Obstructive sleep apnea hypopnea (OSAH) appears to be associated with an increased risk of motor vehicle crashes (MVC). However, its impact on crash patterns and particularly the severity of crashes has not been well described. We sought to determine whether OSAH severity influenced crash severity in patients referred for investigation of suspected sleep-disordered breathing. Objective crash data (including the nature of crashes) for patients with suspected OSAH for the 3 years prior to polysomnography were obtained from provincial insurance records and compared to an age and sex matched control group. Data were obtained for 783 patients with suspected OSAH and 783 matched controls. The patient group was 71% male, with a mean age of 50years, a mean apnea-hypopnea index (AHI) of 22 events/hour and a mean Epworth sleepiness scale score of 10. There were 375 crashes, of which 252 were in patients and 123 in controls in the 3-year period. When compared to controls, patients with mild, moderate, and severe OSAH had an increased rate of MVC with relative risks (95% CI) of 2.6 (1.7, 3.9), 1.9 (1.2, 2.8), and 2.0 (1.4, 3.0) respectively, whereas patients with suspected OSAH and normal polysomnography (AHI 0-5) did not with a relative risk (95% CI) of 1.5 (0.9, 2.5 p =0.21). When we examined the impact of OSAH on MVC associated with personal injury, patients with mild, moderate, and severe OSAH had a substantially increased rate of MVC compared to controls with relative risks of 4.8 (1.8, 12.4), 3.0 (1.3, 7.0), and 4.3 (1.8, 8.9) respectively, whereas patients without OSAH had similar crash rates to control with a relative risk of 0.6 (0.2, 2.5). Very severe MVCs (head-on collisions or those involving pedestrians or cyclists) were rare but 80% of these occurred in OSAH patients (p=0.06).

In this pilot study there were potential improvements in a variety of cardiovascular biomarkers with CPAP. CPAP compliance was reasonably good even though patients were not particularly sleepy. Accordingly, larger randomized controlled trials in this area appear feasible and warranted.

S leep disorders are extremely common and have substantial adverse impacts on both quality of life and mental health. Three of the most common sleep disorders are insomnia, obstructive sleep apnea (OSA), and restless legs syndrome (RLS).Psychiatric disorders such as depression and anxiety are more common in people who have insomnia. Furthermore, chronic insomnia is also a risk factor for the development of psychiatric disorders. 1 OSA is a common respiratory sleep disorder characterized by recurrent upper airway collapse during sleep, leading to recurrent asphyxia and sleep fragmentation. Patients with OSA are at increased risk of having motor vehicle crashes, cardiovascular disease, hypertension, and stroke. 2,3 Furthermore, OSA is an independent risk factor for the development of incident depression. 4 Treatment of OSA leads to substantial improvements in daytime sleepiness, mood, and quality of life. 5,6 RLS is a sensorimotor disorder that has a significant impact on sleep. Characteristic symptoms include the desire to move the limbs associated with paresthesia or dysesthesia, which begin or worsen during periods of inactivity predominately in the

We did not find significant associations between OSA and markers of activated innate immunity (IL-1B, 6, and 8). However, OSA severity was independently associated with serum levels of sVCAM-1 and leptin; these may represent mechanisms involved in the pathogenesis of OSA-related CVD.