April 12, 2024 Research report meeting
PL
Member

2304C.
A cross-cultural
study on healthrelated traffic
accidents in
Asian countries

Masaya Takahashi, Director, Research Center for Overwork-Related Disorders, National Institute ofOccupational Safety &HealthMigiwa Asano, Professor, Department of Forensic Medicine, Ehime University School of Medicine
Kazuko Okamura, Director, Research Office, National Research Institute of Police Science
Takashi Ohguchi, Professor, Institute of Industrial Science, The University of Tokyo
Kazuhiro Ota, Professor, Senshu University School of Commerce
Takeshi Tanikawa, Senior Professor, Department of Public Health, Juntendo University Graduate School of Medicine
Kenji Doi, Professor, Graduate School of Engineering, Osaka University

SpecialResearcher Shiho Kunimatsu, Deputy Director, Nishi-Kasai and Inoue Eye Hospital
Huiqing Jin, Director, Anhui Sanlian Institute for Incident Prevention
Fumihito Fukushima, Chief, Department of Emergency Medicine, Saitama Saiseikai Kazo Hospital
Yusuke Okuyama, Manager, Kuroi Transportation Education Center, Kuroi Sangyo Co.
Naricha Chirakalwasan, Chulalongkorn University
Myo Nyein Aung, Specially Appointed Professor, Juntendo University School of International Liberal Studies
Hiroo Wada, Professor, Department of Public Health, Juntendo University Graduate School of Medicine
Ryutaro Shirahama, Part-time Lecturer, Department of Hygiene and Public Health, Juntendo University School of
Medicine
Kiyohide Tomooka, Assistant Professor, Department of Hygiene and Public Health, Juntendo University School of
Medicine
Setsuko Sato, Associate Professor, Department of Hygiene and Public Health, Juntendo University School of Medicine
Yuito Ueda Assistant Professor, Department of Hygiene and Public Health, Juntendo University School of Medicine
Zhu Qinye, Ph.D. Department of Public Health, Juntendo University Graduate School of Medicine
Zhung Yan, Ph.D. Department of Public Health, Juntendo University Graduate School of Medicine
Huang Jiaqi, Juntendo University Graduate School of Medicine, Department of Public Health, Master's Course
ObserverTakashi Ueda, Specialist, Safety Policy Division, Logistics and Road Transport Bureau, Ministry of Land, infrastructure,
Transport and Tourism
Daisuke Inoue, Chief, Laws and Regulations Section, Traffic Planning Division, Traffic Bureau, National Police Agency
Yo Tanaka, Assistant Director, Driver's License Division, Traffic Bureau, National Police Agency
Takashi Matsuyama, Chief, Driver's License Section, Traffic Bureau, National Police Agency

Health-related accident• Definition of Ministry of Land, Infrastructure,
Transport and Tourism:

Number of accidents reported due tohealth conditions(Number of cases per business category)“The driver is unable to continue to operate
the commercial motor vehicle due to illness."(Article 2 of the Automobile Accident Reporting Regulations)• The number of reported health-related
accidents has been on the rise since 2013,
and although it has remained high inrecent years, further reduction is needed.
• Prevention of health-related accidents is
an important issue in traffic accident
prevention.

Truck

Cab

Charter/
SpecifiedSharedFrom "Health-Related Accidents and Efforts to Prevent Health-Related Accidents," Ministry of Land, Infrastructure, Transport and Tourism
https://www1.mlit.go.jp/jidosha/anzen/03safety/resourse/data/seminar2024_2-2.pdf

Causes of health-related accidents
Breakdown by Disease of Drivers Involved in
Health-Related Accidents (2013-2022)
Total:2,778 People

Unknown
439 People
16%

Heart disease(myocardial infarction,
heart failure, etc.)
406 People, 15%

Brain disease (subarachnoid
hemorrhage, intracerebral
hemorrhage, etc.)
375 People, 13%
Aortic aneurysm and dissection
86 People, 3%
Others1149 People
41%

Respiratory Illness
174 People, 7%
Gastrointestinal disorder
143 People, 5%

Sleep apnea
syndrome
6 People, 0.2%

Breakdown of Drivers who Died as a Result of
Health-related Diseases (2013 - 2022)
Total:470 People

Others
37 People
8%

Unknown
64 People
14%

Respiratory Illness
3 People, 1%
Aortic aneurysm and dissection
62 People, 13%Heart disease(myocardial
infarction, heart
failure, etc.)
252 People, 54%

Brain disease (subarachnoid
hemorrhage, intracerebral
hemorrhage, etc.)
52 People, 11%

