CASE STUDY

Mucormycosis has increasingly been seen in Covid positive and recovered patients, among others, of late. Recovered patients are advised to stay in contact with doctors and immediately inform them in case of black fungus-related symptoms, asserts top doctors and health experts. Early detection will aid prompt treatment of this fungal disease.

TREATMENT Antifungals Amphotericin B and surgical debridement. Steroids and globulins can also help tackle the infection.

A rare fungal infection affecting 1 in 10 lakh people, mucormycosis or black fungus is gradually taking the country into its grip. What is this black fungus? How does it spread in the body? Is there any link between mucormycosis and Covid-19? Top doctors and health experts answer common queries ranging from signs and symptoms to causes to prevention and treatment. 

There is no official number of mucormycosis cases in India; however, estimation of fungal burden in India using computational models by international health experts predicts around 1,750 to 2,500 cases of mucormycosis daily in India. This is just a predictive model so the actual number may be higher.

Dr Atul Mittal, Director & HoD, Department of ENT, Head & Neck Surgery, Fortis Memorial Research Institute, Gurugram; Dr Manjunath Malige, Chief Endocrinologist and Diabetologist, Aster RV Hospital, Bengaluru; Dr Behram Pardiwala – Internal Medicine, Wockhardt Hospital Mumbai Central; Dr Deepak Jaiswal, Consultant Physician and Incharge Covid Care, Shri Balaji Hospital, Raipur; Dr Santosh Sivaswamy, Consultant – ENT, Columbia Asia Hospital Hebbal (A unit of Manipal Hospitals), Bengaluru; Dr ChandraVeer Singh, Consultant, Otorhinolaryngologist and Head & Neck Onco Surgeon, Wockhardt Hospital Mira Road, Mumbai; Dr Sanjay Dhawan, Director & Head – Ophthalmology, Max Super Speciality Hospital, Delhi and Gurugram; Dr Amitabh Malik, Chief, ENT Department, Paras Hospitals, Gurugram; Dr Mubasheer Ali, Senior Internal Medicine Consultant, Apollo TeleHealth; and Dr Bhavika Verma Bhatt, Consultant ENT Surgeon and Medical Consultant- ENTOD International share all that they know about black fungus. 

Q. What is black fungus? What causes it? How is it linked with Covid-19?

Dr Atul Mittal: Mucormycosis or Black Fungus is a rare fungal infection that affects the sinuses, the brain, and the lungs. It can be life-threatening in diabetic or severely immune-compromised individuals such as cancer patients or people with HIV/AIDS.

In the current scenario, the infection is especially affecting Covid patients with weakened immunity due to comorbidities like diabetes, cancer, and kidney or heart failure. Steroids are the cornerstone of Covid treatment, helping to reduce inflammation in the lungs and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive, referred to as cytokine storm, to fight off coronavirus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid patients. It’s thought that this drop in immunity could be triggering these cases of mucormycosis.

Q. What are the warning signs and symptoms of this fungal infection? Which organs can it infect?

Dr Manjunath Malige: During the second wave of the Covid-19 pandemic, it has been found that there is a sudden increase in the cases of mucormycosis across the country. Some of the early symptoms are obstruction in the nose, unexplainable headache even after post-Covid recovery, pain in the teeth, numbness in the face, vision difficulties or loss of vision, local pain in ear, nose or orbital region, nose blocks experienced more towards one side, etc. In case a Covid positive patient experiences any of these symptoms, he/she must inform the treating doctor so that intervention measures can be introduced at the earliest. This infection mainly affects the sinus cavity and lungs and can spread to the brain. In some cases, if left untreated, it can affect the digestive system, heart, skin, or other organs in the body. Once you overcome the disease and are Covid-free, please do stay in touch with your endocrinologist to ensure that your health is well-monitored and there is no risk of developing severe mucormycosis.

Q. What is the possible reason behind the increasing number of mucormycosis cases in the country? What can be done to curb its spread?

