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To the Editor:
We thank Dr. Kumagai et al. [1] for their interest in our study regarding motor vehicle accidents (MVA) in CPAP-compliant patients with obstructive sleep apnea (OSA) [2]. In a long-term study based on objective data of both CPAP adherence and MVA we found that CPAP-treated patients with high adherence did not have lower MVA incidence than those with poor CPAP adherence, or untreated patients. Our results were contradictory to many previous studies, most of them using self-reports of MVA and/or CPAP adherence.
Kumagai et al. are concerned about driving safety, especially among professional drivers. We share their concern. We agree that combination therapy with CPAP and an oral appliance is worthy of investigating as well as taking advantage of technical solutions to improve driving safety for prevention of MVAs.
However, we still encourage our patients to comply with CPAP therapy. In our study, MVA data were based on a national registry in which data of small, near miss accidents or close shaves on the road were not available. Further, Finland is a sparcely populated country and the effect of CPAP therapy on driving safety may be greater in countries with higher traffic density. Of importance, time to the first MVA was almost three times longer among CPAP-treated than those among controls suggesting some beneficial effect of CPAP treatment.
References
Kumagai H, Tsuda H, Shiomi T. (2023) Which treatments are effective in preventing motor vehicle accidents in patients with obstructive sleep apnea? Sleep Breath
Myllylä M, Anttalainen U, Saaresranta T, Laitinen T (2020) Motor vehicle accidents in CPAP-compliant obstructive sleep apnea patients-a long-term observational study. Sleep Breath 24:1089–1095. https://doi.org/10.1007/s11325-020-02023-2
Gurubhagavatula I, Sullivan S, Meoli A, Patil S, Olson R, Berneking M, Watson NF (2017) Management of obstructive sleep apnea in commercial motor vehicle operators: recommendations of the AASM sleep and Transportation safety Awareness task force. J Clin Sleep Med 13:745–758. https://doi.org/10.5664/jcsm.6598
Randerath W, Verbraecken J, de Raaff CAL, Hedner J, Herkenrath S, Hohenhorst W, Jakob T, Marrone O, Marklund M, McNicholas WT, Morgan RL, Pepin JL, Schiza S, Skoetz N, Smyth D, Steier J, Tonia T, Trzepizur W, van Mechelen PH, Wijkstra P (2021) European Respiratory Society statement on sleep apnoea, sleepiness and driving risk. Eur Respir Rev 30:210200. https://doi.org/10.1183/16000617.0200-2021
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Korenius, M., Anttalainen, U., Laitinen, T. et al. Response to the letter entitled ”Which treatments are effective in preventing motor vehicle accidents in patients with obstructive sleep apnea?”. Sleep Breath 27, 1943 (2023). https://doi.org/10.1007/s11325-023-02805-4
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DOI: https://doi.org/10.1007/s11325-023-02805-4