From "Health-Related Accidents and Efforts to Prevent Health-Related Accidents," Ministry of Land, Infrastructure, Transport and Tourism
https://www1.mlit.go.jp/jidosha/anzen/03safety/resourse/data/seminar2024_2-2.pdf

Heart disease
Brain disease

Aortic aneurysm and dissection
Sleep apnea syndrome

GlaucomaSide Effects of Medication
Hypoglycemia
Respiratory illness
Dementia
anaemia

Dizziness

Gastrointestinal disorder

Heatstroke

Epilepsy

Aging drivers
From "Approaches to Health Management for Drivers of Commercial Motor Vehicles," Ministry of Land, Infrastructure, Transport and Tourism

Sleep Apnea Syndrome
SAS: Sleep Apnea Syndrome
Soft Palate
Uvula
Tonsils
Tongueflow
Air

Soft Palate
Tongue Base
Uvula
Tonsils

Under normal conditions, the upper airway does not close andairflow is maintained even when lying down to sleep.

The upper airway is obstructed
and airflow is disrupted.

● frequent oxygen deprivation● Arousals to open the airway, resulting in fragmented sleep
and poor sleep quality increases drowsiness the next day.

Relationship between perceived sleepiness andprevalence of sleep-disordered breathingJudging by ESS scores alone, there is a risk
missing 86% of the seriously ill.

sleep-disordered breathing

Weak ↑
Awarenes
s ofdrowsiness ↓Strong

Total

Normal range

Slight degree

Moderatesevere(RDI less than 5)(RDI 5 to 19.9)(RDI 20-39.9)(RDI 40 or higher)

ESS 0 to 5

1,457
(60%)

1,391
(60%)

201
(53%)

46
(36%)

3,095
(100%)ESS 6-10

774
(32%)

725
(31%)

138
(37%)

52
(40%)

1,689
(100%)

ESS 11-15

142
(6%)

170
(7%)

34
(9%)

23
(18%)

369
(100%)NOSSA:
non 44sleepy sleep apnea
37
5
8
ESS 16-20
(2%)
(2%)
(1%)
(6%)
Sleep apnea
without
subjective
sleepiness
Total

2,410
(100%)

2,330(100%)

378(100%)

129(100%)

Takeshi Tanigawa and Hiroyasu Iso: "Construction of a Traffic Accident Prevention System by Screening Occupational Drivers for Sleep-Disordered Breathing.
Report on Grants-in-Aid for Scientific Research 2006 (MEXT)

94(100%)
5,247(100%)

Sleep-disordered breathing and traffic accidents
Percentage of accidents experienced byseverity of sleep-disordered breathing

Respiratory disturbance index (RDI)
From H2535, H2651, and H2763 (Collaboration with government and organizations)project research reports

Shiho Kunimatsu, Department of Ophthalmology

Glaucoma• Glaucoma: A disease in which the optic nerve is damaged for some reason,
resulting in a narrowing of the visual field (range of vision)• The prevalence rate among Japanese over 40 is 5.0% (1 in 20).

Retina
Iris

視神経が
Optic
nerve is圧迫される‼
compressed!!

CorneaUnder
Pressure• Estimated 4.6 million patients in Japan (2015).
• Early detection and appropriate treatment of glaucoma can slow its
progression.

Ciliary body

Schlemm’s Canal

Optic nerve

Pupil
Optic disk

90% of glaucoma patients are untreated and unaware

progressShiho Kunimatsu, Department of Ophthalmology, To

Percentage of glaucoma unaware or untreated patients by stage of glaucoma in 250 patientswith glaucoma who visited the Department of Ophthalmology, Tajimi City Hospital

Initial〜-6dB

Unaware(Untreated)

Diagnosed withglaucoma andundergoingtreatment

Diagnosed withglaucoma but
untreated

Total

140/149(94.0%)

3/149(2.0%)

6/149(4.0%)

149

Glaucomahas no symptoms in the early, middle, or late stages
mediumterm-12dB〜-6dB

51/56(91.1%)

4/56(7.1%)

1/56(1.8%)

56

final-12dB〜

41/45(91.1%)

3/45(6.7%)

1/45(2.2%)

45

Yuko Ikuno et al. Ophthalmology 100(7): 496-923, 2006

Visual Field Impairment and Traffic Accidents
Combination of visual field impairment(VFI) in three ormore places and surprise box phenomenon(SBP)
associated with traffic

sex- and age-adjusted odds ratio

Num,: 781 ppl
Case: 442 ppl

No VFINo SBP

Num,: 452 ppl
Case: 313 ppl

Num,: 68 ppl
Case: 35 ppl

Num,: 47 ppl
Case: 35 ppl

No VFIVFI in morethan 3 places

VFI in morethan 3 places

SBP¥

No SBP¥BP¥

Combination of visual field impairment in three or more places and surprise box phenomenon

Clock chart

Accidents logistic regression analysis*Excluded those with one or two visual field impairment

From 1707A, 1807B, and 1907C (Independent Study) Project Research Reports

Fiscal 2020 Social Contribution Projects
International Symposium of Social Contribution Project,International Association of Traffic and Safety Sciences• An online international symposium washeld with experts from Japan, China, andThailand.
• During the exchange of opinions, it was
found that in the Asian region, measuresfor health-related accidents have not yet
been fully implemented, and people's
awareness has not yet been raised.

