Per-Olle Haraldsson

Clinical symptoms of sleep apnea syndrome and automobile accidents

Patients with clinical features of sleep apnea syndrome (SAS) and self-reported sleep spells at the wheel do poorly in simulated monotonous driving. To evaluate whether drivers with defined symptoms of SAS (heavy snoring, sleep disturbances and daytime sleepiness) compensate in real traffic by careful driving or not, the rate of car accidents over a 5-year period was investigated. A questionnaire was addressed to 140 patients with and 142 controls without symptoms associated to SAS. Seventy-three of the patients had a complete triad of SAS-associated symptoms. Fifty-two percent of these patients reported habitual sleep spells at the wheel, as opposed to less than one percent by the controls. The ratio of drivers being involved in one or more combined-car accident was similar for patients and control drivers, but for single-car accidents the ratio was about 7 times higher for patients with a complete triad of symptoms of SAS compared to controls (p less than 0.001). When corrected for mileage driven, the total number of single-car accidents was almost 12 times higher among patients with sleep spells whilst driving, compared to controls (p less than 0.001). It is concluded that drivers with the clinical features of SAS are at increased risk especially for single-car accidents and that the risk seems to vary with the severity of symptoms.

Does uvulopalatopharyngoplasty inhibit automobile accidents

Patients with rhonchopathy, which includes obstructive sleep apnea syndrome (OSAS), who report sleepy spells at the wheel do poorly on simulated monotonous driving tests and have a twofold to threefold increase in traffic accidents. To assess whether drivers with rhonchopathy (heavy snoring, sleep disturbances, and daytime sleepiness) cause fewer automobile accidents after uvulopalatopharyngoplasty (UPPP), the car accident rate for the first 5 years after surgery was compared to the rate of the 5 years immediately before the operation. Data were collected by means of a self‐report questionnaire. Fifty‐six patients with rhonchopathy were compared to 142 controls without rhonchopathy who had been subjected to nasal surgery. The response rates were 96% and 94%, respectively. The reported habitual sleepiness while driving had disappeared in 87% (P<.001) of drivers who had the problem preoperative. The accident risk reduction (corrected for mileage) in patients was almost four times greater than the reduction in controls (P<.001) after surgery. The relative rate of patients involved in any single‐car accident fell by 77% (P<.05), and the relative rate of single‐car accidents fell by 83% (P<.001). It is concluded that drivers with rhonchopathy have an increased risk for car accidents, especially single‐car accidents, but that this risk returns to normal after UPPP.

Driving Vigilance Simulator Test

Drivers suffering from sleepiness at the wheel run the risk of being involved in car accidents. To evaluate whether objective data of driving performance can be assessed in patients with excessive tendency of falling asleep at the wheel, two test versions of a computerized driving program were created to fit an advanced driving simulator. For the evaluation 15 male drivers with habitual sleep spells whilst driving were selected among patients with the clinical features of the sleep apnoea syndrome. The brake reaction time and the deviations from straight road-line were significantly increased when compared to the performance of 10 matched controls. Irrespective of test version, the driving simulator with the program used was found to be a sensitive method to ascertain driving vigilance impairment in quantitative terms. It would also be a valuable method to evaluate the efficiency of treatment in selected patients.

SLEEP APNEA SYNDROME SYMPTOMS AND AUTOMOBILE DRIVING IN A GENERAL POPULATION

Automobile accidents are reported as being overrepresented in those suffering from the obstructive sleep apnea syndrome (SAS), evident by snoring, sleep disturbances and diurnal hypersomnia. An estimation of the prevalence of these symptoms amongst an adult population, predominantly automobile drivers, was assessed by using a one-stage questionnaire procedure. From a national random sample of 1214 persons a weighted reply rate of 76% was achieved. Snoring, breath cessations, mid-sleep awakenings, and diurnal hypersomnia were reported in 24, 3.8, 27 and 9.1%, respectively. The maximum prevalence of SAS was estimated as 2.8-5.5% among men, aged 30-69 years, depending on definition used. Driving frequency in potential sleep apneics was similar to that of the entire population studied. Diurnal hypersomnia, considered a consequence of SAS, was reported as an overall 2.2%, corresponding to 100,000 automobile drivers in Sweden.

Simulated Long-Term Driving Performance before and after Uvulopalatopharyngoplasty

To investigate whether automobile drivers with the clinical features of sleep apnea syndrome (SAS) perform worse than controls in a simulated long-term test drive, and to see if their driving improves after uvulopalatopharyngoplasty (UPPP), 15 male drivers with SAS, suffering from sleep spells whilst driving, and 10 matched controls without a history of SAS or hypersomnia at the wheel were tested in an advanced driving simulator. Brake reaction time, lateral position deviation and off-road episodes were measured during a 90-min rural drive at twilight conditions. The clinical evaluation was made by a questionnaire scoring symptoms of snoring, sleep disturbances and diurnal sleepiness before and after surgery. Before UPPP the patient group showed impaired performance in all three effect measures compared to controls. UPPP resulted in improved reaction time performance (average mean improvement: 0.5 s, average 90th percentile improvement 0.8 s). Furthermore, 12 of the 15 patients reported a marked improvement regarding sleepiness whilst driving. For these clinically successful cases the number of off-road episodes decreased substantially. We conclude that most patients improve their long-term driving performance as a result of UPPP.

Long-Term Results after Septal Surgery – Submucous Resection versus Septoplasty

Postoperative controls, 5-9 years after surgery, were made in two groups of patients who had undergone submucous septal resection and septoplasty, respectively. The rate of subjective improvement after septoplasty was higher (77%) than after septal resection (66%). In the septoplasty group, however, the experienced surgeons had an improvement rate of 90%, whereas the untrained surgeons had no better results than after submucous septal resection. Postoperative complications, including septal perforation and deformation of the external nose, were significantly fewer after septoplasty. There were no clear-cut correlations between rhinoscopy findings and subjective results at postoperative examinations. The septoplasty technique is advocated, but in the hands of a trained surgeon.

Uvulopalatopharyngoplasty versus laser uvulopalatoplasty: prospective long-term follow-up of self-reported symptoms.

No study to date has prospectively compared the results of uvulopalatopharyngoplasty (UPPP) and CO 2 laser palatal surgery. This study investigates and compares outcomes in 121 consecutive patients suffering from rhonchopathy, the majority of whom reported apneas. Sixty-one patients underwent UPPP and 60 laser uvulopalatoplasty (LUPP). Patients were requested to assess the frequency of symptoms associated with obstructive sleep apnea syndrome prior to surgery, at 3-month follow-up and 5-8 years postoperatively. All symptoms were significantly improved for the two patient groups, both short and long term (p<0.01) although short-term results were generally better. However, UPPP was superior to LUPP in terms of all clinical effect parameters. Although patients treated with UPPP had more severe symptoms preoperatively they also had a better long-term outcome. Side-effects such as minor swallowing disturbances were frequent, using either surgical modality, but few patients were bothered if surgery was successful.

Voice Quality After Radiofrequency Volumetric Tissue Reduction of the Soft Palate in Habitual Snorers

Objective To evaluate whether radiofrequency volumetric tissue reduction of the soft palate is causing voice changes as a result of velopharyngeal insufficiency in patients with heavy snoring.