Predictors of driving risk in patients with obstructive sleep apnea syndrome treated by continuous positive airway pressure: a French multicenter prospective cohort

Study Objectives To investigate the predictors of persistent driving risk related to sleepiness in patients with obstructive sleep apnea syndrome (OSAS) treated by continuous positive airway pressure (CPAP).Methods Longitudinal analysis of a prospective national database including 5308 patients with OSAS and an indication of CPAP. Near misses related to sleepiness, accidents related to sleepiness, and sleepiness at the wheel (SAW) were assessed before initiation and after >= 90 days of treatment. Multivariable associations with the cumulative incidence of near-misses and accidents under treatment were calculated using Cox models adjusted for age, sex, obesity, sleep duration, SAW, accidents/near-misses history, depressive symptoms, residual apnea-hypopnea index, and adherence to treatment.Results Residual SAW under treatment was associated with an eight-fold higher incidence of near-misses related to sleepiness (hazard ratios [HR] = 8.63 [6.08-12.2]) and five-fold higher incidence of accidents related to sleepiness (HR = 5.24 [2.81-9.78]). Adherence <= 4 h/night was also a significant predictor of persistent driving risk (HR = 1.74 [1.12-2.71] for near-misses and HR = 3.20 [1.37-7.49] for accidents).Conclusions Residual SAW and treatment adherence <= 4 h/night are easy-to-assess markers to detect persistent driving risk during the follow-up evaluations of patients under treatment. Health professionals, but also policymakers, should be aware of the crucial importance of systematically evaluating these elements during the follow-up evaluations of the patients with OSAS treated by CPAP to better evaluate their driving risk.