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Sleep Apnea and Driving Risk

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Conclusions Î Automobile crashes are the fifth leading cause of death and injury in the United States. Î The number of crashes and severity of injury by distance driven are highest in young drivers (15-25 yr) and in those >65 yr. Î Crashes due to sleepiness typically involve running off the road or into the back of another vehicle. Î Sleepiness is most commonly caused by insufficient sleep, which is associated with prolonged wakefulness or chronic sleep restriction due to long hours of work or play, shift work (comprising 7.4% of all those employed), or a variety of medical and neurological disorders. Î Fatality reduction currently targets increasing seat belt use and reducing speeding and alcohol. However, inattentiveness, fatigue, and sleepiness are increasingly recognized as contributing, and possibly primary, factors. Î Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for motor vehicle crashes two to three times. Î Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Î A high-risk driver is defined as one who has moderate to severe daytime sleepiness and a recent unintended motor vehicle crash or a near-miss attributable to sleepiness, fatigue, or inattention. Î There is no compelling evidence to restrict driving privileges in patients with sleep apnea if there has not been a motor vehicle crash or an equivalent event. Î Treatment of OSA improves performance on driving simulators and might reduce the risk of drowsy driving and drowsy driving crashes. Î Timely diagnostic evaluation and treatment and education of the patient and family are likely to decrease the prevalence of sleepiness-related crashes in patients with OSA who are high-risk drivers.

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