An exploratory study evaluating the use of coping strategies whilst driving in Obstructive Sleep Apnoea Syndrome patients and controls

Introduction Sleepiness while driving is potentially fatal, and it is recommended that a driver who starts to feel tired should stop and have a rest. However, some may use various counter measures to try to stay alert. We devised a questionnaire that assessed various potential coping strategies that might be used against fatigue and compared them between OSAS patients and controls and with sleepiness in general (Epworth Sleepiness Scale; ESS), specifically while driving (Driving Sleepiness Scale; DSS) and driving incidents.

Method 119 untreated OSAS patients (Males; 82%, BMI; 37±8, ESS; 14±5, DSS: 3±2, ODI; 39±15) and 105 controls (Males; 70%, BMI; 28±6, ESS; 4±3, DSS; 7± 6) matched for age and driving experience were recruited. All completed a questionnaire, relating to their experience over the last one year, which included sleepiness in general, sleepiness specifically while driving, ten questions about various coping strategies they might adopt in order to avoid sleepiness and their history of incidents while driving. As compared to controls, nearly a third of OSAS patients (29.4%) used more than three coping strategies “frequently”. OSAS patient who used more than three such strategies had worse ESS (17±4 v/s 12±5, p=<0.0001); were more likely to feel sleepy while driving (10±8 v/s 5±7, p= 0.0002) and had more reported accidents (22.85% v/s 2.38%, p= 0.0002) as compared to OSAS patients who used less than three strategies. There was no difference in patient demographics, severity of OSAS, driving experience or episodes of nodding at the wheel and reported near miss events.

Conclusions Untreated OSAS patients frequently use certain strategies which could be surrogate markers of sleepiness. Enquiring about such strategies in clinical practice may aid the clinician in identifying the patients who are at risk of driving incidents and to advise appropriately.