving simulator approach

This study uses a questionnaire survey and a driving simulator test to investigate the temporal patterns of variations in driving fatigue and driving performance in 50 male taxi drivers in Hong Kong. Each driver visited the laboratory three times: before, during, and after a working shift. The survey contained a demographic questionnaire and the Brief Fatigue Inventory. A following-braking simulator test session was conducted at two speeds (50 and 80 km/h) by each driver at each of his three visits, and the driver's performance in brake reaction, lane control, speed control, and steering control were recorded. A random-effects modeling approach was incorporated to address the unobserved heterogeneity caused by the repeated measures. In the results, a recovery effect and a lagging effect were defined for the driving fatigue and performance measures because their temporal patterns were concavely quadratic and had a 1-hour delay compared to the temporal patterns of occupied taxi trips and taxi crash risk in Hong Kong. Demographic variables, such as net income and driver age, also had significant effects on the measured driving fatigue and performance. Policies regarding taxi management and operation based on the modeling results are proposed to alleviate the taxi safety situation in Hong Kong and worldwide.

Factors associated with self-reported driver sleepiness and incidents in city bus drivers

Driver fatigue has received increased attention during recent years and is now considered to be a major contributor to approximately 15-30% of all crashes. However, little is known about fatigue in city bus drivers. It is hypothesized that city bus drivers suffer from sleepiness, which is due to a combination of working conditions, lack of health and reduced sleep quantity and quality. The overall aim with the current study is to investigate if severe driver sleepiness, as indicated by subjective reports of having to fight sleep while driving, is a problem for city based bus drivers in Sweden and if so, to identify the determinants related to working conditions, health and sleep which contribute towards this. The results indicate that driver sleepiness is a problem for city bus drivers, with 19% having to fight to stay awake while driving the bus 2-3 times each week or more and nearly half experiencing this at least 2-4 times per month. In conclusion, severe sleepiness, as indicated by having to fight sleep during driving, was common among the city bus drivers. Severe sleepiness correlated with fatigue related safety risks, such as near crashes.

Clinical symptoms and related factors of obstructive sleep apnea among overweight and obese taxi drivers

Background: Obstructive sleep apnea (OSA) is common condition in commercial drivers while overweight and obesity as the most important risk factors. This study aimed to know the clinical symptoms and risk factors of OSA in overweight and obese taxi drivers in Jakarta, Indonesia. Methods: A cross-sectional study was done in 103 taxi drivers in Jakarta from November 2011–September 2013, by systematic random sampling from 10 taxi stations. Inclusion criteria were taxi drivers with body mass index (BMI) which 23–29.9 and mild or moderate OSA. Portable polysomnography (PSG) test was used to diagnose OSA. Parametric and nonparametric test were used in bivariate analysis. Logistic regression multivariable was used to final evaluate risk factors of OSA.Results: There were 54 (52.4%) of 103 drivers with OSA and 49 (47.6%) without OSA. Clinical symptoms found significantly (p<0.05) were snoring, unrefreshing sleep, occasional sleep while driving, and headache or nausea on waking up in the morning. Risk factors for OSA were increased BMI (OR=0.60, 95% CI=0.45–0.79, p=0.001), snoring history in the family (OR=4.92, 95% CI=1.82–13.31, p=0.002) and sleep duration <7 hours within 24 hours (OR=5.14, 95% CI=1.37–19.23, p=0.015).Conclusion: Clinical symptoms of OSA were snoring, unrefreshing sleep, occasional sleep while driving and headache or nausea on waking up in the morning. Risk factors of OSA were increased BMI, snoring history in the family and sleep duration <7 hours within 24 hours.

Prevention of taxi accidents in Xi'an, China: what matters most?

OBJECTIVES

Since the city of Xi'an has been extremely concerned with the serious problem of taxi involved crashes, injuries and fatalities, the primary purpose of this study is to identify the risk factors associated with the magnitude and nature of the problem and provide possible measures for enhancing the overall safety performance of taxi industry.

METHODS

Using 726 crash samples from the original of 7,183 observations in Xi'an over the period from 2006 to 2012, comparative statistics and systematic analysis were employed to describe the distribution of taxi crashes by driver characteristics, roadway contributors and environmental factors and then determine the significant factors contributing to crash injuries and fatalities.

