0539 Predictors of Driving Risk in CPAP-treated OSAS: A French Multicenter Prospective Cohort

Abstract Introduction 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. Results 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). Conclusion 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. Support (if any)