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

Sharifi, Navid; Najafi, Arezu; Alemohammad, Zahra Banafsheh; Sadeghniiat-Haghighi, Khosro · 2025 · Crossref

DOI: 10.1055/s-0044-1782528

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Summary

This cross-sectional study investigated the association between the risk of obstructive sleep apnea (OSA) and the ten-year risk of cardiovascular disease (CVD) among commercial motor vehicle (CMV) drivers. The research was motivated by the significant role OSA and CVD play in road accidents, particularly among professional drivers who may not report symptoms during health license renewations. The study aimed to determine if OSA risk, as measured by screening tools, correlates with estimated CVD risk and other cardiac risk factors in apparently healthy drivers. The study included 315 male CMV drivers aged 30 to 70 years who were undergoing Commercial Drivers Health License renewal at a clinic in Tehran, Iran. Participants were excluded if they had a history of physician-diagnosed CVD, significant clinical signs of CVD, or used medications affecting consciousness. Data collection involved demographic surveys, physical examinations (including blood pressure, BMI, and circumferences), and laboratory tests for lipid profiles and glucose. OSA risk was assessed using the STOP-Bang questionnaire, while the ten-year CVD risk was calculated using the Framingham Risk Score (FRS). Additional measures included the Epworth Sleepiness Scale and the International Physical Activity Questionnaire. Participants were categorized into high and low OSA risk groups based on a STOP-Bang cutoff score of ≥3. Statistical analyses included t-tests, ANOVA, Chi-squared tests, and logistic regression to adjust for confounding factors. The results indicated that drivers with a high risk of OSA were significantly older and had more years of driving experience than those with low risk. Key CVD risk factors, including body mass index, waist and hip circumference, blood pressure, fasting blood sugar, diabetes mellitus, and metabolic syndrome, were significantly higher in the high-OSA-risk group. The mean FRS and vascular age were also significantly higher in this group. Specifically, 34.9% of high-OSA-risk drivers were classified as having high CVD risk, compared to only 8.6% of low-OSA-risk drivers. Multivariate logistic regression analysis revealed that a high STOP-Bang score was independently associated with a higher ten-year FRS (odds ratio: 1.92; p < 0.001), even after adjusting for age, hypertension, fasting blood sugar, triglycerides, and LDL cholesterol. Physical activity levels and smoking history did not differ significantly between the groups. The study concludes that there is a direct correlation between OSA risk and estimated ten-year CVD risk in CMV drivers. High OSA risk is accompanied by a cluster of cardiovascular risk factors, including older age, hypertension, diabetes, and obesity. The findings suggest that the STOP-Bang questionnaire is a valuable, accessible tool for occupational medicine specialists to identify drivers at high risk for both OSA and CVD. This screening can help mitigate safety risks in safety-critical jobs by identifying individuals who may require further medical evaluation or intervention, thereby addressing a significant cause of road accidents.

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• medical conditions