RESULTS

The trend and pattern of taxi involved crashes vary significantly. Middle aged (77.27%) male (91.60%) drivers with limited education (68.59%) and less driving (31.27%) and job (82.50%) experience were much more likely to be involved in such a crash. Additionally, it is found that a large majority of taxi crashes occurred with the most frequent type of rear end collisions (30.72%), on six-lane segments without median (16.94%) or four legged intersections (15.29%), under adverse weather conditions (31.82%), at weekends (34.99%), and during winter days (34.72%), but fatal and serious crashes were more likely to happen at night (30.72%) or under wet road surface conditions (16.94%), due to driver's overspeeding, unbelted, disregarding signs or signals, or other types of risk driving behaviour.

CONCLUSIONS

The risk of taxi related crashes varies by drivers, roadways and environment. To reduce the risk of potential crashes for taxi drivers, we recommend the targeted legislation and enforcement, stronger night and trip restrictions, awareness of risk behaviour, and periodical training requirement. Such proposals and measures are expected to help mitigate taxi crashes and promote road safety in China.

Driving fatigue in professional drivers: a survey of truck and taxi drivers

OBJECTIVES

Fatigue among truck drivers has been studied extensively; however, less is known regarding the fatigue experience of taxi drivers in heavily populated metropolitan areas. This study aimed to compare the differences and similarities between truck and taxi driver fatigue to provide implications for the fatigue management and education of professional drivers.

METHODS

A sample of 274 truck drivers and 286 taxi drivers in Beijing was surveyed via a questionnaire, which included items regarding work characteristics, fatigue experience, accident information, attitude toward fatigue, and methods of counteracting fatigue.

RESULTS

Driver fatigue was prevalent among professional drivers, and it was even more serious for taxi drivers. Taxi drivers reported more frequent fatigue experiences and were involved in more accidents. Among the contributing factors to fatigue, prolonged driving time was the most important factor identified by both driver groups. Importantly, the reason for the engagement in prolonged driving was neither due to the lack of awareness concerning the serious outcome of fatigue driving nor because of their poor detection of fatigue. The most probable reason was the optimism bias, as a result of which these professional drivers thought that fatigue was more serious for other drivers than for themselves, and they thought that they were effective in counteracting the effect of fatigue on their driving performance. Moreover, truck drivers tended to employ methods that require stopping to counteract fatigue, whereas taxi drivers preferred methods that were simultaneous with driving. Although both driver groups considered taking a nap as one of the most effective means to address fatigue, this method was not commonly used. Interestingly, these drivers were aware that the methods they frequently used were not the most effective means to counteract fatigue.

CONCLUSIONS

This study provides knowledge on truck and taxi drivers' characteristics in fatigue experience, fatigue attitude, and fatigue countermeasures, and these findings have practical implications for the fatigue management and education of professional drivers.

Obstructive sleep apnoea in adult indigenous populations in high-income countries: an integrative review

BACKGROUND

Obstructive sleep apnoea is recognised as a common but under-diagnosed health issue. Currently, there is very little published data relating to the burden and impact of obstructive sleep apnoea among indigenous populations. The purpose of this review was to investigate the prevalence, impact, risk factors and treatment of obstructive sleep apnoea in indigenous populations in high-income countries.

METHODS

An integrative review was conducted on 25 English language studies and reports that investigated obstructive sleep apnoea among indigenous populations in high-income countries. Studies that did not focus on indigenous populations in the results or discussion were excluded. Eligible studies were identified by searching PubMed, Web of Science and Google Scholar databases and reference lists of eligible studies. Publication dates range from 1998 to 2012.

RESULTS

Synthesis of studies indicates the prevalence of obstructive sleep apnoea is higher and severity is greater in indigenous populations compared with non-indigenous populations. Comparable risk factors for obstructive sleep apnoea were identified in indigenous and non-indigenous populations, with only three studies identifying ethnicity as an independent risk factor.

CONCLUSIONS

Indigenous populations in high-income countries are subject to an overall greater prevalence of obstructive sleep apnoea that is also more severe. A higher prevalence of obesity, alcohol and tobacco use and comorbid medical conditions associated with low socioeconomic status rather than indigenous status per se appears to explain this disparity.

