The cost of motor vehicle accidents caused by obstructive sleep apnea syndrome in the Netherlands

1. Introduction Sleep apnea syndrome is characterised by an abnormal high level of respiratory arrests during sleep. There are two different pathways that will result in sleep apnea syndrome. With Central Sleep Apnea Syndrome (CSAS) the brain fails to give enough stimulation to the respiratory muscles responsible for the breathing motion. The other pathway is Obstructive Sleep Apnea Syndrome (OSAS), in this case the soft pharynx tissue and tongue muscles relax too much during sleep which causes an obstruction of the upper airway. The American Academy of Sleep Medicine task force composed worldwide-accepted OSAS criteria. An apnea is defined as a respiratory arrest for at least 10 consecutive seconds. To express the severity of apnea the Apnea Hypopnea Index is used (AHI). The arrests must occur at least five times per sleeping hour (AHI>5) to be qualified as apnea syndrome. Besides this patients must also experience extreme sleepiness during daytime or fulfil at least two of the 5 following criteria: concentration problems, daytime fatigue, unsatisfying sleep, multiple awakenings during sleep, choking or gasping during sleep. A polysomnography allows CSAS to be distinguished from OSAS. This sleep study collects data on activity of the heart, brain and respiratory muscles. In case of CSAS the respiratory muscles are not activated during an apnea.