Sleep Apnea, reason behind Bappi Lahiri's death, a major contributor to road accidents in India

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Sleep disorders are a common phenomenon in today's day and age, given the unhealthy lifestyle. Recently singer-musician Bappi Lahri passed away at the age of 69 due to Obstructive Sleep Apnea (OSA). Lahiri, known as ‘Disco King’ for introducing and popularising synthesised disco music in India, was admitted to Mumbai's CritiCare Hospital in Juhu. Unfortunately, deficient diet, stress, anxiety, and a harmful sleep schedule form a considerable part of our life today, which can easily pave the way for them.

Among the most common sleep disorders is Obstructive Sleep Apnea (OSA), which has impacted more than a billion people worldwide. People with sleep apnea don't get a good night's sleep and drive fatigued, making it dangerous and one of the leading causes of road accidents. To better understand how OSA is connected to road accidents, first, let us understand what OSA is. We recently got in touch with Dr. Sibasish Dey, Head, Medical Affairs, Asia, and Latin America, ResMed to understand OSA.

What is Obstructive Sleep Apnea?

In simple words, OSA is a sleep breathing disorder that causes blockage of breathing for a few seconds while the patient is asleep due to obstruction of the upper airway. This phenomenon causes the patient to wake up abruptly in the middle of the night gasping for air, thus disturbing their sleep. Multiple such apneas at night impact the patient's sleep quality, causing them to wake up with morning headaches, not feeling rested enough.

Such incidences at night cause loss of productivity during the day, and in many severe cases, impact the patient's neurocognitive functioning. Morning headaches, daytime sleepiness, and fatigue are common sleep apnea symptoms. And although it is a common sleep disorder, most people are not aware of it, and over 80% of the patients go undiagnosed.

Usually, we tend to counter our sleepiness with a dose of caffeine, but such practices can have dire consequences in the long run. Scientifically, our body takes over four days to recover from the loss of an hour of sleep. Such habits significantly impact road safety and put the driver's life at risk and the others on the road and their families. Since road safety is a leading cause of death in India, its causes need significant attention, so it is crucial to raise awareness about OSA.

How is OSA related to road safety?

It is a basic understanding that a good driver needs to have all his attention on the road while driving. Drowsy drivers can cause fatal accidents. According to a Swedish survey, patients with OSA had a 2.3 – 2.6 times higher risk of road traffic accidents than the general population. The daytime sleepiness and drowsiness induced by OSA can cause driver inattention and lead to dangerous consequences. Even a tiny amount of sleep loss can have measurable outcomes.

E.g., just five hours of sleep for four consecutive nights impairs task performance to the same degree as blood alcohol level of 0.6%. In another study by the World Bank, sleep disorders increase the risk of road accidents by 300%, with research indicating that approximately 4.3% of all motor vehicle accidents and 4.5% of all workplace injuries are attributable to OSA.

Several other studies have revealed that OSA patients have an elevated risk of falling asleep while driving and are highly likely to cause accidents. For example, in research published in Neurology India, over 20% of all road accident victims were found suffering from sleep-disordered breathing (SDB) and OSA. Moreover, drowsy driver accidents are more dangerous, as drivers do not take adequate measures to save themselves right before the incident due to inattentiveness.

The situation in India is alarming as truck drivers cause most road traffic accidents. These drivers follow an unhealthy lifestyle due to their professional requirements and lack of government regulations in that sector. They are frequently subjected to long working hours and driver for 15-16 hours at a stretch, mainly during the night (as the regulations vary from state to state).

In a study conducted at KGMU-Lucknow, nearly 23% of truck drivers suffered from obstructive sleep apnea. India only makes up 1% of vehicles globally yet accounts for 11% of deaths due to road accidents worldwide. On average, India witnesses an average of 4.5 lakh road accidents every year, claiming around 1.5 lakh lives, corresponding to about 53 road accidents every 4 minutes and a person killed.

How can the situation be tackled in India?

There are various examples of policies abroad that India could learn from to tackle the problem. For instance, in the United States, President Obama passed a bill calling on the Federal Motor Carrier Safety Administration (FMSCA) to define rules for sleep apnea testing for commercial drivers. The legislation required the Federal Motor Carrier Safety Administration (FMSCA) to pursue a rule-making process requiring testing commercial truck and bus drivers for sleep apnea as part of their medical certification.

Even in countries such as Japan and Malaysia, the governments have considered sleep testing an essential step for commercial drivers and even require yearly re-testing in some countries.

Given that sleep awareness is low in India, a centralised campaign on the importance of a healthy sleep cycle is a critical requirement to prevent future losses. Drivers, especially commercial drivers, need to be made aware of the dire consequences of OSA, the importance of testing and the treatment required. Given the advancement of home care a remote monitoring technology, sleep testing is possible at home today, with devices such as the onesleeptest by Ectosense.

However, truck drivers can resort to the STOP-BANG questionnaire, which is inexpensive compared to the other testing mediums. A good sleep cycle for drivers can go a long way in saving lives in India.