The Bordeaux Sleepiness Scale (BOSS): a new questionnaire to measure sleep-related driving risk

STUDY OBJECTIVES

Sleepiness is a well-known risk factor for traffic accidents. Our study presents a new questionnaire, the Bordeaux Sleepiness Scale (BOSS), specifically designed to evaluate sleep-related driving risk in patients with sleep disorders.

METHODS

The BOSS was designed by gathering data on sociodemographics, sleepiness, driving items, and traffic accident exposure (kilometers driven) in the past year of 293 patients followed for sleep disorders at a French sleep clinic. It was then validated on data from a large population-based cohort of 7,296 highway drivers. Its performance was compared to the Epworth sleepiness scale and to self-reported episodes of severe sleepiness at the wheel. Receiver operating characteristic curves were computed.

RESULTS

The sensitivity and specificity of the BOSS (cutoff = 3) to predict sleep-related near-misses or accidents was, respectively, 82% and 74%, with an area under the receiver operating characteristic curve of 0.83. In a cohort of patients and a large population-based cohort, the area under the curve of the BOSS was significantly larger than that of the Epworth sleepiness scale (P < .001). Although the areas under the curve were equivalent between the BOSS and sleepiness at the wheel, the specificity of the BOSS was higher.

CONCLUSIONS

The BOSS scale combining exposure (kilometers driven) and self-perception of situational sleepiness provides a simple and reliable evaluation of sleep-related driving risk. This short, specific questionnaire should be promoted as a first-line tool to evaluate the risk of traffic accidents in sleepy patients.

CITATION

Philip P, Micoulaud-Franchi J-A, Taillard J, et al. The Bordeaux Sleepiness Scale (BOSS): a new questionnaire to measure sleep-related driving risk. J Clin Sleep Med. 2023;19(5):957-965.

Texting on a Smartphone While Walking Affects Gait Parameters

Cell phone use while walking is an ever-increasing traffic hazard, and leads to an augmented risk of accidents. There is a rising number of injuries to pedestrians using a cell phone. Texting on a cell phone while walking is an emerging problem among people of different ages. The aim of this experiment was to investigate whether using a cell phone while walking affects walking velocity, as well as cadence, stride width, and length in young people. Forty-two subjects (20 males, 22 females; mean age: 20.74 ± 1.34 years; mean height: 173.21 ± 8.07 cm; mean weight: 69.05 ± 14.07 kg) participated in the study. The subjects were asked to walk on an FDM-1.5 dynamometer platform four times at a constant comfortable velocity and a fast velocity of their choice. They were asked to continuously type one sentence on a cell phone while walking at the same velocity. The results showed that texting while walking led to a significant reduction in velocity compared to walking without the phone. Width, cadence, and length of right and left single steps were statistically significantly influenced by this task. In conclusion, such changes in gait parameters may result in an increased risk of pedestrian crossing accidents and tripping while walking. Phone use is an activity that should be avoided while walking.

Advanced emergency braking system reduces the risk of motor vehicle collisions caused by falling asleep while driving in patients with untreated obstructive sleep apnea

Obstructive sleep apnea leads to excessive daytime sleepiness and cognitive dysfunction, which are risk factors for motor vehicle collisions. We aimed to clarify if vehicles with an advanced emergency braking system could reduce motor vehicle collisions caused by falling asleep while driving among patients with untreated obstructive sleep apnea. We enrolled patients with untreated obstructive sleep apnea who underwent polysomnography. The questionnaires included the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, history of drowsy driving accidents, and use of an advanced emergency braking system. Multivariate analysis was performed, and odds ratios and 95% confidence intervals were calculated. This study included 1097 patients (mean age, 51.2 ± 12.9 years). Collisions caused by falling asleep while driving were recorded in 59 (5.4%) patients, and were more frequently observed in vehicles without an advanced emergency braking system (p = 0.045). Multivariate analysis showed that these collisions were associated with use of an advanced emergency braking system (odds ratio [95% confidence interval]: 0.39 [0.16-0.97], p = 0.04), length of driving (2.79 [1.19-6.50], p = 0.02), total sleep time (2.40 [1.62-3.55], p < 0.0001), sleep efficiency (0.94 [0.90-0.98], p = 0.003) and periodic limb movement index (1.02 [1.01-1.03], p = 0.004). The collision risk caused by falling asleep while driving in vehicles with an advanced emergency braking system was significantly lower. This study indicates that advanced emergency braking systems may be a preventive measure to reduce motor vehicle collisions among patients with untreated obstructive sleep apnea.

