The role of microsleeps to estimate sleepiness at the wheel and near-miss accidents in obstructive sleep apnea.

STUDY

OBJECTIVES

Obstructive sleep apnea is considered a risk factor for sleepiness at the wheel and near-miss accidents (NMA). To date, there are subjective and objective methods such as the Maintenance of Wakefulness Test (MWT) to investigate sleepiness. However, these methods have limitations. Therefore, a new analysis of the MWT was introduced based on the identification of microsleeps (MS). So, we tested MS analysis to improve the discriminative ability of MWT in recognizing individuals at risk for sleepiness at the wheel and NMA in a population with obstructive sleep apnea.

METHODS

The study was conducted on 100 naïve patients with suspected obstructive sleep apnea referred to our Sleep Medicine Unit. All patients performed a full standard polysomnography and MWT. The MWT was analyzed according to standard criteria, and the presence of MS episodes, the mean MS latency, and the MS density (the mean absolute or relative number of MS) were assessed.

RESULTS

MS were observed in 100% of alert or sleepy patients and 47% of the fully alert patients (P < .0001). Almost 90% of patients reporting NMA showed episodes of MS during MWT. The occurrence of NMA was related to excessive daytime sleepiness, MS latency, and MS density (P < .001). The discriminative power for the NMA of MS density measures was higher than that derived from latency analysis, particularly in patients without excessive daytime sleepiness and with a simultaneous mean sleep latency > 33 minutes.

CONCLUSIONS

MS analysis provides objective evidence of sleepiness and, therefore, could improve the discriminative ability of the MWT in recognizing individuals at high risk for accidents.

CITATION: Tondo P, Pronzato C, Risi I, et al. The role of microsleeps to estimate sleepiness at the wheel and near-miss accidents in obstructive sleep apnea. J Clin Sleep Med. 2025;21(2):287-295.