Toward the Prevention of Health-Related AccidentsPublic Awareness Video

Sleep apnea driving picture scroll

Glaucoma Driving Picture Scroll

Sleep apnea and traffic accidents

Glaucoma and traffic accidents

Proposed Implementation Details and Schedule
2021▶Create foreign language
versions of public awarenessvideos▶Questionnaire survey after
viewing educational videos

2022

2023

▶Further promotion in Japan▶Further promotion in Japan▶Holding an international▶An international comparison of

symposium in Thailand andpost-viewing awareness-raisingconducting a questionnaire

video questionnaires in Japan,

survey after viewing an

China, and Thailand

educational video

Creation of foreign
language versions ofeducational videos(English, Chinese, Thai)
Available on the IATSS
website, "Video
Archive"!

https://www.iatss.or.jp/movie/

Foreign language versions of publicawareness videos

Sleep apnea driving picture scroll(Thai version)

Glaucoma Driving Picture Scroll(Chinese version)

Purpose of this projectIn FY2023, we conducted a questionnaire survey inJapan, China, and Thailand using the public awarenessvideos in foreign languages (English, Chinese, andThai). The purpose of the survey was to verify theusefulness of the videos and to compare the awarenessof health-related accidents internationally.

Details of this project• Spreading awareness of health-related accident
prevention in Japan• Post-viewing questionnaire for educational videos
in Japan, China, and Thailand and international
comparison

Spreading awareness of healthrelated accident prevention inJapanViews of public awareness videos

As of March 18, 2024

6,374 times

4,770 times

Sleep Apnea Driving Picture Scroll

Glaucoma Driving Picture Scroll

3,347 times

43,441 times

Sleep apnea and traffic accidents

Glaucoma and traffic accidents

FY2021 Utilization of Awareness Video(Questionnaires were also conducted after viewing the awareness-raising videos)• Kokusai Jidosha Co., Ltd.
Approximately 450 people participated in• Kuroi Industry Co., LTD.
the event!
• Sompo Japan Insurance Inc.
• SOMPO Risk Management Inc.
• Honda Kaihatsu Co.,Ltd.
Approximately 2,700 people participated• Japan Automobile Federation (JAF)
Approximately 200 people• Tokio Marine & Nichido Fire Insurance Co.
participated in the event!
• National Car Rental Association• Other (e.g., organizations affiliated with project members)

Utilization at Driver's License Examination Center• Distributed DVDs to 51 prefectural police departments nationwide.
• Distributed by each prefecture to Driver's License Examination Offices.

Monitor in the lobby of Saitama
Prefectural Police Driver's License
CenterDuring a senior citizen training course
conducted by the prefectural police.

Clear files were created!

FY2022 Utilization of Awareness Video• Glaucoma Driving Picture Scrolls was
published in “A Practitioner‘s Guide toTeaching Older License Holders”.
• A public awareness video is posted on
the Kanto Traffic Mutual Aid Cooperative
Association's website(https://www.kankokyo.or.jp/anzen/action.htm).

Spreading awareness of video
through the National Police Agency

Manual on Measures to Prevent Visual Field Failure in Motor Carriers• The "Comprehensive Safety Plan 2025 for Commercial
Vehicles" released in March 2021 states that "As a measurefor elderly drivers, elderly will be informed of driving risks
related to visual field disorder and recommend that they
undergo screening tests and visual field examinations at
ophthalmology clinics, etc."

Manual on countermeasuresagainst visual field pollution in
motor carriers• A working group was established at the Ministry of Land,
Infrastructure, Transport and Tourism (MLIT), withparticipation by this project member Mr. Ueda (MLIT) and Dr.
Kunimatsu (Inoue Eye Hospital, Nishi-Kasai).
• In March 2022, the "Manual on Measures to Prevent Visual
Failure in Motor Carriers" was formulated.

