Risk of traffic accidents in patients with sleep-disordered breathing: reduction with nasal CPAP

Abstract

R Ri is sk k o of f t tr ra af ff fi ic c a ac cc ci id de en nt ts s i in n p pa at ti ie en nt ts s w wi it th h s sl le ee ep p--d di is so or rd de er re ed d b br re ea at th h--i in ng g: : r re ed du uc ct ti io on n w wi it th h n na as sa al l C CP PA AP P Fifty nine patients completed the study. The accident rate was significantly decreased from 0.8 per 100,000 km (untreated) to 0.15 per 100,000 km with nCPAP treatment. Variables that were considered to be likely to increase accident risk (sleeping spells, fatigue, vigilance test reaction time, daytime sleep latency) also improved with treatment.We conclude that treatment of sleep-disordered breathing by nasal continuous positive airway pressure is related to reduction in patient motor vehicle accident rates, probably due to the reversal of excessive daytime sleepiness. Eur Respir J., 1996Respir J., , 9, 2606 This study is part of the research project 2.9107: "Sleep related breathing disorders and traffic security", carried out on behalf of the "Bundesanstalt für Straβenwesen".

Driving Simulator Performance Remains Impaired In Patients With Severe OSA after CPAP Treatment

“…[23][24][25][26][27][28] Only two of these studies included a concurrently assessed control population 23,26 to allow an assessment of the degree of normalization of accident rates in CPAP-treated subjects. These studies reached somewhat different conclusions: one study 26 showed accident rates reduced among CPAP treated patients to the level of controls, while the other 23 observed accident rate reductions in both treated patients and re-evaluated controls.…”

“…Several studies and a recent metaanalysis 16 support that continuous positive airway pressure (CPAP) treatment improves driving simulator performance [17][18][19][20][21][22] and reduces accident risk. 16,[23][24][25][26][27][28] Two studies found that CPAP treatment of OSA patients returned driving simulator performance to the level of healthy control subjects, 17,22 while another clinical observational study reported that CPAP therapy reduced motor vehicle accident rates to the background rate of the general population. 26 However, these studies suffered from several methodological limitations.…”

Simulated driving in obstructive sleep apnoea–hypopnoea; effects of oral appliances and continuous positive airway pressure

“…Daytime sleepiness may adversely affect daytime performance and consequently, among other sequelae, influence driving performance [2,3]. Studies evaluating subjective (self-reports) or objective (motor vehicle department) records sustain the opinion that OSAHS confers an increased risk for accidents when driving [4,5]. In addition, performance on driving simulator and vigilance tests of varying complexity have been shown impaired in OSAHS patients [6][7][8][9][10].…”

“…Studies evaluating subjective and objective records indicate that continuous positive airway pressure (CPAP) therapy reduces collision and crash frequency in OSAHS patients [4,8,12]. In addition, successful treatment with CPAP therapy generally results in improvements of simulated driving performance [13][14][15].…”

Estimated cost of crashes in commercial drivers supports screening and treatment of obstructive sleep apnea

“…Data collected from passenger car drivers show that OSA increases vehicular crash rates (6)(7)(8) and off-road deviations in a driving simulator (9). Driving performance (9) and crash risk (10)(11)(12) may improve if affected drivers are identified and treated. These data signal a need for developing screening strategies that find OSA among commercial drivers and assessments to determine whether such strategies are cost-effective.…”