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Obstructive Sleep Apnea and Driving Risk

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If untreated, obstructive sleep apnea (OSA) is a major contributor to road traffic accidents due to daytime sleepiness.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At June 1, 2023
Reviewed AtJanuary 27, 2024

Introduction

The frequency of occurrence of road traffic accidents has increased dramatically in recent years. It arises due to several concurrent factors such as overspeed, alcohol consumption, age, and negligence. Human health conditions are also a major contributor to motor vehicle accidents. They have an increased risk compared to the general population in disease states like cerebrovascular (relating to the brain and blood vessels) diseases, cardiovascular (heart conditions that include diseased vessels, structural problems, and blood clots) diseases, psychiatric conditions, visual disturbances, conditions with sleep disturbances and sleep disorders, etc.

What Is Obstructive Sleep Apnea (OSA)?

Obstructive sleep apnea is the most common disorder associated with excessive sleepiness during the daytime. OSA is a very commonly seen chronic disorder of the respiratory system with a greater incidence among males of greater than 10 %. It is accompanied by excessive daytime sleepiness, which can lead to severe consequences like motor vehicle accidents during drowsy driving. Recent studies show an increased risk of accidents among patients with obstructive sleep apnea. Fortunately, further studies have evaluated that successful therapy of obstructive sleep apnea patients with continuous positive airway pressure can bring down the incidence of accidents to a level equivalent to the general population.

The increased risk of accidents in this population group prompted responsible authorities to study the situation in Europe. The results led to the revision of the European driving license directive, which got implemented. The directive suggested that severe or moderate cases of obstructive sleep apnea patients should be allowed to drive only after establishing an effective therapy. The implemented regulations balanced the safety objective without affecting the OSA patients taking regular and effective therapy. The main objective of the regulation was to encourage OSA patients to seek medical attention and undertake proper therapy, not to prevent them from coming forward.

What Is the Relation Between Obstructive Sleep Apnea and Motor Vehicle Accidents?

Obstructive sleep apnea is marked by repeated obstruction of upper airways during sleep resulting in fragmentation of sleep leading to nonrestorative sleep and drowsiness during the daytime. During the past two decades, the relationship between obstructive sleep apnea and motor vehicle accidents has become increasingly obvious. A recent analysis suggests that the risk of accidents in the OSA population is 2.4 times of the general public.

Sleepiness and drowsiness during the day are key features of obstructive sleep apnea. The subject will have a strong tendency to fall asleep or doze off in inappropriate situations, and the most dangerous of them is while driving. Studies suggest that approximately 5 to 7 % of all motor vehicle accidents are contributed by excessive sleepiness, of which 17 % are associated with fatalities. Research evaluating the drivers' performance has shown that drivers suffering from OSA have a performance comparable to those with sleep deprivation or alcohol consumption, thus, making them unfit for driving.

Other factors that increase sleepiness in OSA patients include the time of day (early morning and afternoon), lack of sleep, work shifts, alcohol use, poor sleep hygiene habits, and sedative medications. These factors are of significance, particularly in commercial drivers. Thus OSA patients are warned about the contributing factors to avoid the additional risk of motor vehicle accidents. Several warning signs appear in sleepy drivers beforehand. These include yawning and constant blinking, a feeling of driving automatically, nodding, difficulty maintaining a constant speed, drifting off the lane, etc. In these situations, the driver will try to counteract by rolling down the window or taking highly caffeinated drinks. However, all these measures are effective only to a certain limit, and the drivers are strongly recommended to pull over and take a nap to avoid a serious situation.

What Is the Treatment Plan For Obstructive Sleep Apnea?

Continuous positive airway pressure (CPAP) can control obstructive sleep apnea. It is a machine that keeps the upper airway open. The device uses a tube to deliver continuous pressurized air into a mask the patient wears while sleeping. They are used in the treatment of obstructive sleep apnea and central sleep apnea, in which the patient experiences interrupted breathing during the sleep cycle. The machine takes the air in the room, filters and pressurizes, and delivers the air into the patient's mask through a connecting tube. The continuous airflow through the upper airways keeps the tongue, soft palate, and uvula from blocking the airway. Thus, it will help stabilize the breath and improve the patient's sleep quality.

What Is the Effect of Therapy on Obstructive Sleep Apnea and Motor Vehicle Accidents?

Several studies were conducted to assess the effect of the treatment of obstructive sleep apnea on motor vehicle accidents. The therapy employed is generally continuous positive airway pressure (CPAP). A comparison made between the population who underwent therapy and the general population as the control in almost every study, the results suggested that effective therapy significantly decreased motor vehicle accidents caused by this group of people.

In a study conducted in Ontario, Canada, a comparison was made between the accident rates in OSA patients for three years before initiating the CPAP therapy and three years after initiating the therapy. The whole accident rate for six years was then compared to the accident rate in the general population for those six years. The results suggested that, before the CPAP therapy, the accident rate was three-fold higher than in the general population. After the therapy, there was no significant difference from the general population.

Conclusion

In conclusion, millions of people across the world suffer from the deadly medical disorder obstructive sleep apnea (OSA). It is characterized by a partial or total obstruction of the airways while you sleep, which lowers oxygen levels and causes frequent awakenings. This illness may have a substantial negative impact on a person's general health, increasing their risk of diabetes, heart disease, and stroke.

The possibility of car accidents is one of the most concerning dangers related to OSA. According to studies, people with OSA are more likely to be involved in car accidents because of daytime sleepiness, cognitive decline, and slower reaction times. Professional drivers should be especially concerned about these hazards because their job requires them to maintain focus and alertness for lengthy periods of time.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)

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