March 29, 2022
Automobile Bureau, Ministry of Land,
Infrastructure, Transport and Tourism

https://www.mlit.go.jp/jidosha/anzen/03manual/data/visual_field_impairment_manual.pdf

FY2023 Actual use of educational videos• Shinki Bus Co., Ltd: Himeji City, Hyogo• National Agency for Automotive Safety & Victims' Aid(NASVA): Sumida-ku, Tokyo• Toyota Mobility Foundation: Bunkyo-ku, Tokyo• Tokyo Metropolitan Medical Association: Chiyoda-ku, Tokyo• Odakyu Bus Co., Ltd: Chofu City, Tokyo• Kanto Traffic Mutual Aid Cooperative Society:Shinjuku-ku, Tokyo• Hatsukaichi Kotsu : Hatsukaichi City, Hiroshima• Chiba City Bus : Chiba City, Chiba

Toyota Mobility FundCan glaucoma cause you to not see traffic lights? A Story of Visual Field
Impairment(Interview with Dr. Shiho Kunimatsu, Inoue Hospital , ophthalmology, NishiKasai)

Introduction of Glaucoma Driving Picture Scroll- About the glaucoma awareness video created by Dr. Kunimatsu

Has this ever happened to you all?
A passenger pointed out to you saying, "You almost ran a red light.”
Or You have been walking and suddenly almost hit someone.
Maybe it was not "carelessness" but a symptom caused by an illness.
In this issue, we asked Dr. Shiho of Inoue Hospital ophthalmology in Nishi-Kasai
about visual field impairment and the outpatient driving clinic established by Dr.
to reduce traffic accidents caused by visual field impairment.

Dr. Kunimatsu: I made this video in the style of Ukiyoe, especiallyfor elderly to learn about glaucoma in a fun way. I hope people
will enjoy watching it. Patients with visual field impairment may
think that their vision is exactly the same as that of healthy people,
and they have no subjective symptoms. For this reason, I would
like to encourage people to visit an ophthalmologist to learn more
about your own vision and whether or not you have a disease.
Glaucoma cause you to miss traffic lights? A Story of Visual Field Disorder | OlderDrivers.com
https://koureidriver.com/interview-anopsia/?padid=from_top_mv_interview-anopsia

Post-viewing questionnaire foreducational videos in Japan, China,
and Thailand
International Comparison
Sleep apnea driving picture scroll
Glaucoma Driving Picture Scroll

Subjects of the survey
Sleep apnea driving picture scroll*1
Japan

China

Thai

Glaucoma Driving Picture Scroll*1
Japan

China

Tai

WEB
survey*2

Driving
SchoolTruck
AssociationWEB
survey*2WEB
survey*2WEB
survey*2

DrivingschoolWEB
survey*2WEB
survey*2

125 ppl404 ppl182 ppl

100 ppl

100 ppl60 ppl1,173 ppl

100 ppl

100 pplExclude respondents
who answered"teenagers".

Exclude respondents
who answered"teenagers".

Exclude respondents
who answered"teenagers".

Exclude respondents
who answered"teenagers".

99 ppl98 pplExcludes respondents in their teens andthose in their 60s or older

91 ppl149 ppl393 ppl153 pplExcludes respondents in theirteens and those in their 60s
or older44 ppl99 ppl98 ppl771 ppl815 ppl*1 In Japan, the subjects of the sleep apnea driving picture scroll and the glaucoma driving picture scroll were different, but the same subjects were included in China and Thailand.
*2 In Japan, Google Form was used. In China and Thailand, the survey was outsourced to a web-based survey company.

Subject Attributes
Japan
393/815
peopleMainoccupation,
persons (%)

Major
industries,
persons (%)

Main
business,
persons(%)

Trucking
associations
and driving
schoolstudents

China
99/99 people
Company employee
Company owner, etc.
Public servant

Thai
98/98 people

58 (59)33 (33)5 ( 5)

Company employee
Self-employed, etc.
Public servant

69 (69)15 (16)13 (13)

Construction, building,
IT andTelecommunications
Other manufacturing

14 (14)9 ( 9)
7 ( 7)

Government
Administration office
Other services
Manufacture of daily
necessities, etc.

13 (13)12 (12)6 ( 6)

Sales
DeliveryCab

49 (49) Sales
17 (17) Cab
7 ( 7) Delivery

33 (34)11 (11)9 ( 9)

Questionnaire items (21 questions in total)
1 Age
2 Gender3 Current Residence
4 Please check (☑) the applicable box for frequency ofdriving.
5 Have you ever been diagnosed with sleep
apnea/glaucoma?
6 Are you aware of the disease sleep apnea/glaucoma?
7 Before watching the video, did you know that sleep
apnea/glaucoma can cause car accidents?
8 After watching the video, do you have a better
understanding of sleep apnea/glaucoma and car
accidents?
9 Was this video useful to you?
10 Please rate your overall impression of this video on ascale of 1 to 10.
11 Was the duration (length) of the video appropriate?
12 Was the video easy to understand?
13 Please indicate the reason for your answer to 12.

