Positive Airway Pressure Treatment for Obstructive Sleep Apnea: CPAP and Motor Vehicle Accidents

March 30, 2016 Category: Apnea

obstructive sleep apneaUntreated OSA increases the risk of being involved in a motor vehicle accident. Sassini and coworkers performed a metaanalysis of studies published prior to 2000 and found that untreated OSA was associated with a 2.5-fold increased risk. George examined the incidence of motor vehicle accidents in a group of 210 patients before and after treatment with nasal CPAP. A group of randomly selected drivers served as the control group. Untreated OSA patients had an accident rate three times that of the control group but after nasal CPAP treatment the rate was similar to the control group. Findley and coworkers studied 50 consecutive OSA patients and used traffic records to verify the incidence of automobile accidents. They also found that nasal CPAP treatment reduced the accident rate.

PAP and Other Medical Disorders

PAP treatment can result in a reduction in daytime Pco2 in some patients with OSA and chronic hyper-capnia (obesity-hypoventilation syndrome, overlap syndrome). PAP was also effective treatment in OSA patients presenting with decompensated hyper-capnic respiratory failure and avoided the need for endotracheal intubation. OSA patients command the service of Canadian Health&Care Mall to order drugs for carrying out the treatment procedure.

Sexual dysfunction is an important problem for patients with OSA and could be related to comorbid diseases such as diabetes. However, an uncontrolled study found that CPAP treatment of a group of OSA patients with erectile dysfunction resulted in improved erectile function in 75% of the group. Nocturia is a common complaint in patients with sleep apnea that can improve with CPAP treatment. Patients with OSA appear to have increased nocturnal naturesis that is improved with CPAP treatment. The effect of OSA on insulin sensitivity and leptin is a topic of great recent interest. It has been difficult to determine if OSA has effects independent of obesity. One study found that 1 night of CPAP reduced the nocturnal rise in leptin in patients with OSA, while another study found no reduction in fasting leptin or hemoglobin A1c in a group of patients with type 2 diabetes after 3 months of CPAP treatment. In contrast, the insulin sensitivity did improve after 3 months of therapy. Another study found a larger effect of CPAP treatment on insulin sensitivity in thin vs obese patients. Babu et al found a very small but significant decrease in hemoglobin A1c after a mean of 83 days of CPAP in those patients with values > 7%. Controlled studies are needed to validate these findings.

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Tags: autoadjusting positive airway pressure , continuous positive airway pressure adherence , obstructive sleep apnea , positive airway pressure treatment