Driving to better health: cancer and cardiovascular risk assessment among taxi cab operators in Chicago

While a number of investigations of the health of taxi cab drivers have been conducted in Europe, Asia, and Africa, virtually none have been conducted in the United States. We undertook a survey of taxi cab operators in the Chicago area to understand better their health status and health promotion practices. The survey was completed by a convenience sample of 751 Chicago taxi drivers. Taxi drivers had low rates of insurance coverage, fruit and vegetable consumption, and physical activity compared with the general Chicago population. Participation in cancer screening tests was also lower for this group. A high proportion of taxi drivers are immigrants. They tend to be highly educated and report a readiness to engage in more health-promoting behaviors. Further research is needed to develop a targeted intervention for this population.

Obstructive sleep apnea syndrome: assessing and managing risk in the motor vehicle operator

PURPOSE OF REVIEW

Obstructive sleep apnea (OSA) is a common condition that can significantly affect daytime functioning, leading to excessive daytime sleepiness and fatigue. Motor vehicle crashes are common, resulting in financial burden, property loss, injury, and death. Motor vehicle operators are at increased risk for crash in the context of excessive daytime sleepiness and fatigue, largely due to inattention. The physician caring for individuals with risk of or diagnosed OSA must be aware of the potentially increased risk for motor vehicle crashes, especially in professional drivers. Because of empiric data on increased risk for crashes in commercial vehicle operators, the importance of identifying OSA has become the subject of focused attention by the Federal Motor Carrier Safety Administration (FMCSA). A task force has published recommendations for clinical care and urged further research on the interplay between sleep apnea, sleepiness, and crash risk.

RECENT FINDINGS

Despite the logical relationship between OSA and motor vehicle crashes, data to support this theory remain of overall modest quality. Recent case-control and cohort studies continue to produce supportive evidence. Additionally, several meta-analyses of past studies have supported the crash risk associated with OSA and confirmed improvement with effective treatment using continuous positive airway pressure.

SUMMARY

Further study is needed to more fully characterize the interplay between sleepiness and OSA, the crash risk associated with untreated OSA, and the benefit of treatment on reducing crash risk. For now, empiric recommendations are offered to screen and manage all individuals who drive, particularly those who drive professionally.

Ethnic disparities in CPAP adherence in New Zealand: effects of socioeconomic status, health literacy and self-efficacy

STUDY OBJECTIVES

We aimed to investigate the influence of ethnicity on adherence with continuous positive airway pressure (CPAP) in a sample of New Zealand patients.

DESIGN

Observational study over one month.

SETTING

A university-based sleep laboratory.

PATIENTS

126 consecutively consenting CPAP-naïve patients (19.8% Māori, mean±SD apnea-hypopnea index 57.9 ± 38.9 events/h, CPAP 11.1 ± 3.1 cm H2O).

INTERVENTIONS

Patients underwent a 4-week supervised home trial of CPAP following pressure titration.

MEASUREMENTS AND RESULTS

Self-identified ethnicity (Māori/non-Māori), Epworth Sleepiness Scale, Self-Efficacy Measure for Sleep Apnea, Rapid Estimate of Adult Literacy in Medicine, New Zealand Deprivation Index (calculated from residential address), New Zealand Individual Deprivation Index (validated 8-item questionnaire), educational history, income, and employment assessed at baseline were compared to objective CPAP adherence after one month. Māori demonstrated significantly lower usage than non-Māori (median 5.11, interquartile range 2.24 h/night compared with median 5.71, interquartile range 2.61 h/night, P = 0.05). There were no significant relationships between adherence and subjective sleepiness, health literacy, or self-efficacy. In a multivariate logistic regression model incorporating 5 variables (ethnicity, eligibility for government-subsidized healthcare, individual deprivation scores, income, and education), non-completion of tertiary education, and high individual socioeconomic deprivation remained significant independent predictors of average CPAP adherence not reaching ≥ 4 h (odds ratio 0.25, 95% CI 0.08-0.83, P = 0.02; odds ratio 0.10, 95% CI 0.02-0.86, P = 0.04, respectively). The overall model explained approximately 23% of the variance in adherence.

CONCLUSIONS

The disparity in CPAP adherence demonstrated between Māori and non-Māori can be explained in part by lower education levels and socioeconomic status.