PubMed · 4675261
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I L Rowe. 1972-12-02. Multiphasic health screening.. https://doi.org/10.5694/j.1326-5377.1972.tb47596.x
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We provide a 25-fold range for the ecstacy-related death rate per 10,000 15-24-year-old users in the UK: from 0.2 to 5.3, compared with the death rate of 1.0 from road traffic accidents in the same age-group. The heroin-related death rate in 15-24-year-old heroin users was much higher, but also imprecisely estimated: from 9.1 to 81.5 deaths per 10,000 15-24-year-old users. Data deficiencies which inhibit the calculation of drug-specific rates in this population should be remedied.
Loss of attention with time-on-task reflects the increasing instability of the waking state during performance in experimentally induced sleepiness. To determine whether patients with disorders of excessive sleepiness also displayed time-on-task decrements indicative of wake state instability, visual sustained attention performance on "Steer Clear," a computerized simple RT driving simulation task, was compared among 31 patients with untreated sleep apnea, 16 patients with narcolepsy, and 14 healthy control subjects. Vigilance decrement functions were generated by analyzing the number of collisions in each of six four-minute periods of Steer Clear task performance in a mixed-model analysis of variance and linear regression equations. As expected, patients had more Steer Clear collisions than control subjects (p=0.006). However, the inter-subject variability in errors among the narcoleptic patients was four-fold that of the apnea patients, and 100-fold that of the controls volunteers; the variance in errors among untreated apnea patients was 27-times that of controls. The results of transformed collision data revealed main effects for group (p=0.006), time-on-task (p=0.001), and a significant interaction (p=0.022). Control subjects showed no clear evidence of increasing collision errors with time-on-task (adjusted R2=0.22), while apnea patients showed a trend toward vigilance decrement (adjusted R2=0.42, p=0.097), and narcolepsy patients evidenced a robust linear vigilance decrement (adjusted R2=0.87, p=0.004). The association of disorders of excessive somnolence with escalating time-on-task decrements makes it imperative that when assessment of neurobehavioral performance is conducted in patients, it involves task durations and analyses that will evaluate the underlying vulnerability of potentially sleepy patients to decrements over time in tasks that require sustained attention and timely responses, both of which are key components in safe driving performance.
BACKGROUND: As a group, patients with obstructive sleep apnea (OSA) are at increased risk of having automobile accidents. Previous studies using actual accident data have used only small numbers of subjects. OBJECTIVE: To determine the rate of automobile accidents in a large population of OSA patients using objective data from the Ministry of Transportation of Ontario (MTO). DESIGN: Retrospective study SETTING: Academic sleep disorders clinic and laboratory. PARTICIPANTS: All cases of OSA polygraphically confirmed between June 1990 and June 1994. INTERVENTIONS: Cases of OSA were a priori divided into groups based on apnea-hypopnea index (AHI): (OSA1 - AHI 10-25, OSA2 - AHI 26-40, OSA3 - AHI>40) and driving records were obtained from the MTO. Age and sex matched controls were selected at random from drivers in the MTO driver database who hold passenger vehicle licences. Analysis was restricted to drivers with the same licence class. MAIN OUTCOME MEASURES: Primary outcome measure was accidents in the five years preceding diagnosis. Secondary outcome was citations during the same period. RESULTS: There were 155 of 460 OSA patients with one or more accidents compared with 150 of 581 Controls for the same time period (x2=7.7,p<0.01). The rate of accidents/year, for the preceding five years, was 0.07+/-0.14 for Controls versus 0.09+/-0.14 for OSA (p <0.05). This difference could all be accounted for by increased accident rate in OSA patients with the highest AHI (OSA3) (MVA/yr: 0.11+/-0.15, 0.08+/-0.12, 0.06+/-0.14 for OSA groups 3,2,1 respectively) as there was no differences among Control, OSA1 and OSA2 accident rates. OSA patients had twice as many citations as Controls (1.74+/-2.13 vs 0.86+/-1.43 p<0.001) although the types of citation were the same. CONCLUSIONS: Increased automobile accidents in OSA may be restricted to cases with more severe apnea (AHI >40). Despite the large sample size (an order of magnitude greater than previous reports using accident data) further study is needed with even larger numbers, including more measures of disease severity and rigorously controlling for driving exposure.