14 Please describe any memorable aspects of the video.
15 Do you think this video is useful as an initiative toprevent traffic accidents caused by illness?
16 Please indicate the reason for your answer to 15.
17 Please answer the following questions about thesymptoms of sleep apnea and glaucoma shown inthe video.
1) Please check ☑ for all that apply to you.
2) Is there anyone in your family, close people atwork, etc. who fits this description?
18 After watching this video, if you or someone close to
you in your family or workplace is suspected ofhaving sleep apnea/glaucoma, would you
personally see a health care provider orrecommend that person see a health care provider?
19 Please provide the reason for your answer to 18.
20 What efforts do you think are needed to prevent traffic
accidents caused by illness?
21 We would love to hear your comments and feedback on
this initiative.

1. Age
China

Japan
N=393

N=815

N=99

13ppl, 2%

90 ppl,23%

82ppl,
10%

152
ppl,
39%
414ppl, 51%

N=98

5ppl,
5%

8ppl,
8%

22ppl,
22%

15ppl,
15%

29ppl,
30%
26ppl,
26%

306ppl, 37%

89ppl,
22%

57ppl,
58%

62ppl,
16%

sleep apnea syndrome
picture scroll depicting
scene of driving

ThailandGlaucoma Driving
Picture Scroll■20’s ■ 30’s ■ 40’s ■ 50’s

35ppl,
36%

2. Gender
Japan
N=393

N=815
5ppl, 1%

6ppl, 1%

N=99
1ppl,
0%

N=98

16ppl, 2%72ppl,
9%77ppl,
20%

ThailandChina

30ppl,
30%
40ppl,
41%

69ppl,
70%
305ppl,78%

sleep apnea syndrome
picture scroll depicting
scene of driving

726ppl, 89%

58ppl,
59%

Glaucoma Driving
Picture Scroll■Male ■Female ■Others ■No Answer

4. Driving frequency
Japan
N=393

China
N=99

N=815
1人, 0%

93ppl,
24%

2ppl, 0%12ppl, 2%

1ppl,
0%

7ppl, 1%

1ppl, 1%

N=98
1人, 1%

65ppl,
8%

3ppl, 1%235ppl, 60%728ppl, 89%1ppl, 1% 1ppl, 1%

21ppl,
21%
30人, 30%

17ppl, 4%Thailand

67ppl,
68%

11人, 3%
33ppl, 8%

Sleep apnea syndrome
picture scroll depicting
scene of driving

Glaucoma Driving
Picture Scroll■Almost every day ■ About once per week ■About once per month ■More than once per year ■ Less than once per month ■Do not drive■Going to diving school ■No Answer

