Excessive Daytime Sleepiness Increases the Risk of Motor Vehicle Crash in Obstructive Sleep Apnea
1Centre for Genetic Origins of Health and Disease, The University of Western Australia, Perth, Australia; 2Western Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Perth, Australia; 3Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gardiner Hospital, Perth, Australia; 4Busselton Population Medical Research Institute, The University of Western Australia, Perth, Australia; 5School of Population Health, The University of Western Australia, Perth, Australia; 6School of Anatomy and Human Biology, The University of Western Australia, Perth, Australia; 7Women's College Research Institute, Women's College Hospital, Toronto, Canada; 8Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Subiaco, Australia; 9Ontario Institute for Cancer Research, Toronto, Canada; 10Center for Sleep and Circadian Neurobiology, University of Pennsylvania, PA; 11Department of Medicine, University of Toronto, Toronto, Canada
(1) To describe the incidence rate of motor vehicle crashes (MVCs) in patients with obstructive sleep apnea (OSA); and (2) to investigate MVC risk factors in OSA patients.
A retrospective case-series observational study was conducted using data from the West Australian Sleep Health Study at a tertiary hospital-based sleep clinic. Participants were patients (N = 2,673) referred for assessment of suspected sleep disordered breathing. Questionnaire data were collected including age, sex, years of driving, near-misses and MVCs, sleepiness, and consumption of alcohol and caffeinated drinks. Overnight laboratory-based polysomnography was performed using standard methodology.1 Poisson univariate and negative binomial multivariable regression models were used to investigate associations between risk factors and MVC and near-miss risk in patients with untreated OSA.
In patients with untreated OSA, the crash rate was 0.06 MVC/person-year compared with the general community crash rate of 0.02 MVC/person-year. The rate ratio comparing very sleepy men with normal men was 4.68 (95% CI 3.07, 7.14) for near-misses and 1.27 (95% CI 1.00, 1.61) for crashes, after adjusting for confounders. In women there was a significant association with sleepiness score (p = 0.02) but no dose effect across quartiles.
Untreated OSA is associated with an increased risk of near-misses in men and women and an increased risk of MVCs in very sleepy men. There is a strong association between excessive daytime sleepiness and increased report of near-misses. Our data support the observation that it is those patients with increased sleepiness regardless of OSA severity who are most at risk.
Ward KL; Hillman DR; James A; Bremner AP; Simpson L; Cooper MN; Palmer LJ; Fedson AC; Mukherjee S. Excessive daytime sleepiness increases the risk of motor vehicle crash in obstructive sleep apnea. J Clin Sleep Med 2013;9(10):1013-1021.
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