Dr Behram Pardiwala: In Covid-19 we use steroids as part of therapy and it worsens preexisting diabetes. This is a very good nidus for the black fungus to grow. The only way that you can prevent the black fungus from growing is to control the patient’s diabetes very strictly. Further, one must have a high degree of suspicion for the existence of the fungus and look out for it in almost all diabetics. And when the black fungus is diagnosed it is imperative that you hit it very hard with appropriate drugs before it is allowed to spread.

Q. How can the possibility of black fungus be stalled amongst Covid-19 patients—both who are being treated and those who have recovered?

Dr Deepak Jaiswal: The chances of this fungus infection have increased in patients with weak immune systems, on long term immunosuppressive drugs and steroids, Covid-19 positive and diabetic. Such patients can get affected by mucormycosis. There is nothing like all Covid positive patients will be affected. In case you get infected by it, proper diagnosis and treatment are crucial. If any Covid patient experiences any black fungus-related symptoms, then they should consult the doctor immediately. Mucormycosis is a medical emergency with high morbidity and mortality. A team approach is required with specialist microbiologist, histopathologist, intensivist, neurologist, ENT specialist, ophthalmologist, dentist, surgeon and radiologist.

Q. Can you tell us about the people who are more prone to developing mucormycosis? Can they take any precautions?

Dr Santosh Sivaswamy: Mucormycosis is a deadly fungal disease. With increasing Covid-19 cases, we are witnessing a lot of patients coming to us with mucormycosis condition post-Covid-19 infection. We had seen quite a few cases during the first Covid wave as well. This infection can develop when there is an increase in the usage of steroids and uncontrolled diabetes. Not only do these two factors contribute to the occurrence of the mucormycosis, but other factors like age, high ferritin levels in the blood, usage of unrationalised antibiotics, and the rate of overall immunosuppression of the patients can also lead to this infection. The incidence of mucormycosis is most commonly seen in the coastal belts and people with uncontrolled diabetes. A hot and humid climate is one of the reasons to develop this infection. To prevent patients from developing this infection, it is advised to avoid high steroid dosages, blood sugar control, Covid-appropriate behaviour, and rationalised use of antibiotics.

Q. What is the treatment for this fungal disease?

Dr ChandraVeer Singh: Antifungals Amphotericin B and surgical debridement wherein surgery is done to remove all fungus debris help treat the black fungus. Steroids and globulins can also help tackle the infection. However, the treatment may vary from person to person. 

Q. Is mucormycosis also affecting young people?

Dr Bhavika Verma Bhatt: No, mucormycosis is rare, but it’s more common among people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. Black fungus generally affects Covid-19 recovered patients who have other comorbidities like diabetes, kidney or heart failure, cancer as well as patients who are on steroids or have had a transplant, irrespective of their age. However, it is most common in diabetic patients, as per the Centers for Disease Control and Prevention (CDC) of the United States.

Dr Mubasheer Ali: There is no specific age group who are more susceptible but mainly it affects people with diabetes mellitus and other immunodeficiency disorders. Though there is no official number of mucormycosis cases in India, estimation of fungal burden in India using computational models by international health experts predicts around 1,750 to 2,500 cases of mucormycosis daily in India. This is just a predictive model so the actual number may be higher.

Dr Amitabh Malik: It is affecting young people also with all age groups, who have recovered from Covid-19. Vulnerable groups include people who have health problems or take medicines that lower the body’s ability to fight germs and sickness. These include those with diabetes, cancer, or people who have had organ transplants.

