Adherence to Treatment and Residual Sleepiness at the Wheel are Predictors of Driving Risk in CPAP-Treated OSAS: Data from a French Multicenter Prospective Database

Background: Continuous Positive Airway Pressure (CPAP) therapy is effective in reducing Excessive Daytime Sleepiness (EDS) and driving risk in the vast majority of Obstructive Sleep Apnea Syndrome (OSAS) patients. There is a need to identify predictors of residual driving risk in CPAP-treated patients. We aimed to investigate the determinants of persistent driving risk related to sleepiness in CPAP-treated OSAS patients. Methods: Longitudinal analysis of a prospective national database including 5,308 patients with OSAS and an indication of CPAP treatment. Near-misses, accidents, and sleepiness at the wheel were assessed before initiation and after ≥ 90 days of CPAP treatment. Multivariate associations with the cumulative incidence of near-misses and accidents on CPAP were calculated using Cox models adjusted for age, sex, obesity, sleep duration, sleepiness at the wheel, accidents/near-misses history, depressive symptoms, residual apnea-hypopnea index, and adherence to treatment. Findings: Residual sleepiness at the wheel on CPAP was associated with eight-fold higher incidence of near-misses (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 ≤4h/night was also a significant contributor of persistent driving risk (HR=1·74 [1·12-2·71] for near-misses and HR=3·20 [1·37-7·49] for accidents). Interpretation: Residual sleepiness at the wheel and CPAP-adherence ≤4h/night are easy-to assess markers to detect persistent driving risk during the follow-up evaluations of patients on CPAP. Health professionals, but also policy makers, should be aware of the crucial importance to systematically evaluate these elements during the follow-up evaluations of the patients with OSAS treated by CPAP therapy to improve driving risk.Funding: JL Pépin, S Baillieul, R Tamisier and S Bailly are supported by the French National Research Agency in the framework of the "Investissements d’avenir” program (ANR-15-IDEX-02) and Grenoble Alpes University Foundation (ANR-19-P3IA-0003) ‘Chair of excellence’ “e-health and integrated care and trajectories medicine and MIAI artificial intelligence”. TDeclaration of Interest: None.Ethical Approval: All included patients provided written informed consent prior to their inclusion in the registry. Ethical committee approval was obtained from « Le Comité consultatif sur le traitement de l’information en matière de recherche en santé » (C.C.T.I.R.S n° 09·521) and authorization from “La Commission Nationale Informatique et Liberté » (C.N.I.L), the French information technology, and personal data protection authority. The OSFP Independent Scientific Advisory Committee approved data extraction for this study. Periodic quality control checks were performed to ensure up-to-standard data recording. The reporting of the study is handled according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.