Treatment with Nasal CPAP Decreases Automobile Accidents in Patients with Sleep Apnea

Abstract

We studied 50 consecutive patients to test the hypothesis that successful treatment of obstructive sleep apnea with nasal continuous positive airway pressure (nasal CPAP) will decrease automobile accidents in patients with sleep apnea. Thirty-six (72%) of the patients reported using nasal CPAP regularly during 2 yr. Fourteen patients reported they had not used CPAP during 2 yr. The patients with sleep apnea in this study had a higher automobile crash rate than all drivers in the state of Colorado (0.07 versus 0. 01 crash per driver per year, p < 0.02). Patients who were treated with nasal CPAP had a lower crash rate while being treated than before treatment (0.07 versus 0 crash per driver per year, p < 0.03). Untreated patients with sleep apnea continued to have a high crash rate (0.07 crash per driver before and after diagnosis). Drivers with sleep apnea were reluctant to report their automobile crashes, for the drivers in this study reported only one-third of the crashes in which they were involved. This is the first study to confirm with traffic records that patients with sleep apnea have fewer automobile crashes while being treated with nasal CPAP.

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

“…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.…”

Effects of Armodafinil on Simulated Driving and Self-Report Measures in Obstructive Sleep Apnea Patients prior to Treatment with Continuous Positive Airway Pressure

“…This increased risk of crashes was fi rst recognized in the 1980s and has since been reported by multiple investigators. 2,3 In this regard, a meta-analysis has shown a 3.71-fold increase in the relative risk for motor vehicle crashes for individuals with untreated OSA. 4 Sleepiness related crashes generally result from falling asleep while driving or from impairment of the cognitive, perceptual, or motor abilities essential to the complex task of driving.…”

“…The obvious concern is that these patients are at higher risk for driving related accidents. 2,3 In this regard, practitioners have asked whether it would be advisable to start a newly diagnosed OSA patient on a stimulant medication approved for treatment of residual EDS (e.g., armodafinil) while they are awaiting initiation of CPAP treatment. 22 However, an additional concern is that prior use of stimulant treatment might negatively impact subsequent CPAP compliance.…”

“…10 It has been estimated that there is at least a 50% reduction in crash risk. 2,11 Improved driving safety is also refl ected in betStudy Objectives: Obstructive sleep apnea (OSA) has been associated with an increased risk of motor vehicle crashes. This driving risk can be reduced (≥ 50%) by treatment with continuous positive airway pressure (CPAP).…”

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.…”