Q. What can be the repercussions if this fungal disease spreads to the lungs?

Dr Sanjay Dhawan: In the cases that I have come across and treated so far, it hasn’t reached the lungs. The Black fungus is an opportunistic pathogen that affects and invades the body only when its defences are low, otherwise, it will not as this fungus is always there in the environment at all times. It starts spreading from the nasal sinus and move upwards to the eyes and then the brain. The fungus forms a layer on the surface of paranasal sinus walls (hollow air spaces), it doesn’t go into the tissues directly. It first grows in the walls of the sinuses and from there it starts taking nutrition from the walls of sinuses and begins invading the blood vessels, causing blockage in blood vessels and thereby deriving nutrition for itself. It doesn’t go into the tissues directly. This is also the reason why the drugs given or even injected intravenously do not reach the body of the fungus and thus, surgical debridement is needed. We are using a new technique at our hospital whereby we are able to save the eyeball and structures around the eye to some extent, we introduce a special device into the orbit and directly deliver the drug into the orbit. But it is possible only in early cases and not in advanced ones. After surgical debridement, we treat the patients with an intravenous high dose of antifungal drugs that are quite toxic. 

Q. In what scenario do you have to surgically remove the eye or the jaw bone to stop the spread of the black fungus?

Dr Ali: Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proves successful in most of the cases of mucormycosis. Appropriate surgical intervention prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. In the present scenario where mucormycosis has a high mortality rate, anti-fungal therapy should be used secondarily or as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

Rhinocerebral or rhino-orbito cerebral (mucormycosis) usually occurs among patients with poorly controlled diabetes mellitus (especially those with ketoacidosis), in patients undergoing treatment with glucocorticosteroid agents, or in post-Covid patients who were on immune modulators and long term oxygen therapy. The fungus may spread to invade the palate, sphenoid sinus, cavernous sinus, orbits, or cranially to invade the brain. Pain and swelling precede oral ulceration and the resulting tissue necrosis can result in palatal perforation. Infection can sometimes extend from the sinuses into the mouth and produce painful, necrotic ulceration of the hard palate. If untreated, infection usually spreads from the ethmoid sinus to the orbit, resulting in the loss of extraocular muscle function and proptosis. Surgical treatment includes the resection of involved tissues of the face, including skin and muscle, any skin of the nose that is involved, maxillary and ethmoid sinuses, necrotic tissue of the temporal area and infratemporal fossa, and orbital exenteration along with the mandibular part. The keys to successful therapy include early diagnosis and early recognition of the signs and symptoms and complications, correction of underlying medical disorders and quick surgical intervention. An aggressive surgical approach has appeared to enhance survival in many scientific studies conducted.

Dr Bhatt: While it is treated with antifungal drugs, mucormycosis may eventually require surgery. This disease affects the tooth, eye, and sinus. Involvement of the eye is an advanced stage that starts affecting the nervous system, thus the removal of the eye takes place.

So, it is of utmost importance to control diabetes, reduce steroid use, and discontinue immunomodulating drugs. To maintain adequate systemic hydration, the treatment includes an infusion of normal saline (IV) before the infusion of amphotericin B and antifungal therapy, for at least four to six weeks.

Dr Malik: The eye is cosmetically preserved but the dead tissue is removed around the eyeball in the Endoscopic Endonasal approach which is currently being practised. Removal of Jawbone is done if the disease spread involves the bone.

Q. What are your views on the severity and the frequency of this disease?

Dr Malik: Mucormycosis, has an overall mortality rate of 50%, maybe triggered by the use of steroids, a life-saving treatment is done in case of severe and critically ill Covid-19 patients with this disease. Steroids reduce inflammation in the lungs for Covid-19 patients and appear to help stop some of the damage that can happen when the body’s immune system goes into overdrive to fight off the virus. But they also reduce immunity and push up blood sugar levels in both diabetics and non-diabetic Covid-19 patients. The drop in immunity could be triggering these cases of mucormycosis.

 Dr Ali: Complications of mucormycosis can be dire: blindness, organ dysfunction, loss of body tissue due to infection and debridement, and death. Its prognosis (outcomes) range from fair to poor. So the early detection of the signs and symptoms and early intervention will have a better outcome.

Dr Bhatt: Eight out of 200 patients treated so far in various parts of Maharashtra have died due to black fungus. They survived Covid-19 but the fungal infection attacked their weak immune system which proved fatal.

