Studies have consistently shown that sleep apnea patients have high accident rates, but the generalisability of the association beyond clinic populations has been questioned. The goal of this investigation was to determine if unrecognised sleep-disordered breathing in the general population, ranging from mild to severe, is associated with motor vehicle accidents. The sample comprised 913 employed adults enrolled in an ongoing study of the natural history of sleep-disordered breathing status was determined by overnight in-laboratory polysomnography and motor vehicle accident (MVA) history was obtained from a state-wide data base of all traffic violations and accidents from 1988 to 1993. Men with five or more apneas and hypopneas per hour of sleep [apnea-plus-hypopnea index (AHI) > 5], compared to those without sleep-disordered breathing, were significantly more likely to have at least one accident in 5 years (adjusted odds ratio = 3.4 for habitual snorers, 4.2 for AHI 5-15, and 3.4 for AHI > 15). Men and women combined with AHI > 15 (versus no sleep-disordered breathing), were significantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unrecognised sleep-disordered breathing in the general population is linked to motor vehicle accident occurrence. If the association is causal, unrecognised sleep-disordered breathing may account for a significant proportion of motor vehicle accidents. (A)
Abstract