Brain mitochondrial dysfunction and driving simulator performance in untreated obstructive sleep apnea

It is challenging to determine which patients with obstructive sleep apnea (OSA) have impaired driving ability. Vulnerability to this neurobehavioral impairment may be explained by lower brain metabolites levels involved in mitochondrial metabolism. This study compared markers of brain energy metabolism in OSA patients identified as vulnerable vs resistant to driving impairment following extended wakefulness. 44 patients with moderate-severe OSA underwent 28hr extended wakefulness with three 90min driving simulation assessments. Using a two-step cluster analysis, objective driving data (steering deviation and crashes) from the 2nd driving assessment (22.5 h awake) was used to categorise patients into vulnerable (poor driving, n = 21) or resistant groups (good driving, n = 23). ¹ H magnetic resonance spectra were acquired at baseline using two scan sequences (short echo PRESS and longer echo-time asymmetric PRESS), focusing on key metabolites, creatine, glutamate, N-acetylaspartate (NAA) in the hippocampus, anterior cingulate cortex and left orbito-frontal cortex. Based on cluster analysis, the vulnerable group had impaired driving performance compared with the resistant group and had lower levels of creatine (PRESS p = ns, APRESS p = 0.039), glutamate, (PRESS p < 0.01, APRESS p < 0.01), NAA (PRESS p = 0.038, APRESS p = 0.035) exclusively in the left orbito-frontal cortex. Adjusted analysis, higher glutamate was associated with a 21% (PRESS) and 36% (APRESS) reduced risk of vulnerable classification. Brain mitochondrial bioenergetics in the frontal brain regions are impaired in OSA patients who are vulnerable to driving impairment following sleep loss. These findings provide a potential way to identify at risk OSA phenotype when assessing fitness to drive, but this requires confirmation in larger future studies.

The Causes of Occupational Accidents and Injuries in Romanian Firms: An Application of the Johansen Cointegration and Granger Causality Test

Organizational risks are present in any activity, so it is important to manage them properly. The jobs are dynamic and involve a series of processes and activities. The entire human resource is exposed to several risks. If these risks are approached correctly, the organizational capacity to achieve its objectives and vision will increase considerably. This paper aims to investigate the relationships between work accidents (fatal and non-fatal) and the causes that contribute to their occurrence (causes dependent on the executor, causes dependent on the means of production, workload-dependent causes, and work-dependent causes—the work environment). The augmented Dickey–Fuller (ADF) test is employed to check the data stationarity series, while the Johansen test determines the cointegration relation of variables. The data have been collected from Romanian organizations. The vector error correction model (VECM) and Granger causality test are applied for speed of adjustment, nature, and direction of variables’ relationship. This research demonstrated that both data series are free from the unit-root problem at first difference. The lag length criterions select the third lag for model fitness, and Johansen cointegration declares that variables are cointegrated for the long term. The vector error correction model shows the speed of adjustment from the short to the long run is 83.35% and 42.60% for work and fatal accidents. The study results show that fatal accidents have a series relationship with selected cases for the short run and have a long-run relationship with the means of production. Fatal accidents are directly related to means of production. Fatal accidents are not designed by executors, workload-dependent causes, or work environments in the short run. Fatal accidents are directly related to the means of production and sudden incidents happening in the long run. Fatal accidents are considered by executors, workload-dependent causes, or work environments in the short run. In the long run, fatal accidents are directly related to the means of production and sudden incidents happening.

Obstructive Sleep Apnea: A View from the Back Door

Obstructive sleep apnea (OSA) is a common disease that may affect up to 50% of the adult population and whose incidence continues to rise, as well as its health and socio-economic burden. OSA is a well-known risk factor for motor vehicles accidents and decline in work performance and it is frequently accompanied by cardiovascular diseases. The aim of this Special Issue is to focus on the characteristics of OSA in special populations which are less frequently investigated. In this regard, seven groups of experts in the field of sleep medicine gave their contribution in the realization of noteworthy manuscripts which will support all physicians in improving their understanding of OSA with the latest knowledge about its epidemiology, pathophysiology and comorbidities in special populations, which will serve as a basis for future research.

The Impact of Treatments for OSA on Monetized Health Economic Outcomes: A Systematic Review

OBJECTIVE

To review systematically the published literature regarding the impact of treatment for OSA on monetized health economic outcomes.

METHODS

Customized structured searches were performed in PubMed, Embase (Embase.com), and the Cochrane Central Register of Controlled Trials (Wiley) databases. Reference lists of eligible studies were also analyzed. Titles and abstracts were examined, and articles were identified for full-text review. Studies that met inclusion criteria were evaluated in detail, and study characteristics were extracted using a standardized template. Quantitative characteristics of the studies were summarized, and a qualitative synthesis was performed.

