Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis.
OBJECTIVE
We performed a systematic review of the OSA-related risk of crash in commercial motor vehicle (CMV) drivers. The primary objective involved determining whether individuals with obstructive sleep apnea (OSA) are at an increased risk for a motor vehicle crash when compared to comparable individuals who do not have the disorder. A secondary objective involved determining what factors are associated with an increased motor vehicle crash risk among individuals with OSA.


METHODS
Seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) were searched (through May 27, 2009), as well as the reference lists of all obtained articles. We included controlled studies (case-control or cohort) that evaluated crash risk in individuals with OSA. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the body of evidence, and tested for publication bias. Data were extracted by 2 independent analysts. When appropriate, data from different studies were combined in a fixed- or random-effects meta-analysis.


RESULTS
Individuals with OSA are clearly at increased risk for crash. The mean crash-rate ratio associated with OSA is likely to fall within the range of 1.21 to 4.89. Characteristics that may predict crash in drivers with OSA include BMI, apnea plus hypopnea index, oxygen saturation, and possibly daytime sleepiness.


CONCLUSIONS
Untreated sleep apnea is a significant contributor to motor vehicle crashes.
Tregear
Stephen
S
MANILA Consulting Group, McLean, VA, USA.
Reston
James
J
Schoelles
Karen
K
Phillips
Barbara
B
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D015992:Body Mass Index; D003071:Cognition; D006970:Disorders of Excessive Somnolence / Q000150:complications; D006304:Health Status; D006801:Humans; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D011597:Psychomotor Performance; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications*
Sleep. 2000 May 1;23(3):383-9
10811382
Surgery. 2007 Mar;141(3):354-8
17349847
Sleep. 1989 Dec;12(6):487-94
2595172
Obesity (Silver Spring). 2007 Oct;15(10):2504-11
17925477
Clin Cardiol. 1993 Mar;16(3):167-8
8095197
Am J Epidemiol. 2006 Jan 15;163(2):188-95
16306310
Thorax. 2004 Jan;59(1):56-9
14694250
Chest. 2006 Sep;130(3):902-5
16963693
Respiration. 2007;74(1):44-9
16804289
Sleep. 1991 Dec;14(6):540-5
1798888
Respir Med. 2000 Jan;94(1):87-90
10714485
Sleep. 2005 Jan;28(1):113-21
15700727
Am J Epidemiol. 1999 Jul 15;150(2):206-15
10412966
Stat Med. 2002 Jun 15;21(11):1539-58
12111919
Decubitus. 1992 Nov;5(6):42-4
1489514
Pain. 2000 Apr;85(3):415-424
10781914
ORL J Otorhinolaryngol Relat Spec. 1990;52(1):57-62
2304760
Thorax. 2001 Jul;56(7):508-12
11413347
Sleep. 1994 Oct;17(7):619-23
7846460
Sleep. 1996 Feb;19(2):104-15
8855032
Am J Respir Crit Care Med. 2000 Mar;161(3 Pt 1):857-9
10712333
Psychiatry Clin Neurosci. 2002 Jun;56(3):333-4
12047620
Thorax. 2001 Oct;56(10):800-5
11562521
Sleep Breath. 2004 Jun;8(2):61-72
15211390
Neurol India. 2003 Dec;51(4):497-9
14742931
Chest. 1996 Jun;109(6):1470-6
8769496
Am Rev Respir Dis. 1988 Aug;138(2):337-40
3195832
BMJ. 2000 Jun 10;320(7249):1574-7
10845965
J Appl Physiol (1985). 2005 Oct;99(4):1592-9
16160020
Am J Respir Crit Care Med. 2004 Nov 1;170(9):1014-21
15317672
Sleep. 1995 Apr;18(3):158-66
7610311
Eur Respir J. 2005 Nov;26(5):898-903
16264053
Respir Med. 2000 Oct;94(10):971-6
11059950
BMJ. 2002 May 11;324(7346):1125
12003884
J Intern Med. 2003 May;253(5):536-43
12702031
Am J Respir Crit Care Med. 1998 Jul;158(1):18-22
9655701
Psychiatry Clin Neurosci. 1999 Apr;53(2):301-2
10459718
Am J Respir Crit Care Med. 2002 May 1;165(9):1217-39
11991871
Inj Prev. 2008 Feb;14(1):51-8
18245316
Thorax. 2008 Jun;63(6):536-41
18234904
Psychiatry Clin Neurosci. 1998 Apr;52(2):221-2
9628162
Sleep. 1997 Aug;20(8):608-13
9351127
J Sleep Res. 1997 Dec;6(4):272-5
9493528
Eur Respir J. 1996 Dec;9(12):2606-11
8980976
Thorax. 1995 Sep;50(9):994-5
8539684
N Engl J Med. 1999 Mar 18;340(11):847-51
10080847
Ann N Y Acad Sci. 2006 Nov;1083:329-44
17148748
Sleep. 2009 Mar;32(3):382-91
19294958
J Clin Sleep Med. 2006 Apr 15;2(2):193-200
17557495
Stat Med. 1998 Dec 30;17(24):2815-34
9921604
Sleep. 1999 Sep 15;22(6):790-5
10505825
Am J Respir Crit Care Med. 2006 Aug 15;174(4):446-54
16690976
Chest. 1988 Jul;94(1):32-7
3383654
Neurology. 1996 May;46(5):1254-7
8628462