Download PDF
CC BY-NC-ND 4.0 · Sleep Sci
DOI: 10.1055/s-0044-1782528
Original Article

Ten-Year Cardiovascular Risk Estimation through the Framingham Risk Score among Commercial Motor Vehicle Drivers with High and Low Risk of Obstructive Sleep Apnea

Navid Sharifi
1   Occupational Sleep Research Center, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Occupational Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
,
Arezu Najafi
1   Occupational Sleep Research Center, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3   Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
,
Zahra Banafsheh Alemohammad 
3   Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
,
Khosro Sadeghniiat-Haghighi
1   Occupational Sleep Research Center, Baharloo Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
3   Sleep Breathing Disorders Research Center, Tehran University of Medical Sciences, Tehran, Iran
› Author Affiliations Funding The authors declare that the Tehran University of Medical Sciences supported the present study.
› Further Information
   Permissions and Reprints

Abstract

Objective Obstructive sleep apnea (OSA) and cardiovascular disease (CVD) are both major medical causes of road accidents among commercial motor vehicle (CMV) drivers. The present study aimed to determine the association of the ten-year risk of developing CVD and other cardiac risk factors with the risk of developing OSA among apparently healthy CMV drivers.

Materials and Methods The present cross-sectional study was conducted on 315 male CMV drivers. Demographic characteristics were collected, and the Epworth Sleepiness Scale (ESS), the Snoring, Tiredness, Observed Apnea, High Blood Pressure, Body Mass Index (BMI) > 35 kg/m2, Age > 50 Years, Neck Circumference > 40 cm, and Male Gender (STOP-Bang) questionnaire, and International Physical Activity Questionnaire-Short Form (IPAQ-SF) were filled out, and the ten-year CVD risk was calculated through the Framingham Risk Score (FRS) for each individual. Laboratory tests also were performed. The participants were divided into two groups based on the STOP-Bang score and FRS, and other CVD risk factors were compared, accordingly. The Chi-squared test, the Student t-test, analysis of variance (ANOVA), and logistic regression were used for the analysis.

Results The mean age of the drivers was of 45.57 (range: 30 to 70) years. In the univariate analysis, the mean age, years of driving experience, FRS, vascular age, blood pressure, diabetes mellitus, metabolic syndrome, ESS score, BMI, and circumference of the waist and hip presented a significant association with STOP-Bang score ≥ 3 (p < 0.05). The metabolic equivalents of task (METs) for total physical activity and walking (min/week), time spent sitting (h/day), lipid profiles, smoking history, vehicle type, and shift type were statistically similar in both groups. In the multivariate analysis, a high risk of OSA was independently associated with higher FRS (odds ratio: 1.92; p < 0.001).

Conclusion The STOP-Bang score presented a direct correlation with the estimated ten-year CVD risk in CMV drivers. The high risk of developing OSA among CMV drivers is accompanied by higher CVD risk factors such as old age, diabetes, hypertension, BMI, and waist and hip circumference. The FRS was statistically higher in CMV drivers with high OSA risk.

Keywords

commercial motor vehicle drivers - obstructive sleep apnea - Framingham risk score - cardiovascular disease - STOP-Bang questionnaire - International Physical Activity Questionnaire-Short Form