Also, Delhi’s Sir Ganga Ram Hospital has reported a rise in the number of Covid-induced mucormycosis cases. Sir Ganga Ram Hospital in New Delhi reported over 15 cases of mucormycosis amongst patients on the path to recovery who had been admitted to the Covid-19 ward.

In Gujarat, more than 100 cases of black fungus have been notified across state government hospitals and Gujarat Medical Education Research Society (GMERS) hospitals. Currently, Ahmedabad’s Zydus Hospital has around 40 such patients while Vadodara’s SSG hospital is treating 35 patients.

We had a Covid-19 patient who was a diabetic and on admission, his fasting sugar was around 200 and post-lunch it was 300 and HbA1c 9.6. He had temperature also and we started giving him remdesivir immediately and also started giving him rapid-acting insulin. The saturation on admission was about 97-98 with two litres of oxygen on the first day. By the second day, oxygen came down further and the patient still had a high temperature. Under these circumstances, we decided to shift him to ICU overnight as he was deteriorating rapidly. We gave him a high flow of nasal oxygen. With the high flow of nasal oxygen, gradually the patient started improving, we continued with the insulin and brought the sugar under control. After 72 hrs in ICU, we shifted him to a ward where we maintained nasal prong oxygen and his saturation was about 96-97% with two litres of oxygen. Gradually it improved until the three-minute walk showed a saturation of 97%. At the time of discharge, he had a headache. But after the discharge, he started complaining about pain in the head and behind the eye, which was alarming. We called him in immediately. His eye was red. We did a CT Scan immediately, we discovered that he had mucormycosis. His sugar at that time was a little high and we got him admitted and started giving him intravenous amphotericin for 15 days and he recovered rapidly. A repeat scan showed almost complete resolution, shares Dr Behram Pardiwala – Internal Medicine, Wockhardt Hospital Mumbai Central.

New research led by Swansea University says appreciating nature can have a positive impact on our well-being.

The ability to connect and feel a sense of belonging are basic human needs but new research has examined how these are determined by more than just our personal relationships. Psychologist Professor Andrew Kemp, of the College of Human and Health Sciences, worked with PhD student Jess Mead and consultant clinical psychologist Dr Zoe Fisher, of the University’s Health and Wellbeing Academy, on the study which presents a transdisciplinary framework to help understand and improve wellbeing.

Professor Kemp said: “We define wellbeing as a positive psychological experience, promoted by connections to self, community and environment, supported by healthy vagal function, all of which are impacted by socio-contextual factors that lie beyond the control of the individual.”

The researchers say their latest findings, which have just been published in Frontiers in Psychology, are particularly topical as society looks to recover and learn from COVID-19.

He said: “Our framework has already contributed to a better understanding of how to protect wellbeing during the pandemic and has led to the development of an innovative wellbeing science intervention, targeting university students and people living with acquired brain injury.”

Professor Kemp added: “We feel our invited paper is timely as it not only aligns with a post-pandemic future that requires societal transformation, but it also picks up on global efforts to promote planetary wellbeing.”

“Globalisation, urbanisation and technological advancements have meant that humans have become increasingly disconnected from nature. This continues despite research showing that contact with nature improves wellbeing.”

The research reveals the advantages to health and wellbeing derived from connecting to oneself, others and nature and emphasises a need for focused efforts to tackle major societal issues that affect our capacity for connection.”

He added: “The poorest are disproportionally impacted by major societal challenges including the increasing burden of chronic disease, societal loneliness and anthropogenic climate change.”

“Economic inequality has adverse impacts on the entire population, not just the poor, so improving economic inequality is fundamental to improving population wellbeing.”

A new study has found that college students who are under pressure may bust their stress by spending time petting a therapy dog.

The study was published in AERA Open, a peer-reviewed journal of the American Educational Research Association. According to the new Washington State University research, programs exclusively focused on petting therapy dogs improved stressed-out students’ thinking and planning skills more effectively than programs that included traditional stress-management information.

The study demonstrated that stressed students still exhibited these cognitive skills improvements up to six weeks after completion of the four-week-long program.

