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OSA is common among commercial vehicle operators (CVOs) in all modes of transportation, including truck, bus, air, rail, and maritime operations. OSA is highly prevalent and increases the risk of drowsiness-related crashes in CVOs. Internationally, specific regulations regarding its identification and management vary widely or do not exist; medical examiners and sleep medicine specialists are urged to use available guidance documents in their absence. Education, screening, prompt identification and treatment, and ongoing surveillance to ensure effective therapy can lower the risk of fatigue-related crashes. [ABSTRACT FROM AUTHOR]

This study examined the association between depressive symptoms, as well as depressive symptom dimensions, and three candidate biological pathways linking them to Obstructive sleep apnea (OSA): (1) inflammation; (2) circulating leptin; and (3) intermittent hypoxemia. Participants included 181 obese adults with moderate-to-severe OSA enrolled in the Cardiovascular Consequences of Sleep Apnea (COSA) trial. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II). We assessed inflammation using C-reactive protein levels (CRP), circulating leptin by radioimmunoassay using a double antibody/PEG assay, and intermittent hypoxemia by the percentage of sleep time each patient had below 90% oxyhemoglobin saturation. We found no significant associations between BDI-II total or cognitive scores and CRP, leptin, or percentage of sleep time below 90% oxyhemoglobin saturation after controlling for relevant confounding factors. Somatic symptoms, however, were positively associated with percentage of sleep time below 90% saturation (β = 0.202, P = 0.032), but not with CRP or circulating leptin in adjusted models. Another significant predictor of depressive symptoms included sleep efficiency (β = −0.230, P = 0.003; β = −0.173, P = 0.030 (β = -0.255, P = 0.001). In patients with moderate-to-severe OSA, intermittent hypoxia may play a role in somatic rather than cognitive or total depressive symptoms. [ABSTRACT FROM AUTHOR]

The article presents a study on the use of continuous positive airway pressure (CPAP) and weight loss intervention for treating obstructive sleep apnea. Topics include assessments of C-reactive protein (CRP) levels, insulin sensitivity, and blood pressure, the effectivity of combined interventions on mean arterial pressure, the use of a randomized, parallel-group method. It also discusses the use of diet plans recommended by the National Cholesterol Education Program in the U.S.

The authors attempted to validate a 2-stage strategy to screen for severe obstructive sleep apnea syndrome (s- OSAS) among hypertensive outpatients, with polysomnography ( PSG) as the gold standard. Using a prospective design, outpatients with hypertension were recruited from medical outpatient clinics. Interventions included (1) assessment of clinical data; (2) home sleep testing ( HST); and (3) 12-channnel, in-laboratory PSG. The authors developed models using clinical or HST data alone (single-stage models) or clinical data in tandem with HST (2-stage models) to predict s- OSAS. For each model, area under receiver operating characteristic curves ( AUCs), sensitivity, specificity, negative likelihood ratio, and negative post-test probability ( NPTP) were computed. Models were then rank-ordered based on AUC values and NPTP. HST used alone had limited accuracy ( AUC=0.727, NPTP=2.9%). However, models that used clinical data in tandem with HST were more accurate in identifying s- OSAS, with lower NPTP: (1) facial morphometrics ( AUC=0.816, NPTP=0.6%); (2) neck circumference ( AUC=0.803, NPTP=1.7%); and Multivariable Apnea Prediction Score ( AUC=0.799, NPTP=1.5%) where sensitivity, specificity, and NPTP were evaluated at optimal thresholds. Therefore, HST combined with clinical data can be useful in identifying s- OSAS in hypertensive outpatients, without incurring greater cost and patient burden associated with in-laboratory PSG. These models were less useful in identifying obstructive sleep apnea syndrome of any severity. [ABSTRACT FROM AUTHOR]

A plethora of medical consequences have been associated with the syndrome of obstructive sleep apnoea (OSA). These are global, affecting nearly every body function, and have been related to two key pathophysiologieal findings in sleep apnoea: repetitive falls in oxyhaemoglobin saturation during sleep, and recurrent arousals from sleep which terminate apnoea episodes. Sufferers of OSA may experience daytime sleepiness, which has been measured both subjectively using the Epworth Sleepiness Scale and the Stanford Sleepiness Scale, but also objectively, using Multiple Sleep Latency Testing, Maintenance of Wakefulness testing, and the Oxford Sleep Resistance test. In addition to the loss of alertness, sleep apnoea contributes to memory deficits, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life. Importantly, afflicted individuals experience improvements in these outcomes with treatment. Taken together, this evidence forms a compelling basis to identify and treat latent cases of sleep apnoea. Not only do patients have the opportunity to achieve improvements in these outcomes and health-related quality of life, but the enormous economic burden that untreated apnoea imposes on the health care system may be eased. [ABSTRACT FROM AUTHOR]

Abstract: Sleep apnea among commercial drivers may increase the risk of fall-asleep crashes, which incur large expenses. Drivers of passenger cars whose apnea is treated experience lower crash risk. Among community-based holders of commercial driver''s licenses, we considered three methods for identifying sleep apnea syndrome: (1) in-lab polysomnography; (2) selective in-lab polysomnography for high-risk drivers, where high risk is first identified by body mass index, age and gender, followed by oximetry in a subset of drivers; (3) not screening. The costs for each of these three programs equaled the sum of the costs of testing, treatment of identified cases, and crashes. Assuming that treatment prevents apnea-related crashes, polysomnography is not cost-effective, because it was more expensive than the cost of crashes when no screening is done. Screening with BMI, age and gender, however, with confirmatory in-lab polysomnography only on high-risk drivers was cost-effective, as long as a high proportion (73.8%) of screened drivers accepts treatment. These findings indicate that strategies that reduce reliance on in-laboratory polysomnography may be more cost-effective than not screening, and that treatment acceptance may need to be a condition of employment for affected drivers. [Copyright &y& Elsevier]

A response by A. B. Platt, L. C. Wick, S. Hurley and colleagues to their article "Hits and misses: screening commercial drivers for obstructive sleep apnea using guidelines recommended by a Joint Task Force" in the 2013 issue is presented.

