Comparative Treatment Strategies for Obstructive Sleep Apnea and Their Relationships with Aberrant Driving Behaviors: Taxi Drivers in Taipei Metropolitan Area.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is prevalent among professional drivers and is associated with an increased risk of aberrant driving behaviors (ADBs). This study evaluated and compared the effectiveness of continuous positive airway pressure (CPAP) and conservative treatments in mitigating ADBs and improving sleep health among urban taxi drivers. METHODS: In this prospective non-randomized comparative study, taxi drivers diagnosed with OSA through polysomnography were assigned to either the CPAP group or the conservative treatment group. Home-based sleep parameters (oxygen desaturation index [ODI], cyclic variation of the heart rate index [CVHRI], and chest effort index [CEI]) were measured using wearable devices. Driving data were recorded with a validated navigation application. Subjective measures such as Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the 27-item Driving Behavior Questionnaire (DBQ) were also collected. Pre- and post treatment outcomes were compared within and between groups using non-parametric statistical tests following the 3-month treatment. RESULTS: Twenty-four taxi drivers were enrolled, with 13 in the CPAP group and 11 in the conservative treatment group. CPAP treatment significantly improved objective and subjective measures of sleep health and driving performance, evidenced by decreases in PSQI (p=0.04), ESS (p=0.01), and DBQ errors (p<0.01) and lapses (p=0.03). Additionally, the occurrence of ADBs per 20 km decreased (p<0.01), and sleep disorder indices improved (ODI, p<0.01; CEI, p=0.03). CONCLUSION: The conservative treatment group showed no significant changes in these measures. CPAP demonstrated its potential as a primary intervention for occupational drivers with severe OSA. Conservative treatment showed limited effectiveness and could serve as a supplementary approach.