Introduction: Previous studies have documented increased risk of motor vehicle accidents (MVAs) in patients with obstructive sleep apnea (OSA); however, clinical practices for diagnosing/treating OSA have since changed. This study examined the relationship between OSA and risk of MVAs among health plan members in Washington State during 2005-2014.
Methods: This retrospective cohort study linked Kaiser Permanente Washington electronic health data with Washington State Department of Transportation MVA records. OSA was defined as ≥1 OSA or unspecified sleep apnea diagnostic code. The primary outcome was first MVA, as reported to a police officer. Multivariable Cox proportional hazards regression models, adjusting for demographic/clinical covariates, were used to estimate adjusted hazard ratios (HRs). A post-hoc sensitivity analysis (OSA defined as ≥2 codes, ≤180 days apart) was also performed.
Results: Of 879,547 eligible persons (mean age, 41.5 years; 46% male), 29,189 had OSA at cohort entry and 37,182 were diagnosed during follow-up (7.5% of cohort). In persons with and without OSA, unadjusted rates of first MVA were 238 and 229 per 10,000 person-years, respectively. Adjusted risk of first MVA was 17% greater in persons with OSA compared with those without (adjusted HR, 1.17; 95% confidence interval, 1.13-1.20). Post-hoc sensitivity analysis results were similar.
Conclusion: In this large population-based cohort study, persons with OSA had a 17% higher MVA risk compared with those without OSA. An increased risk of this magnitude, when applied to a large population like the US, is of public health importance and indicates a potential need for improved management of OSA.