75ppl,
77%

5. Have you ever been diagnosed with sleep apnea/glaucoma?
Japan
N=393

2ppl,
0%

China
18ppl, 5%N=992ppl, 2%Thailand18ppl, 18%

N=98

9ppl, 9%75ppl,
19%

sleep apnea syndrome
picture scroll depicting
scene of driving
N=815

13ppl,
13%
47ppl, 48%298ppl
, 76%

N=99

14ppl, 2%1ppl, 0%32ppl, 32%

25ppl, 3%7ppl, 7%
1ppl, 1%

10ppl,…

76人,
78%

N=98
2ppl, 2%

9ppl, 9%9ppl, 9%Glaucoma Driving
Picture Scroll

775pp
l, 95%

81ppl, 82%■Yes ■Suspected ■No ■No Answer

78ppl, 80%

6. Are you aware of the disease sleep apnea/glaucoma?
Japan
N=393

37人,
9%

16人,
4%

7人,
7%

8人,
8%

N=98

1ppl, 0%28ppl,…

235person,.
29%

316ppl,
39%

N=99

6人,
6%
13人,
13%

53ppl, 54%236ppl, 60%

235ppl, 29%

Glaucoma Driving
Picture Scroll

N=99

Thailand

31ppl, 31%

sleep apnea syndrome
picture scroll depicting 104ppl, 27%
scene of driving
N=815

China

28ppl, 29%

51ppl,
52%

3ppl,…

N=98

6ppl, 6%

16ppl, 16%
40ppl, 41%40ppl, 40%■Yes ■Little ■Not a lot ■No ■No Answer

20ppl, 20%

22ppl, 23%

50ppl, 51%

7. Before watching the video, did you know that sleep apnea/glaucoma cancause car accidents?
Japan
N=393

China

Thailand
N=98

N=99

1人,
0%

12ppl, 12%
16人,
16%

71人,
18%

sleep apnea syndrome
picture scroll depicting
scene of driving

18人,
18%

168ppl,
43%

72人,
18%

N=815

3ppl, 0%126ppl, 16%

29人,
30%

32人,
32%

81人,
21%

145ppl, 18%

N=99

40ppl,
41%

13人,
13%

37ppl,
38%

N=98

7ppl,
7%

18ppl, 18%

Glaucoma Driving
Picture Scroll

188ppl, 23%

23ppl,
23%

34ppl,
34%

353ppl, 43%
35ppl, 36%■Yes ■Little ■Not a lot ■No ■No Answer

30ppl, 31%
18ppl, 18%
32ppl, 33%

8. After watching the video, do you have a better understanding of sleep
apnea/glaucoma and car accidents?
Japan
N=393

13ppl, 3%

China
N=99

3ppl, 1%
4ppl, 1%

274ppl, 70%

N=815
10ppl, 1%

Glaucoma Driving
Picture Scroll

1人,
1%

N=98

18人,
18%

99人,
25%

sleep apnea syndrome
picture scroll depicting
scene of driving

1人,
1%Thailand2ppl,
0%523ppl, 64%

38人,
39%
57ppl, 58%

79ppl, 80%

N=99

N=98

2ppl, 2%

2ppl,
2%

23人,
23%

280人,
35%

3ppl,
3%

3ppl, 3%

1ppl,
1%

32人,
33%
72ppl, 73%■Yes ■Little ■Not a lot ■No ■No Answer

62ppl, 63%

9. Was this video useful to you?
Japan
N=393

5ppl, 1% 7ppl, 2%China
2ppl, 1%N=99

1ppl, 1%Thailand
N=98

1ppl,
1%

20ppl, 20%

sleep apnea syndrome
picture scroll depicting
scene of driving

106ppl, 27%273ppl,69%

N=8159ppl, 1%

1ppl, 0%4ppl, 0%258ppl, 32%

Glaucoma Driving
Picture Scroll

97ppl, 99%

78ppl, 79%543ppl, 67%

N=99

N=98

2ppl,
2%

5ppl,
5%

27ppl, 27%
70ppl, 71%■Yes ■Little ■Not a lot ■No ■No Answer

93ppl, 95%

10. Please rate your overall impression of this video on a scale of 1 to 10.
70.0%
sleep apnea syndrome
59.2%
Average
60.0%
picture scroll
50.0%Japan China Thai
40.4%
depicting scene of
40.0%
35.8%
8.1
8.5
8.6
28.3%
driving
30.0%
23.5%
20.0%
10.0%
0.0%

14.3%

14.1%
2.0% 3.1%
0.5%

00.3% 1.0%

0.5%

1

2

3.0%
2.0% 2.0%

5.1%

3.0%
1.5%

3
4
Japan (N=391)

8.4%

2.0%

1.0%

5
China (N=99)

9.7%

7.9%
3.0%

7.1%

5.1%

4.0%

2.0%

6
Thailand (N=98)

7

9.7%

8

9

10

70.0%
60.0%
50.0%
40.0%
30.0%

Average
Japan China Thai
8.1
8.5
8.8

Glaucoma
Driving Picture
Scroll
17.4%

3.1%

1.0%

0.0%
0

1

1.0%

0.2%

2

40.4%
28.3%

26.5%

20.0%
10.0%

63.3%

3.0%2.0%
0.2%

3.0%
2.0%
1.1%

3
Japan (N=812)

4

7.1%
5.1%

3.1%

5
China (N=99)

5.9%
1.0% 1.0%

6

14.1%
7.1%

4.0% 4.1%

7
Thailand (N=98)

8

32.5%

13.3%
9.0%

9

10

11. Was the duration (length) of the video appropriate?
Japan

China

N=393

9ppl, 2% 8ppl, 2%
20ppl, 5%
23ppl, 6%

N=99

1ppl,
1%

Thailand
N=98

2ppl, …

9ppl, …

22ppl,
22%

sleep apnea syndrome
picture scroll depicting
scene of driving

51ppl,
52%

333ppl, 85%

N=81517ppl, 2% 6ppl, 1%

6ppl, 1%
15ppl, 2%

N=99

38ppl,
38%

7ppl, …

74ppl,
76%

N=98
2ppl, 2%

4ppl, …

123ppl,…

Glaucoma Driving
Picture Scroll

648ppl, 79%

58ppl,
59%

23ppl,
24%

34ppl,
34%■Long ■Little long ■Adequate ■Little short ■Short ■No answer

69ppl,
70%

12. Was the content of the video easy to understand?
Japan
N=393

11ppl,
3%

China
6ppl,
1%

N=99

Thailand1ppl,
1%13ppl, 13%

N=981ppl,…

11ppl, 11%78ppl,…

sleep apnea syndrome
picture scroll depicting
scene of driving

298ppl, 76%

N=815

6ppl, 1%

2ppl, 0%116ppl, 14%

Glaucoma Driving
Picture Scroll

691ppl, 85%

86ppl, 88%

85ppl, 86%

N=99

2ppl,
2%

N=98
14ppl,
14%

16ppl, 16%

81ppl, 82%

84ppl, 86%■Easy to understand ■Somewhat easy to understand ■Somewhat hard to understand ■Hard to understand ■No answer

