Obstructive sleep apnea syndrome: assessing and managing risk in the motor vehicle operator

Obstructive sleep apnea (OSA) is a common condition that can significantly affect daytime functioning, leading to excessive daytime sleepiness and fatigue. Motor vehicle crashes are common, resulting in financial burden, property loss, injury, and death. Motor vehicle operators are at increased risk for crash in the context of excessive daytime sleepiness and fatigue, largely due to inattention. The physician caring for individuals with risk of or diagnosed OSA must be aware of the potentially increased risk for motor vehicle crashes, especially in professional drivers. Because of empiric data on increased risk for crashes in commercial vehicle operators, the importance of identifying OSA has become the subject of focused attention by the Federal Motor Carrier Safety Administration (FMCSA). A task force has published recommendations for clinical care and urged further research on the interplay between sleep apnea, sleepiness, and crash risk.

Despite the logical relationship between OSA and motor vehicle crashes, data to support this theory remain of overall modest quality. Recent case-control and cohort studies continue to produce supportive evidence. Additionally, several meta-analyses of past studies have supported the crash risk associated with OSA and confirmed improvement with effective treatment using continuous positive airway pressure.

Further study is needed to more fully characterize the interplay between sleepiness and OSA, the crash risk associated with untreated OSA, and the benefit of treatment on reducing crash risk. For now, empiric recommendations are offered to screen and manage all individuals who drive, particularly those who drive professionally.