Highlights: [•] Our study examines sleep duration relative to self-reported and objective cardiometabolic risk factors. [•] Very short sleep (<5h) was associated with self-reported hypertension, hyperlipidemia and diabetes mellitus (DM). [•] Very short sleep (<5h) was associated with objectively determined hyperlipidemia and obesity. [•] Short sleep (5–6h) was associated with self-reported hypertension and obesity, and objective obesity. [•] Race/ethnicity interactions are significant for self-reported and objective hypertension, hyperlipidemia, DM, and obesity. [Copyright &y& Elsevier]

Highlights: [•] Overall, more drowsy driving in short sleepers and less in long sleepers. [•] With 7 nights/wk insufficient sleep, more drowsy driving in both short and long sleepers. [•] With 0 nights/wk insufficient sleep, more drowsy driving in short sleepers. [•] Short sleepers at greater risk of drowsy driving, irrespective of sufficient sleep. [ABSTRACT FROM AUTHOR]

The association between obstructive sleep apnea ( OSA) and hypertension by race/ethnicity has not been well characterized in a national sample. Adult participants in the 2007-2008 National Health and Nutrition Examination Survey were reviewed by self-report of sleep apnea diagnosis, snorting, gasping or stopping breathing during sleep, and snoring to derive whether OSA was probable ( pOSA). Multivariable logistic regression determined whether pOSA predicted hypertension in the overall cohort, and by body mass index ( BMI) group and ethno-racial strata. pOSA predicted hypertension in several groups: (1) Within BMI strata, there was a significant association among overweight individuals [odds ratio [ OR], 1.82; 95% confidence interval [ CI], 1.26-2.62); (2) In race/ethnicity subgroups, the association was significant among Hispanic/Latinos ( OR, 1.69; 95% CI, 1.13-2.53) and whites ( OR, 1.40; 95% CI, 1.07-1.84); (3) In models stratified by both race/ethnicity and BMI, pOSA predicted hypertension among overweight black/ African Americans ( OR, 4.74; 95% CI, 1.86-12.03), overweight whites ( OR, 1.65; 95% CI, 1.06-2.57), and obese Hispanic/ Latino participants ( OR, 2.01; 95% CI, 1.16-3.49). A simple, self-report tool for OSA was strongly associated with hypertension, and may serve as a potential future opportunity for OSA diagnosis. [ABSTRACT FROM AUTHOR]

The article provides information on the significant impact of obstructive sleep apnea (OSA) to motor vehicle safety. It has been shown in several medical researches that OSA is one of the major causes of motor vehicle accidents. Medical researches have also proven that OSA significantly increases the risk in safety and health in the U.S. Furthermore, reports have indicated that OSA is present in a greater prevalence in operators of commercial motor vehicle operators than in the general population.

The article discusses the medical research about obstructive sleep apnea (OSA). Research assessed that OSA increases safety and health risk among motorists, as well as provide significant health problems. The health problems associated with OSA include hypertension and stroke. It was found that commercial motor vehicles have higher prevalence of OSA compared to the general population. The research suggests the motorists to undergo medical examination every 2 years.

Background: Self-reported short and long sleep duration have been associated with adverse cardiometabolic health outcomes in laboratory and epidemiologic studies, but interpretation of such data has been limited by methodological issues. Methods: We analyzed adult 2007-2008 US National Health and Nutrition Examination Survey (NHANES) data (N=5,649). Average self-reported nightly sleep duration was reported and categorized as either very short (<5h), short (5-6h), normal (7-8h), or long (=9h). Self-reported as well as objective evidence of obesity, diabetes, hypertension, and hyperlipidemia were recorded. Univariate comparisons were conducted across sleep duration categories for all variables. Binary logistic regression analyses were performed using cardiometabolic factor as the outcome variable, and sleep duration category as the predictor variable, before and after adjusting for age, sex, race/ethnicity, acculturation, education, access to insurance, food security, home ownership, smoking, and caffeine use. Results: See table. In adjusted analyses, very short sleep was associated with selfreported hypertension, self-reported hyperlipidemia, objective hyperlipidemia, self-reported diabetes, and objective obesity. Regarding short sleep (5-6hrs), in adjusted analyses, elevated risk was seen for self-reported hypertension selfreported obesity and objective obesity. Regarding long sleep (=9hrs), no elevated risk was found for any outcomes. Conclusions: Very short and short sleep duration are associated with self-reported and objectively-determined adverse cardiometabolic outcomes, even after adjustment for covariates. [ABSTRACT FROM AUTHOR]

The article focuses on the connection of obstructive sleep apnea (OSA) to motor vehicle accidents. OSA has been proved to significantly increase the risk in safety and health. It has been shown in several medical researches that OSA is one of the major causes of motor vehicle accidents. Researches also showed that OSA increases the possibility of individual developing health problems. Furthermore, the Federal Motor Carrier Safety Administration has changed the medical examination reporting form that includes a question asking drivers whether they have sleep problems.