Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP

George, C. F. · 2001 · OpenAlex-citations

DOI: 10.1136/thorax.56.7.508

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Summary

This study addresses the lack of objective data confirming whether treatment for obstructive sleep apnoea (OSA) reduces the risk of motor vehicle collisions (MVCs). While untreated OSA is widely recognized as a risk factor for accidents due to daytime sleepiness and impaired alertness, previous evidence relied largely on subjective reports or small studies lacking control groups. The authors aimed to examine actual MVC records in a large cohort of OSA patients before and after treatment with nasal continuous positive airway pressure (CPAP), comparing these rates against a matched control group. The research utilized data from 210 patients with moderate to severe OSA (mean apnoea/hypopnoea index of 54 events/h) who had been treated with CPAP for at least three years. These patients were drawn from a larger pool of 740 confirmed OSA cases identified via overnight polysomnography. A control group of equal size was randomly selected from the Ontario Ministry of Transportation database, matched for age, sex, and driver’s licence type. MVC records were obtained for three years prior to and three years following CPAP initiation for both groups. Statistical analysis employed Poisson regression models to assess collision rates, while driving exposure was monitored via patient logs to ensure comparability. The results demonstrated that untreated OSA patients had significantly higher MVC rates than controls (0.18 vs. 0.06 collisions per driver per year, p<0.001). Following CPAP treatment, the collision rate in the patient group fell to 0.06 collisions per driver per year, a level statistically indistinguishable from the control group. In contrast, the control group’s collision rate remained unchanged over the same period. The difference in collision rate change between the groups was highly significant (change = –0.12, p<0.001). Patients who did not use CPAP maintained elevated collision rates. Driving exposure did not differ significantly between pre- and post-treatment periods, ruling out reduced driving as a cause for the decline in accidents. The study concludes that successful treatment of OSA with nasal CPAP removes the excess risk of motor vehicle collisions associated with the disorder, returning patients’ accident rates to those of the general driving population. These findings provide objective evidence supporting the removal of driving restrictions for OSA patients after effective treatment. The authors note that while not all OSA patients experience collisions, treatment eliminates the specific risk attributable to sleep apnoea, offering critical guidance for clinicians assessing patient fitness to drive.

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