Continuous positive airway pressure reduces risk of motor vehicle crash among drivers with obstructive sleep apnea: systematic review and meta-analysis.
BACKGROUND
Obstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle crash.


OBJECTIVE
We performed a systematic review of the literature concerning the impact of continuous positive airway pressure (CPAP) treatment on motor vehicle crash risk among drivers with OSA. The primary objective was to determine whether CPAP use could reduce the risk of motor vehicle crash among drivers with OSA. A secondary objective involved determining the time on treatment required for CPAP to improve driver safety.


METHODS
We searched seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) and the reference lists of all obtained articles.


METHODS
We included studies (before-after, case-control, or cohort) that addressed the stated objectives. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the evidence. We also tested for publication bias.


METHODS
Data were extracted by two independent analysts. When appropriate, data were combined in a fixed or random effects meta-analysis.


RESULTS
A meta-analysis of 9 observational studies examining crash risk of drivers with OSA pre- vs. post-CPAP found a significant risk reduction following treatment (risk ratio = 0.278, 95% CI: 0.22 to 0.35; P < 0.001). Although crash data are not available to assess the time course of change, daytime sleepiness improves significantly following a single night of treatment, and simulated driving performance improves significantly within 2 to 7 days of CPAP treatment.


CONCLUSIONS
Observational studies indicate that CPAP reduces motor vehicle crash risk among drivers with OSA.
MANILA Consulting Group, McLean, VA, USA.
Stephen
S
Tregear
James
J
Reston
Karen
K
Schoelles
Barbara
B
Phillips
D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D013997:Time Factors