Publication History

Received: 08 November 2021

Accepted: 31 January 2024

Article published online:
15 May 2024

© 2024. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 World Health Organization.. Global status report on road safety 218: summary. Geneva:: World Health Organization.; 2018
    Google Scholar
  • 2 NTSB U. Fatigue, Alcohol, Other Drugs, and Medical Factors in Fatal-to-the-Driver Heavy Truck Crashes. Washington DC NTSB Safety Study. 1990
    PubMedGoogle Scholar
  • 3 Büttner A, Heimpel M, Eisenmenger W. Sudden natural death ‘at the wheel’: a retrospective study over a 15-year time period (1982-1996). Forensic Sci Int 1999; 103 (02) 101-112
    CrossrefPubMedGoogle Scholar
  • 4 Empana J-P, Boulanger CM, Tafflet M. et al. Microparticles and sudden cardiac death due to coronary occlusion. The TIDE (Thrombus and Inflammation in sudden DEath) study. Eur Heart J Acute Cardiovasc Care 2015; 4 (01) 28-36
    CrossrefPubMedGoogle Scholar
  • 5 Stecker EC, Vickers C, Waltz J. et al. Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: two-year findings from the Oregon Sudden Unexpected Death Study. J Am Coll Cardiol 2006; 47 (06) 1161-1166
    CrossrefPubMedGoogle Scholar
  • 6 Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014; 146 (05) 1387-1394
    CrossrefPubMedGoogle Scholar
  • 7 Gurubhagavatula I, Sullivan S, Meoli A. et al. Management of obstructive sleep apnea in commercial motor vehicle operators: recommendations of the AASM Sleep and Transportation Safety Awareness Task Force. J Clin Sleep Med 2017; 13 (05) 745-758
    CrossrefPubMedGoogle Scholar
  • 8 Strohl KP, Brown DB, Collop N. et al; ATS Ad Hoc Committee on Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers. An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 Statement. Am J Respir Crit Care Med 2013; 187 (11) 1259-1266
    CrossrefPubMedGoogle Scholar
  • 9 Powell NB, Riley RW, Schechtman KB, Blumen MB, Dinges DF, Guilleminault C. A comparative model: reaction time performance in sleep-disordered breathing versus alcohol-impaired controls. Laryngoscope 1999; 109 (10) 1648-1654
    CrossrefPubMedGoogle Scholar
  • 10 Roehrs T, Beare D, Zorick F, Roth T. Sleepiness and ethanol effects on simulated driving. Alcohol Clin Exp Res 1994; 18 (01) 154-158
    CrossrefPubMedGoogle Scholar
  • 11 Wallace A, Bucks RS. Memory and obstructive sleep apnea: a meta-analysis. Sleep 2013; 36 (02) 203-220
    CrossrefPubMedGoogle Scholar
  • 12 Yaffe K, Laffan AM, Harrison SL. et al. Sleep-disordered breathing, hypoxia, and risk of mild cognitive impairment and dementia in older women. JAMA 2011; 306 (06) 613-619
    CrossrefPubMedGoogle Scholar
  • 13 Olaithe M, Bucks RS. Executive dysfunction in OSA before and after treatment: a meta-analysis. Sleep 2013; 36 (09) 1297-1305
    CrossrefPubMedGoogle Scholar
  • 14 Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342 (19) 1378-1384
    CrossrefPubMedGoogle Scholar
  • 15 Punjabi NM, Caffo BS, Goodwin JL. et al. Sleep-disordered breathing and mortality: a prospective cohort study. PLoS Med 2009; 6 (08) e1000132
    CrossrefPubMedGoogle Scholar
  • 16 Gottlieb DJ, Yenokyan G, Newman AB. et al. CLINICAL PERSPECTIVE. Circulation 2010; 122 (04) 352-360
    CrossrefPubMedGoogle Scholar
  • 17 Cadby G, McArdle N, Briffa T. et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest 2015; 148 (04) 945-952
    CrossrefPubMedGoogle Scholar
  • 18 Redline S, Yenokyan G, Gottlieb DJ. et al. Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 2010; 182 (02) 269-277
    CrossrefPubMedGoogle Scholar
  • 19 Brooks B, Cistulli PA, Borkman M. et al. Obstructive sleep apnea in obese noninsulin-dependent diabetic patients: effect of continuous positive airway pressure treatment on insulin responsiveness. J Clin Endocrinol Metab 1994; 79 (06) 1681-1685
    PubMedGoogle Scholar
  • 20 Carlson JT, Hedner JA, Ejnell H, Peterson L-E. High prevalence of hypertension in sleep apnea patients independent of obesity. Am J Respir Crit Care Med 1994; 150 (01) 72-77
    CrossrefPubMedGoogle Scholar
  • 21 Jennum P, Sjøl A. Snoring, sleep apnoea and cardiovascular risk factors: the MONICA II Study. Int J Epidemiol 1993; 22 (03) 439-444
    CrossrefPubMedGoogle Scholar
  • 22 Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365 (9464) 1046-1053
    CrossrefPubMedGoogle Scholar
  • 23 Chami HA, Resnick HE, Quan SF, Gottlieb DJ. Association of incident cardiovascular disease with progression of sleep-disordered breathing. Circulation 2011; 123 (12) 1280-1286
    CrossrefPubMedGoogle Scholar
  • 24 D'Agostino Sr RB, Vasan RS, Pencina MJ. et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008; 117 (06) 743-753