15. Do you think this video is useful as an effort to prevent traffic accidents
caused by illness?
Japan
N=393

China
5ppl, 1%

5ppl, 1%Thailand
N=98 11ppl,

N=99

11%

17ppl,…
20人,
20%
110人,
28%

sleep apnea syndrome
picture scroll depicting
scene of driving

79ppl, 80%

256ppl, 65%

N=815

18ppl,
2%

1ppl, 0%35ppl, 4%N=99

87people,89%

N=98

2ppl,
2%

9ppl,
9%

18人,
18%

Glaucoma Driving
Picture Scroll

276ppl,34%
485ppl,…

79ppl, 80%■Yes ■Somewhat ■Not really ■No ■No answer

89ppl, 91%

17. Please answer the following questions about the symptoms of sleep apnea
presented in the video.
1) Please check ☑ for all that apply to you.
Japan

Thailand

China

N=386

N=98

N=99
0.0%

20.0%

40.0%

33.8%

Told I snore loudly

22.1%

Stops breathing during sleep
Sleepy during the day even when
getting enough sleep
Sudden sleepiness during the day
Have a headache when wake up
in the morning

16.8%

24.9%

Fre quent trips to the bathroom
during the night
N/A

40.0%

53.5%

Sleepy during the day evenwhen getting enough sleep

Sudden sleepiness during the day

53.5%

Sudden sleepiness during the
day

N/A

32.7%
61.2%
40.8%

Have a headache when wake up
in the morning

22.2%
37.4%
27.3%
12.1%

50.0%

Told I snore loudly

50.5%

Fre quent trips to the bathroom
during the night

36.6%

0.0% 20.0% 40.0% 60.0% 80.0%

Stops breathing during sleep

25.3%

Have trouble concentrating

10.9%

60.0%

Sleepy during the day even when
getting enough sleep

Have a headache when wake up in
the morning

14.2%

20.0%

Told I snore loudly

Stops breathing during sleep

9.2%

Have trouble concentrating

0.0%

33.7%

Have trouble concentrating

38.8%

Fre quent trips to the bathroom
during the night

38.8%

N/A

13.3%

17. Please answer the following questions about the driving situations often experienced bypeople with glaucoma shown in the video
Please answer the following questions about.
1) Please check ☑ all that apply to you.
China

Japan
N=756

N=99
0.0%

Have had cars or people suddenly
jump out in front ofHave had difficulty understanding
tra ffic signals or signs

Family me mbers or passengers
have ever pointed out that you
were driving dangerously

Have had trouble keeping up withthe flow of cars around me

None applicable

20.0% 40.0% 60.0% 80.0%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0%

11.5%

Have had cars or people suddenly
jump out in front of

10.1%

Have had difficulty understanding
tra ffic signals or signs

10.4%

Family me mbers or passengers haveever pointed out that you were driving
dangerously

3.7%

Have had trouble keeping up with theflow of cars around me

70.1%

ThailandNone applicable

36.4%

33.3%

29.3%

N=98

0.0% 10.0%20.0%30.0%40.0%50.0%

Have had cars or people
suddenly jump out in front ofHave had difficulty
understanding traffic signals or
signs

33.7%

Family me mbers or passengers
have ever pointed out that you
were driving dangerously

35.7%

Have had trouble keeping up
with the flow of cars around me

19.2%

41.4%

44.9%

None applicable

28.6%

39.8%

17. Please answer the following questions about driving situations often experienced by sleep
apnea/glaucoma sufferers presented in the video.
2) Does anyone in your family, close people at work, etc. apply to you?
Japan

China

N=393 35ppl,

N=98

N=99

9%

Thai

26人,
26%

sleep apnea syndrome
picture scroll depicting
scene of driving
N=815

Glaucoma Driving
Picture Scroll

41人,
42%

148ppl, 38%
210ppl, 53%

57ppl, 58%

73ppl, 74%

N=99

96ppl,
12%N=9887ppl,…

632ppl,77%

52ppl,
53%■Yes ■No ■No Answer

30peopl…

47ppl, 47%
68人,
69%

18. after watching this video, do you suspect that you or someone close to you in your family, workplace, etc. has sleep
apnea?
After watching this video, if you suspect that you or someone close to you in your family or workplace has sleep
apnea, would you personally seek medical attention or recommend that he/she seek medical attention?

