• Stephen Tregear, James Reston, Karen Schoelles, and Barbara Phillips.
• MANILA Consulting Group, McLean, VA, USA.
• Sleep. 2010 Oct 1;33(10):1373-80.

ContextObstructive sleep apnea (OSA) is associated with an increased risk of motor vehicle crash.ObjectiveWe performed a systematic review of the literature concerning the impact of continuous positive airway pressure (CPAP) treatment on motor vehicle crash risk among drivers with OSA. The primary objective was to determine whether CPAP use could reduce the risk of motor vehicle crash among drivers with OSA. A secondary objective involved determining the time on treatment required for CPAP to improve driver safety.Data SourcesWe searched seven electronic databases (MEDLINE, PubMed (PreMEDLINE), EMBASE, PsycINFO, CINAHL, TRIS, and the Cochrane library) and the reference lists of all obtained articles.Study SelectionWe included studies (before-after, case-control, or cohort) that addressed the stated objectives. We evaluated the quality of each study and the interplay between the quality, quantity, robustness, and consistency of the evidence. We also tested for publication bias.Data ExtractionData were extracted by two independent analysts. When appropriate, data were combined in a fixed or random effects meta-analysis.ResultsA meta-analysis of 9 observational studies examining crash risk of drivers with OSA pre- vs. post-CPAP found a significant risk reduction following treatment (risk ratio = 0.278, 95% CI: 0.22 to 0.35; P < 0.001). Although crash data are not available to assess the time course of change, daytime sleepiness improves significantly following a single night of treatment, and simulated driving performance improves significantly within 2 to 7 days of CPAP treatment.ConclusionsObservational studies indicate that CPAP reduces motor vehicle crash risk among drivers with OSA.

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