A sleep apnea related risk of vehicle accident is reduced by CPAP - Swedish traffic accident data acquisition (STRADA) registry
2014
Objectives: Obstructive sleep apnea (OSA) is associated with
excessive daytime sleepiness (EDS) and two to seven times
increased risk of motor vehicle accidents (MVAs) compared with
the general population. The MVA rate in patients with suspected
OSA, clinical features and the effect of treatment on risk prediction
was investigated.
Methods: Clinical sleep laboratory patients were cross-analyzed with
a matched control group from the general population. The 10-year
incidence of MVA among patients (n = 1478, 70.4% males, mean
age 54 (13) years) and accidents (n = 21118) in the general
population was analyzed. Risk factors associated with MVA risk
were determined in patients with OSA.
Results: Observed accidents among patients (n = 74) were compared
with the expected number (n = 29.91, risk ratio 2.47,
P < 0.001) predicted from the control population. Observed MVAs
were more prevalent among younger (18–44 years) patiens but
estimated OSA related excess accident risk was most prominent in
elderly (65–80 years, risk ratio 3.5) drivers. Risk factors within the
OSA patient cohort (high traffic exposure≥15 000 km/year, Epworth
Sleepiness Score ≥16, habitual sleep time ≤5 h/night and use of
hypnotics) were associated with increased accident risk (odds ratio
1.2, 2.1, 2.7 and 2.1, respectively, all P ≤ 0.03. Compliance with
CPAP (≥4 h/night), was associated with a reduction of MVA
frequency (7.6 to 2.5 accidents/1000 drivers/year).
Conclusions: The motor vehicle accident risk in this large cohort of
unselected sleep apnea patients suggests a need for accurate tools
to identify individuals at risk. Conventional metrics of sleep apnea
severity (e.g. apnea-hypopnea-index) failed to identify patients at
risk.
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