Japan
N=393
41ppl,
10%

11ppl, 3%6ppl, 2%Thailand
N=98

N=99
26人,
26%

sleep apnea syndrome
picture scroll depicting 142ppl,
36%
scene of driving
N=815

China

2ppl, 2%24人,
25%

193ppl, 49%

71ppl, 72%

73ppl, 74%

31ppl,…

6ppl,…

12ppl, 1%

N=99

2ppl,
2%

1ppl,
1%

2ppl,
2%

N=98

3ppl,
3%

3ppl,
3%

13ppl, 13%

17ppl,…
199ppl, 24%

Glaucoma Driving
Picture Scroll

567ppl, 70%

78ppl, 79%■Yes ■Partially yes ■Not really ■No ■No answer

79people,8…

Summary andDiscussion

Prevalence of sleep apnea and glaucoma
Sleep apnea syndrome
Japan

China

Thai

Glaucoma
Japan

China

Thai

Percentage of those who have ever been diagnosed
This
study

Precedingresearch

5%

18%

9%

2%

7%

9%.

14.8%

8.8

14.7%

4.0%

3.1%

3.8%

Prevalence of obstructive sleep
apnea (AHI >15 breaths/hr) in 30-69
year olds*1

Over 40 years old*2

Over 50
years old*3*1 Benjafield et al. Lancet Respir Med. 2019; *2 Quigley & Broman. Br J Ophthalmol. 2006; *3 Bourne et al. Br J Ophthalmol. 2003.

l Rates of diagnosed sleep apnea and glaucoma are higher in China
and Thailand than in Japan (deviating from previous studies).

Awareness of sleep apnea and glaucoma
sleep apnea syndrome
Japan

China

Thai

glaucoma
Japan

China

Thai

41%

23%

Percentage of those who know of the disease.
60%

31%

29%

29%

Percentage of those who know that illness can cause traffic
accidents
43%

38%

41%

18%

34%

31%

l In contrast to the expectation that sleep apnea and glaucoma are notwell recognized in China and Thailand (opinion exchange with experts[2020] and hearing survey in Thailand [2022]), awareness was high.

Symptoms and experiences related to sleep apnea
and glaucoma
sleep apnea syndrome
Japan

China

Thai

glaucoma

Japan

China

Thai

Percentage of respondents who have one or more of the following symptoms or situations
that they often experience while driving

63%

88%

87%

30%

59%

60%

Percentage of respondents who reported that someone close to them applies to their
symptoms and situations they often experience while driving.

38%

74%

58%

11%

47%

31%

l The percentage of people with symptoms or experiences of suspected sleep apnea
or glaucoma was higher in Thailand and China than in Japan, not only among those
who viewed the videos but also among those who were around them.
l Potential patients with sleep apnea and glaucoma may exist more than Japan.

Evaluation and Effectiveness of Awareness Videos
sleep apnea syndrome
Japan

China

Thai

glaucoma
Japan

China

Thai

My understanding of the disease and traffic accidents has "deepened" or "somewhat
deepened"
95%

98%

97%

99%

96%

96%

99%

98%

100%

The video was "useful" or "somewhat useful".
96%

99%

100%

The video was "easy to understand" and "somewhat easy to understand".
96%

99%

99%

99%

98%

100%

3%

41%

28%

Video length was "long" or "somewhat long"
8%

47%

24%

“Agree" and "somewhat agree" that it is useful as an initiative to prevent health-related
accidents.
83%

100%

100%

94%

98%

100%

Notes on this survey
lJapan, China, and Thailand have different driver's license
systems and health care systems. In addition, the method ofadministering the questionnaire is different in each country,
and the gender and age structure of the target population are
not uniform, so a simple comparison of results is not possible.
lThe sample representativeness should be kept in mind, as
there are deviations from previous studies in terms ofprevalence and disease awareness among subjects in
Thailand and China.

Conclusion
lCreated awareness videos (in Japanese, Chinese, and Thai)on sleep apnea and glaucoma, and conducted aquestionnaire survey after viewing the videos.
lAlthough it is necessary to keep in mind therepresentativeness of the sample, it was thought that there
may be more potential sleep apnea and glaucoma patients in
China and Thailand than in Japan.
lThe awareness-raising video was highly rated in China andThailand and is considered to be a useful tool for preventing
health-related accidents.

Thank you for your attention.