Excessive sleepiness: too many coping strategies in the car can be a cause for concern

LEEDS: Whether it's rolling down the window, drinking coffee or singing, many drivers use a wide variety of strategies to stay alert at the wheel.

But if you use more than three of these coping strategies, it could mean that you're suffering from excessive sleepiness due to obstructive sleep apnea, and that you're at greater risk of road accidents, according to a new study from researchers in the UK.

France's National Institute of Health and Medical Research, Inserm, defines obstructive sleep apnea as being characterised by repeated, uncontrolled pauses in breathing during sleep.

These lead to incessant micro-wakings, of which the patient is unaware.

The scientific research organisation specifies that these pauses can last between 10 and 30 seconds, or even longer, that they can be repeated at least five times per hour of sleep.

Inserm says that age is a risk factor. More than three in 10 people over 65 are affected by the disorder, compared with 7.9% of 20-44 year-olds.

And obstructive sleep apnea is not without consequences, since it can lead to snoring, chronic fatigue and daytime drowsiness. Hence the importance of diagnosing those affected, to avoid exposing them to certain dangers, particularly on the road.

A team of researchers at St James's University Hospital in Leeds (UK) looked into the various tricks drivers use to stay alert at the wheel.

The aim was to find out whether this can make it easier to spot people suffering from obstructive sleep apnea.

"Up to one fifth of collisions on the road may be caused by fatigue or sleepiness. Many obstructive sleep apnea patients drive either for personal or for professional reasons and there is good evidence to suggest that some patients are at increased risk of collisions on the road," said study co-author, Dr Akshay Dwarakanath, quoted in a news release.

The research involved 119 people suffering from obstructive sleep apnea and receiving no treatment, whom the scientists compared with 105 people not suffering from the disorder.

All participants were asked to answer a questionnaire about their sleepiness in general, their drowsiness at the wheel, their use of any tricks to stay alert in the car (drinking tea or coffee, opening the window, turning on the radio, singing, eating, talking to themselves, or chewing gum).

They were also asked about their history of road accidents. Published in the journal ERJ Open Research from the European Respiratory Society, this study suggests that people suffering from obstructive sleep apnea are more likely to turn to these coping strategies to stay alert at the wheel than other participants.

In detail, almost three in ten (29.4%) sufferers reported "frequent" use of more than three of these coping strategies to stay alert. In comparison, none of the participants in the control group used more than three of these tricks.

"Our research suggests that untreated obstructive sleep apnea patients often use coping strategies that could be surrogate markers of sleepiness. Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately," said Dr Akshay.

In addition to snoring and excessive daytime sleepiness, those affected may also suffer from uncontrollable moments of sleep or impaired memory, mood and concentration, and may be more likely, in the long term, to develop cardiovascular disease.