“It’s a really powerful finding,” said Patricia Pendry, associate professor in WSU’s Department of Human Development.

“Universities are doing a lot of great work trying to help students succeed academically, especially those who may be at risk due to a history of mental health issues or academic and learning issues. This study shows that traditional stress management approaches aren’t as effective for this population compared with programs that focus on providing opportunities to interact with therapy dogs,” added Pendry.

The researchers measured executive functioning in the 309 students involved in the study. Executive function is a term for the skills one needs to plan, organize, motivate, concentrate, memorize, “all the big cognitive skills that are needed to succeed in college,” Pendry said.

Pendry conducted this study as a follow-up to previous work, which found that petting animals for just 10 minutes had physiological impacts, reducing students’ stress in the short term.

In the three-year study, students were randomly assigned to one of three academic stress-management programs featuring varying combinations of human-animal interaction and evidenced-based academic stress management. The dogs and volunteer handlers were provided through Palouse Paws, a local affiliate of Pet Partners, a national organization with over 10,000 therapy teams.

“The results were very strong,” Pendry said.

Pendry added, “We saw that students who were most at risk ended up having most improvements in executive functioning in the human-animal interaction condition. These results remained when we followed up six weeks later.”

Many universities, including WSU, have provided academic stress management programs and workshops for many years. These are traditionally very similar to college classes, where students listen to an expert, watch slideshows and take notes. They’re often evidence-based courses that talk about ways to get more sleep, set goals, or manage stress or anxiety.

“These are really important topics, and these workshops are helping typical students succeed by teaching them how to manage stress,” Pendry said.

“Interestingly though, our findings suggest that these types of educational workshops are less effective for students that are struggling. It seems that students may experience these programs as another lecture, which is exactly what causes the students to feel stressed,” Pendry added.

Human-animal interaction programs help by letting struggling students relax as they talk and think about their stressors. Through petting animals, they are more likely to relax and cope with these stressors rather than become overwhelmed. This enhances students’ ability to think, set goals, get motivated, concentrate and remember what they are learning, Pendry said.

“If you’re stressed, you can’t think or take up information; learning about stress is stressful!” she said.

Animal sessions aren’t just about changing behavior; they help students engage in positive thoughts and actions.

“You can’t learn math just by being chill. But when you are looking at the ability to study, engage, concentrate and take a test, then having the animal aspect is very powerful. Being calm is helpful for learning especially for those who struggle with stress and learning,” Pendry concluded.

During a recent study, psychologists at Ural Federal University reached the conclusion that yoga and breathing exercises have a positive effect on children with attention deficit hyperactivity disorder (ADHD). After special classes, children improve their attention, decrease hyperactivity, they do not get tired longer, they can engage in complex activities longer.

The psychologists studied the effect of exercise on functions associated with voluntary regulation and control in 16 children with ADHD aged six to seven years. The results of the study were published in the journal Biological Psychiatry. “For children with ADHD, as a rule, the part of the brain that is responsible for the regulation of brain activity – the reticular formation – is deficient,” said Sergey Kiselev, head of the Laboratory of Brain and Neurocognitive Development at UrFU, head of the study.

He added, “This leads to the fact that they often experience states of inadequate hyperactivity, increased distraction and exhaustion, and their functions of regulation and control suffer a second time. We used a special breathing exercise based on the development of diaphragmatic rhythmic deep breathing – belly breathing. Such breathing helps to better supply the brain with oxygen and helps the reticular formation to better cope with its role. When the reticular formation receives enough oxygen, it begins to better regulate the child’s state of activity”.

In addition to breathing exercises, psychologists used body-oriented techniques, in particular, exercises with polar states “tension-relaxation”. The training took place three times a week for two to three months (depending on the program).

“Exercise has an immediate effect that appears immediately, but there is also a delayed effect. We found that exercise has a positive effect on regulation and control functions in children with ADHD and one year after the end of the exercise. This happens because the child’s correct breathing is automated, it becomes a kind of assistant that allows a better supply of oxygen to the brain, which, in turn, has a beneficial effect on the behavior and psyche of a child with ADHD,” says Sergey Kiselev.

