title: Sleep apnea-related risk of motor vehicle accidents is reduced by continuous positive airway pressure: Swedish Traffic Accident Registry data.
abstract: OBJECTIVE
  Obstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle accidents (MVAs). The rate of MVAs in patients suspected of having OSA was determined and the effect of continuous positive airway pressure (CPAP) was investigated.
  
  
  METHODS
  MVA rate in patients referred for OSA was compared to the rate in the general population using data from the Swedish Traffic Accident Registry (STRADA), stratified for age and calendar year. The risk factors for MVAs, using demographic and polygraphy data, and MVA rate before and after CPAP were evaluated in the patient group.
  
  
  METHODS
  Clinical sleep laboratory and population based control (n = 635,786).
  
  
  METHODS
  There were 1,478 patients, male sex 70.4%, mean age 53.6 (12.8) y.
  
  
  METHODS
  CPAP.
  
  
  RESULTS
  The number of accidents (n = 74) among patients was compared with the expected number (n = 30) from a control population (STRADA). An increased MVA risk ratio of 2.45 was found among patients compared with controls (P < 0.001). Estimated excess accident risk was most prominent in the elderly patients (65-80 y, seven versus two MVAs). In patients, driving distance (km/y), EDS (Epworth Sleepiness score ≥ 16), short habitual sleep time (≤5 h/night), and use of hypnotics were associated with increased MVA risk (odds ratios 1.2, 2.1, 2.7 and 2.1, all P ≤ 0.03). CPAP use ≥ 4 h/night was associated with a reduction of MVA incidence (7.6 to 2.5 accidents/1,000 drivers/y).
  
  
  CONCLUSIONS
  The MVA risk in this large cohort of unselected patients with OSA suggests a need for accurate tools to identify individuals at risk. Sleep apnea severity (e.g., apnea-hypopnea index) failed to identify patients at risk.
authors.affiliation: Centre for Sleep and Vigilance Disorder, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Mahssa
authors.initials: M
authors.lastname: Karimi
authors.affiliation: Centre for Sleep and Vigilance Disorder, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Hedner
authors.affiliation: Department of Mathematical Sciences, Chalmers University of Technology and Department of Mathematical Sciences University of Gothenburg, Gothenburg, Sweden.
authors.forename: Henrike
authors.initials: H
authors.lastname: Häbel
authors.affiliation: Department of Mathematical Sciences, Chalmers University of Technology and Department of Mathematical Sciences University of Gothenburg, Gothenburg, Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Nerman
authors.affiliation: Centre for Sleep and Vigilance Disorder, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Ludger
authors.initials: L
authors.lastname: Grote
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000523:psychology / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000523:psychology*; D016022:Case-Control Studies; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000523:psychology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: CPAP; daytime sleepiness; driving distance; risk factors; traffic accident