Serious motor vehicle crashes: the cost of untreated sleep apnoea

Findley, Larry J. · 2001 · OpenAlex-citations

DOI: 10.1136/thorax.56.7.505

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Summary

This editorial addresses the significant public health and economic burden of motor vehicle crashes caused by untreated sleep apnoea. Motor vehicle crashes are the leading cause of injury morbidity and mortality in the United States, resulting in over 40,000 deaths and 6 million injuries annually. Sleep-related accidents account for 15–20% of these incidents. The authors highlight that sleep apnoea affects at least 4% of working men and 2% of women, with prevalence reaching 5% among commercial drivers. Despite this high prevalence, more than 80% of affected individuals remain undiagnosed or untreated. Untreated sleep apnoea causes severe sleep disruption, daytime sleepiness, cognitive impairment, and a motor vehicle crash rate two to four times higher than normal. The editorial argues that treating this disorder is a critical intervention for preventing serious, high-speed highway crashes that endanger drivers, passengers, and other road users. The analysis relies on data from two recent studies demonstrating the efficacy of continuous positive airway pressure (CPAP) treatment. Findley et al. reported that treating 36 subjects with CPAP over two years prevented five serious "at-fault" crashes, reducing the crash rate by 0.07 crashes per driver per year. In contrast, a control group of 14 untreated subjects showed no reduction in crash rates. A larger study by George confirmed these findings, showing that treating 210 patients with nasal CPAP over three years prevented 75 serious crashes involving property damage or personal injury, corresponding to a decrease of 0.12 crashes per driver per year. These studies provide objective evidence that successful treatment significantly reduces the incidence of serious motor vehicle collisions. Using data from these studies, the authors extrapolate the potential impact of widespread treatment in the USA. They estimate that treating 500 patients for three years would prevent 180 serious crashes, including 105 where the driver was at fault. Given that approximately 20% of reported crashes result in serious personal injury, this intervention would prevent 36 serious injuries. The economic implications are substantial: preventing these crashes and injuries would save approximately US$369,000 in direct property damage and medical expenses, and US$648,000 in lost wages and administrative costs for insurance companies and government entities. The total economic savings would exceed US$1,000,000. Furthermore, considering the ratio of traffic fatalities to collisions, treating 500 patients carries at least a 20% chance of preventing a fatality. The authors conclude that treating sleep apnoea is beneficial to all stakeholders, preventing injury, death, and economic loss for drivers, employers, and insurers. They criticize current policies by some government agencies and insurance companies that arbitrarily limit treatment access, describing these restrictions as shortsighted obstacles that contribute to preventable, costly, and dangerous motor vehicle crashes. The editorial advocates for removing these barriers to improve road safety and reduce the societal costs associated with untreated sleep-disordered breathing.

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