RESULTS

Literature searches identified 2,017 nonredundant abstracts, and 196 full-text articles were selected for review. Seventeen studies met inclusion criteria and were included in the final synthesis. Seven studies included formal cost-effectiveness or cost-utility analyses. Ten studies employed cohort designs, and four studies employed randomized controlled trial or quasi-experimental designs. Positive airway pressure was the most common treatment modality, but oral appliances and surgical approaches were also included. The most common health economic outcomes were health-care use (HCU) and quality-adjusted life years (QALYs). Follow-ups ranged from 6 weeks to 5 years. Overall, 15 of 18 comparisons found that treatment of OSA resulted in a positive economic impact. Treatment adherence and OSA severity were positively associated with cost-effectiveness.

CONCLUSIONS

Although study methodologies varied widely, evidence consistently suggested that treatment of OSA was associated with favorable economic outcomes, including QALYs, within accepted ranges of cost-effectiveness, reduced HCU, and reduced monetized costs.

Effects of texting on accident risk during a sudden hazardous event: Analysis of predetection and postdetection phases

OBJECTIVE

The present study aims to quantify the effects of texting and driver behavior on the accident risk associated with a sudden event. Further, the study attempts to compare the effects of driving behavior of inexperienced young and professional drivers on risk during predetection and postdetection phases of the event.

METHODS

Forty-nine drivers from 2 categories-inexperienced young drivers and experienced professional drivers-took part in simulated experiments. The participants drove in a free-flow road environment under 3 driving conditions: no distraction (baseline) and writing short and long texts while driving. The participants were exposed to a sudden hazardous event during each drive. Accident probability during the sudden event was modeled with a generalized linear mixed model (with a logit link function).

RESULTS

As expected, both texting tasks increased accident risk, and the risk was much higher for inexperienced young drivers than for professional drivers. Time lapsed in reducing speed increased the odds for accident risk significantly. A comparative analysis of the driver categories showed that impairment in driving behavior due to the texting tasks was similar for both groups during the predetection phase. However, the risk associated with the texting tasks was higher for young drivers during the postdetection phase. A possible reason could be that young drivers had 65% and 75% higher approach speeds (than the professional drivers) during the short and long text tasks, respectively.

CONCLUSIONS

The results provide statistical evidence that increased speed is expressed as increased risk-taking behavior among young drivers, which subsequently is the main reason for their higher accident risk during texting tasks. Moreover, the results confirm that professional drivers are not able to mitigate the increased accident risk associated with texting tasks due to late detection of the event during the tasks.

Commentary: One way attention-deficit/hyperactivity disorder can be life threatening? A travelogue on Nikolas et al. (2016)

I provide a brief commentary on the brilliant accompanying study of Nikolas et al. concerning risky bicyclist-automobile behavior in ADHD and typical youth. The sophistication of the simulator and procedures and the number and precision of measurements are remarkable and afford us an excellent glimpse into the specific mechanisms by which previously documented injury risk in such natural settings may be increased by ADHD in youth. I also briefly note clinically important implications of these and other research results on accident risk in ADHD.

The characteristics of sleepiness during real driving at night--a study of driving performance, physiology and subjective experience

STUDY OBJECTIVES

Most studies of sleepy driving have been carried out in driving simulators. A few studies of real driving are available, but these have used only a few sleepiness indicators. The purpose of the present study was to characterize sleepiness in several indicators during real driving at night, compared with daytime driving.

DESIGN

Participants drove 55 km (at 90 km/h) on a 9-m-wide rural highway in southern Sweden. Daytime driving started at 09:00 or 11:00 (2 groups) and night driving at 01:00 or 03:00 (balanced design).

SETTING

Instrumented car on a real road in normal traffic.

PARTICIPANTS

Eighteen participants drawn from the local driving license register.

INTERVENTIONS

Daytime and nighttime drives.

MEASUREMENT AND RESULTS

The vehicle was an instrumented car with video monitoring of the edge of the road and recording of the lateral position and speed. Electroencephalography and electrooculography were recorded, together with ratings of sleepiness every 5 minutes. Pronounced effects of night driving were seen for subjective sleepiness, electroencephalographic indicators of sleepiness, blink duration, and speed. Also, time on task showed significant effects for subjective sleepiness, blink duration, lane position, and speed. Sleepiness was highest toward the end of the nighttime drive. Night driving caused a leftward shift in lateral position and a reduction of speed. The latter two findings, as well as the overall pattern of sleepiness indicators, provide new insights into the effects of night driving.

CONCLUSION

Night driving is associated with high levels of subjective, electrophysiologic, and behavioral sleepiness.