This technique was developed by the Russian neuropsychologist Anna Semenovich as part of a neuropsychological correction technique. UrFU psychologists tested how well this approach helps children with ADHD.

But the study is pilot, says Kiselev. It showed that these exercises have a positive effect. However, more work needs to be done, involving more children with ADHD. This will also take into account factors such as gender, age, the severity of the disease, concomitant problems in children (speech, regulatory, etc.).

Attention deficit hyperactivity disorder is a disorder associated with impaired development of the child’s nervous system. Most often it manifests itself at the age of seven or at the beginning of regular education. ADHD is characterized by inattention, excessive activity, and impulsive behavior.

Since 2013, the Laboratory of the Brain and Neurocognitive Development of UrFU has been conducting research on the maturation of the brain and mental processes in typically developing children, as well as in children with deviant development, in particular, those at risk of developing autism and ADHD, children with moderate traumatic brain injury severity. The laboratory is one of the leading Russian centers for the study of brain development and neurocognitive processes in children.

Even your local city park may be improving your health, according to the findings of a recent study by researchers from Stanford University.The research, published in Proceedings of the National Academy of Sciences, lays out how access to nature increases people’s physical activity – and therefore overall health – in cities. Lack of physical activity in the U.S. results in USD 117 billion a year in related health care costs and leads to 3.2 million deaths globally every year. It may seem like an intuitive connection, but the new research closes an important gap in understanding how building nature into cities can support overall human wellbeing.“Over the past year of shelter-in-place restrictions, we’ve learned how valuable and fulfilling it can be to spend time outdoors in nature, especially for city-dwellers,” said study lead author Roy Remme, a postdoctoral researcher at the Stanford Natural Capital Project at the time of research. “We want to help city planners understand where green spaces might best support people’s health, so everyone can receive nature’s benefits.”In cities, nature provides cooling shade to neighborhood streets, a safe harbor for pollinators, and rainwater absorption to reduce flooding. It’s widely understood that physical activity improves human health, but how parks, lakes, trees and other urban green spaces boost physical activity and overall wellbeing is an unsolved piece of the puzzle.The team combined decades of public health research with information on nature’s benefits to people in cities. They considered how activities like dog walking, jogging, cycling and community gardening are supported by cities’ natural spaces. They also factored in things like distance to urban greenery, feelings of safety and accessibility to understand how those elements can alter the benefits of nature for different people. From tree-lined sidewalks to city parks and waterfronts, the team created a model framework to map out urban nature’s physical health benefits.The researchers’ framework explores how people might choose to walk an extra few blocks to enjoy a blooming garden or bike to work along a river path, reaping the health benefits of physical activity they may have missed if not motivated by natural spaces.In Amsterdam, city planners are currently implementing a new green infrastructure plan. Using the city as a hypothetical case study, the researchers applied their framework to understand how Amsterdam’s plans to build or improve new parks might affect physical activity for everyone in the city. They also looked at the effects on different sub-populations, like youth, elderly and low-income groups. This example illustrates how the city could invest in urban nature to have the greatest physical activity benefits for human health.The research will ultimately serve as the basis for a new health model in Natural Capital Project software – free, open-source tools that map the many benefits nature provides people. The software was recently used to inform an assessment of 775 European cities to understand the potential of nature-based solutions for addressing climate change. Eventually, the new health model software will be available to city planners, investors and anyone else interested in new arguments and tools for targeting investments in nature in cities.Nature’s contributions are multidimensional – they can support cognitive, emotional and spiritual well-being, as well as physical health. Previous work from the Natural Capital Project has shown many of these connections, but the new research adds an important link to physical health that had been missing from the equation.“Nature experience boosts memory, attention and creativity as well as happiness, social engagement and a sense of meaning in life,” said Gretchen Daily, senior author on the paper and faculty director of the Stanford Natural Capital Project. “It might not surprise us that nature stimulates physical activity, but the associated health benefits – from reducing cancer risks to promoting metabolic and other functioning – are really quite astonishing.”As our world becomes more urbanized and city-centric, the ability to easily access outdoor natural spaces becomes increasingly challenging, especially for overburdened communities. Identifying where urban nature is missing in vulnerable or overburdened communities – then working to fill those gaps – could provide people with valuable new opportunities to improve their health. The researchers hope the new study will equip urban planners with a more complete understanding of the benefits nature can provide their communities.“Our ultimate goal is to create more healthy, equitable and sustainable cities,” said Anne Guerry, co-author and Chief Strategy Officer at the Natural Capital Project. “This research is actionable – and gets us one big step closer.”

