LETTER
Crashes and Violations among Older Drivers
Siraj O. Wali;
Morley Lertzman; and
Meir Kryger
1 June 1995 | Volume 122 Issue 11 | Page 885
TO THE EDITOR:
In the article by Marottoli and colleagues [1] about automobile crashes among elderly drivers, data were collected from 283 drivers on independent variables in demographic, health, psychosocial, activity, and physical performance. However, data should have been obtained about sleep disorders that are common in elderly persons, including sleep-disordered breathing, periodic leg movements, and poor sleep habits. These may result in excessive daytime somnolence, which may lead to automobile crashes [2].
Obstructive sleep apnea is present in 2% to 4% of the population in North America [3]. It increases with advancing age even in healthy elderly persons. It is the most common disorder seen in patients reporting excessive daytime somnolence, which is present in more than 90% of patients with obstructive sleep apnea. The apnea-hypopnea index is abnormal in 2.9% of 60-year-old persons, 33% of 70-year-old persons, and 39.5% of 80-year-old persons [4]. In patients with obstructive sleep apnea, the risk for having an automobile accident is about twice that of normal persons [5]. For this reason, physicians in most provinces of Canada are required to report patients with sleep disorders to the local licensing agencies for motor vehicles. Sleep-related disorders with subsequent daytime somnolence are common in elderly persons and should be considered when collecting data related to automobile accidents.
1. Marottoli RA, Cooney LM Jr, Wagner DR, Doucette J, Tinetti ME. Predictors of automobile crashes and moving violations among elderly drivers. Ann Intern Med. 1994; 121:842-6.
2. Sleep apnea, sleepiness and driving risk. Official Statement of American Thoracic Society. Am J Respir Crit Care Med. 1994; 150:1463-73.[Medline]
3. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. Occurrence of sleep disordered breathing among middle aged adults. N Engl J Med. 1993; 328:1230-5.
4. Hoch C, Reynolds CF 3d, Monk TH, Buysse DJ, Yeager AL, Houck PR, et al. Comparison of sleep disordered breathing among healthy elderly in the seventh, eighth, and ninth decades of life. Sleep. 1990; 13:502-11.
5. Findley LJ, Unverzagt ME, Suratt PM. Automobile accidents in patients with obstructive sleep apnea. Am Rev Resp Dis. 1988; 138:337-40.
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