title: Obstructive sleep apnea and risk of motor vehicle crash: systematic review and meta-analysis.
abstract: 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.
authors.affiliation: MANILA Consulting Group, McLean, VA, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tregear
authors.forename: James
authors.initials: J
authors.lastname: Reston
authors.forename: Karen
authors.initials: K
authors.lastname: Schoelles
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips
mesh_terms: 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*
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