Effect of Continuous Positive Airway Pressure on the Risk of Road Accidents in Sleep Apnea Patients

Background: Continuous positive airway pressure (CPAP) reduces daytime somnolence in the obstructive sleep apnea syndrome (OSAS) and may contribute to a reduction in the risk of motor vehicle accidents. Objective: To evaluate the effects of CPAP on automobile collisions in patients with OSAS. Methods: We compared the number of motor vehicle accidents in 80 patients with OSAS and 80 healthy subjects during the 2 years before and the 2 years after study entry, at which CPAP treatment was initiated. Results: Patients with OSAS had a 2.6 times higher risk of suffering an automobile collision compared to controls (rate ratio, RR = 2.57; 95% confidence interval, CI = 1.30–5.05). After 2 years of CPAP treatment, the rate of collisions was reduced more than half in patients with OSAS (RR = 0.41; 95% CI = 0.21–0.79), but this occurred also in controls (RR = 0.49; 95% CI = 0.17–1.40). The magnitude of this fall between groups was not different (p for interaction = 0.68), even after adjusting for body mass index, alcohol intake and Epworth scale. Conclusions: Patients with OSAS have an increased risk of suffering a traffic collision. This risk was significantly reduced after their inclusion in the study. Yet, as this reduction also occurred in the control group, this effect may not be due to CPAP therapy.

[1]  Meir Kryger,et al.  Reducing motor-vehicle collisions, costs, and fatalities by treating obstructive sleep apnea syndrome. , 2004, Sleep.

[2]  R. Chervin.  Epworth sleepiness scale? , 2003, Sleep medicine.

[3]  W. Flemons,et al.  Obstructive Sleep Apnea , 2002 .

[4]  W. Flemons.  Clinical practice. Obstructive sleep apnea. , 2002, The New England journal of medicine.

[5]  D. Navajas,et al.  Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome: a randomized controlled study with an optimized placebo. , 2001, American journal of respiratory and critical care medicine.

[6]  C. George.  Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP , 2001, Thorax.

[7]  L J Findley,et al.  Serious motor vehicle crashes: the cost of untreated sleep apnoea , 2001, Thorax.

[8]  N. Douglas,et al.  Treatment with Continuous Positive Airway Pressure Is Not Effective in Patients with Sleep Apnea but No Daytime Sleepiness , 2001, Annals of Internal Medicine.

[9]  L. Findley,et al.  Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. , 2000, American journal of respiratory and critical care medicine.

[10]  J. Stradling,et al.  The efficacy of nasal continuous positive airway pressure in the treatment of obstructive sleep apnea syndrome is proven. , 2000, American journal of respiratory and critical care medicine.

[11]  P M Suratt,et al.  Treatment with nasal CPAP decreases automobile accidents in patients with sleep apnea. , 2000, American journal of respiratory and critical care medicine.

[12]  T. Akashiba,et al.  Long-term effects nasal continuous positive airway pressure on daytime sleepiness, mood and traffic accidents in patients with obstructive sleep apnoea. , 2000, Respiratory medicine.

[13]  A. Smiley,et al.  Sleep apnea & automobile crashes. , 1999, Sleep.

[14]  S. Grufferman.  Complexity and the Hawthorne effect in community trials. , 1999, Epidemiology.

[15]  J. Terán-Santos,et al.  The Association between Sleep Apnea and the Risk of Traffic Accidents , 1999 .

[16]  J. Terán-Santos,et al.  The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. , 1999, The New England journal of medicine.

[17]  L. Findley,et al.  Automobile accidents in patients with sleep apnea syndrome. An epidemiological and mechanistic study. , 1998, American journal of respiratory and critical care medicine.

[18]  J. Montserrat,et al.  Tratamiento del síndrome de las apneas-hipoapneas durante el sueño , 1998 .

[19]  J C Sailly,et al.  Accidents in obstructive sleep apnea patients treated with nasal continuous positive airway pressure: a prospective study. The Working Group ANTADIR, Paris and CRESGE, Lille, France. Association Nationale de Traitement à Domicile des Insuffisants Respiratoires. , 1997, Chest.

[20]  T. Young,et al.  Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. , 1997, Sleep.

[21]  C. Becker,et al.  Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP. , 1996, The European respiratory journal.

[22]  N J Douglas,et al.  Self-reported use of CPAP and benefits of CPAP therapy: a patient survey. , 1996, Chest.

[23]  Han Wu,et al.  Self‐reported automobile accidents involving patients with obstructive sleep apnea , 1996, Neurology.

[24]  A I Pack,et al.  Review of regulations and guidelines for commercial and noncommercial drivers with sleep apnea and narcolepsy. , 1995, Sleep.

[25]  Terry Young,et al.  Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes. American Thoracic Society. Official statement adopted March 1944. , 1994, American journal of respiratory and critical care medicine.

[26]  N. Clark,et al.  Management of asthma by patients and families. , 1994, American journal of respiratory and critical care medicine.

[27]  D. Léger.  The cost of sleep-related accidents: a report for the National Commission on Sleep Disorders Research. , 1994, Sleep.

[28]  H. Minemura,et al.  [Traffic accidents in obstructive sleep apnea patients and effect of nasal CPAP treatment]. , 1993, Nihon Kyobu Shikkan Gakkai zasshi.

[29]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[30]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[31]  D. Crowell,et al.  Identifying sleep apnea from self-reports. , 1988, Sleep.

[32]  L. Findley,et al.  Automobile accidents involving patients with obstructive sleep apnea. , 1988, The American review of respiratory disease.

[33]  M. Kryger,et al.  SLEEP APNOEA PATIENTS HAVE MORE AUTOMOBILE ACCIDENTS , 1987, The Lancet.