    CrossrefPubMedGoogle Scholar
  • 25 Association AD. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33 (Suppl 1, Suppl 1) S62-S69
    CrossrefPubMedGoogle Scholar
  • 26 Marfell-Jones MJ, Stewart A, De Ridder J. International standards for anthropometric assessment 2012
    PubMed
  • 27 World Health Organization.. Waist circumference and waist-hip ratio: report of a WHO expert consultation,. Geneva, 8–11 December 2008. 2011
    Google Scholar
  • 28 Chobanian AV, Bakris GL, Black HR. et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289 (19) 2560-2572
    CrossrefPubMedGoogle Scholar
  • 29 Series CC, Challenge E, Mind OM, Doodle C. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106 (25) 3143-3421
    CrossrefPubMedGoogle Scholar
  • 30 Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI-P). Sleep Breath 2012; 16 (01) 79-82
    CrossrefPubMedGoogle Scholar
  • 31 Nagappa M, Liao P, Wong J. et al. Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PLoS One 2015; 10 (12) e0143697
    CrossrefPubMedGoogle Scholar
  • 32 Chen L, Pivetta B, Nagappa M. et al. Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep Breath 2021; 25 (04) 1741-1751
    CrossrefPubMedGoogle Scholar
  • 33 Sadeghniiat-Haghighi K, Montazeri A, Khajeh-Mehrizi A. et al. The STOP-BANG questionnaire: reliability and validity of the Persian version in sleep clinic population. Qual Life Res 2015; 24 (08) 2025-2030
    CrossrefPubMedGoogle Scholar
  • 34 Chung F, Yang Y, Brown R, Liao P. Alternative scoring models of STOP-bang questionnaire improve specificity to detect undiagnosed obstructive sleep apnea. J Clin Sleep Med 2014; 10 (09) 951-958
    CrossrefPubMedGoogle Scholar
  • 35 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (06) 540-545
    CrossrefPubMedGoogle Scholar
  • 36 Sadeghniiat Haghighi K, Montazeri A, Khajeh Mehrizi A. et al. The Epworth Sleepiness Scale: translation and validation study of the Iranian version. Sleep Breath 2013; 17 (01) 419-426
    CrossrefPubMedGoogle Scholar
  • 37 Moghaddam MB, Aghdam FB, Jafarabadi MA, Allahverdipour H, Nikookheslat SD, Safarpour S. The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability. World Appl Sci J 2012; 18 (08) 1073-1080
    Google Scholar
  • 38 Shahar E, Whitney CW, Redline S. et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001; 163 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 39 Archontogeorgis K, Voulgaris A, Nena E. et al. Cardiovascular risk assessment in a cohort of newly diagnosed patients with obstructive sleep apnea syndrome. Cardiol Res Pract 2018; 2018: 6572785
    CrossrefPubMedGoogle Scholar
  • 40 Cho J, Choi SM, Park YS. et al. Prediction of cardiopulmonary events using the STOP-Bang questionnaire in patients undergoing bronchoscopy with moderate sedation. Sci Rep 2020; 10 (01) 14471
    CrossrefPubMedGoogle Scholar
  • 41 Ebrahimi MH, Jahanfar S, Shayestefar M. The Relationship between the Metabolic Syndrome and the Risk of Obstructive Sleep Apnea Evaluated by STOP-Bang Questionnaire in Professional Drivers in Shahroud, Iran, in 2020: A Case-Control Study. J Obes Metab Syndr 2021; 30 (01) 55-62
    CrossrefPubMedGoogle Scholar
  • 42 Hall KA, Singh M, Mukherjee S, Palmer LJ. Physical activity is associated with reduced prevalence of self-reported obstructive sleep apnea in a large, general population cohort study. J Clin Sleep Med 2020; 16 (07) 1179-1187
    CrossrefPubMedGoogle Scholar
  • 43 Esen AD, Akpinar M. Relevance of obstructive sleep apnea and smoking: Obstructive sleep apnea and smoking. Fam Pract 2021; 38 (02) 181-186
    PubMedGoogle Scholar
  • 44 Hsu W-Y, Chiu N-Y, Chang C-C, Chang T-G, Lane H-Y. The association between cigarette smoking and obstructive sleep apnea. Tob Induc Dis 2019; 17: 27
    PubMedGoogle Scholar
  • 45 Hoflstein V. Relationship between smoking and sleep apnea in clinic population. Sleep 2002; 25 (05) 519-524
    PubMedGoogle Scholar
  • 46 Bielicki P, Trojnar A, Sobieraj P. The impact of smoking status on obstructive sleep apnea (OSA) severity. Eur Respiratory Soc; 2018
    CrossrefGoogle Scholar
  • 47 Lloyd-Jones DM, Allen NB, Anderson CAM. et al; American Heart Association. Life's Essential 8: Updating and Enhancing the American Heart Association's Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association. Circulation 2022; 146 (05) e18-e43 DOI: 10.1161/CIR.
    CrossrefGoogle Scholar
  • 48 Sadeghniiat-Haghighi K, Moller HJ, Saraei M, Aminian O, Khajeh-Mehrizi A. The Epworth Sleepiness Scale for screening of the drowsy driving: comparison with the maintenance of wakefulness test in an Iranian sample of commercial drivers. Acta Med Iran 2014; 52 (02) 125-129
    PubMedGoogle Scholar