As people working late-night may face a couple of health issues due to the disturbance in body clock, they may suffer from shift work sleep disorder. According to researchers, people who develop this condition are also three times more likely to be involved in an accident.

Individuals working in late shifts such as 11 pm -7 am, or the ‘graveyard’ shift, are more likely than people with traditional daytime work schedules to develop a chronic medical condition — shift work sleep disorder — that disrupts their sleep. According to researchers at the University of Missouri, people who develop this condition are also three times more likely to be involved in a vehicle accident. “This discovery has many major implications, including the need to identify engineering countermeasures to help prevent these crashes from happening,” said Praveen Edara, department chair and professor of civil and environmental engineering.

Edara added, “Such measures can include the availability of highway rest areas, roadside and in-vehicle messaging to improve a driver’s attention, and how to encourage drivers who may have a late-night work shift to take other modes of transportation, including public transit or ride-share services.”

Edara, one of the authors of the study, said the analysis was based on data collected from a real-world driving study for the second Strategic Highway Research Program established by the U.S. Congress.

As the demand for 24/7 business operations has increased in recent years to meet customer needs during all hours of the day and across multiple time zones, the traditional workday — once defined as 9 am -5 pm — has shifted for many people to include evening and night shifts, causing sleeping difficulties and leading to shifting work sleep disorder.

Edara said he was surprised to see shift work sleep disorder increase the risk of a traffic crash by nearly 300 per cent, as compared to both sleep apnea and insomnia, which both increased the risk of a crash by approximately 30 per cent.

Edara said previous studies have shown sleep disorders increase the risk for a traffic crash, but the majority of these studies were conducted in a controlled environment, such as a laboratory driving simulator. He believes this real-world data now validates those efforts.

“In the past, researchers have studied sleep disorders primarily in a controlled environment, using test-tracks and driving simulators,” Edara said.

Edara added, “Our study goes a step further by using actually observed crash and near-crash data from approximately 2,000 events occurring in six U.S. states. We’ve known for a while now that sleep disorders increase crash risk, but here we are able to quantify that risk using real-world crash data while accounting for confounding variables such as roadway and traffic characteristics.”

Edara said some of the limitations of their study include not having data for fatal crashes, and no formal measurement to define drowsiness.

PUTTING A SPOTLIGHT ON A NATIONAL PROBLEM

In the United States, the National Transportation Safety Board, or NTSB, is the federal agency that investigates major traffic accidents. Each year, they issue an annual “most wanted list” of safety improvements, and their 2019-2020 list includes “screening and treating obstructive sleep apnea” among the top 10 topic areas.

Edara said he hopes that by showing how big of a risk there is for traffic crashes caused by excessive daytime sleepiness, the researchers can help draw additional attention toward finding ways to keep people safe behind the wheel, including taking the driver out of the equation with ride-sharing options and automated vehicles. He said the ideal next step in this research would be to partner with medical professionals who have expertise in this area to better understand why this is happening.

“We want to partner with public health and medical professionals whose expertise is in sleep-related research to better understand why this is happening,” Edara said.

“That will also allow us to explore what kind of countermeasures we can develop and test to improve the overall safety of these drivers and the other motorists around them,” Edara concluded.