T. Young et al., SLEEP-DISORDERED BREATHING AND MOTOR-VEHICLE ACCIDENTS IN A POPULATION-BASED SAMPLE OF EMPLOYED ADULTS, Sleep, 20(8), 1997, pp. 608-613
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.