SLEEP-DISORDERED BREATHING AND MOTOR-VEHICLE ACCIDENTS IN A POPULATION-BASED SAMPLE OF EMPLOYED ADULTS

Studies have consistently shown that sleep apnea patients have high ac cident rates, but the generalizability of the association beyond clini c populations has been questioned. The goal of this investigation was to determine if unrecognized sleep-disordered breathing in the general population, ranging from mild to severe, is associated with motor veh icle accidents. The sample comprised 913 employed adults enrolled in a n ongoing study of the natural history of sleep-disordered breathing. Sleep-disordered breathing status was determined by overnight in-labor atory polysomnography and motor vehicle accident (MVA) history was obt ained from a statewide data base of all traffic violations and acciden ts from 1988 to 1993. Men with five or more apneas and hypopneas per h our of sleep [apnea-plus-hypopnea index (AHI) >5], compared to those w ithout sleep-disordered breathing, were significantly more likely to h ave at least one accident in 5 years (adjusted odds ratio = 3.4 for ha bitual snarers, 4.2 for AHI 5-15, and 3.4 for AHI >15). Men and women combined with AHI >15 (vs. no sleep-disordered breathing) were signifi cantly more likely to have multiple accidents in 5 years (odds ratio = 7.3). These results, free of clinic selection bias, indicate that unr ecognized sleep-disordered breathing in the general population is link ed to motor vehicle accident occurrence. If the association is causal, unrecognized sleep-disordered breathing may account for a significant proportion of motor vehicle accidents.