Since around 1990, it has been reported that the risk of motor vehicle accidents (MVAs) among patients with obstructive sleep apnea (OSA) is higher compared to general drivers, with a quite high accident rate among professional drivers. The primary causes are considered to be excessive daytime sleepiness (EDS) brought about by frequent nighttime sleep disruptions and intermittent hypoxemia due to apneic events and its related declines in various driving-related functions. Additionally, factors such as fatigue, age, and some psychological disturbance may contribute to the occurrence of accidents. Real-world driving tests would be ideal for predicting the risk of accidents in individuals with OSA. However, since it is impossible to implement such tests widely, other evaluations, including the Epworth Sleepiness Scale, which assesses subjective sleepiness; the Maintenance of Wakefulness Test, which evaluates the ability to stay awake objectively; and driving simulator tests, are conducted either individually or in combination. For professional drivers, where accident prevention is of utmost importance, it is desirable to conduct home sleep apnea tests for those with OSA risk factors such as obesity. For OSA drivers who are at risk of MVAs, treatment with nasal continuous positive airway pressure (CPAP) is desirable, as the treatment suppresses EDS in most of the affected individuals. However, a certain number of cases show residual sleepiness even after the treatment. In such cases, the use of wake-promoting drugs should be considered. Additionally, to reduce the risk of driving accidents caused by drivers with OSA, it would be desirable to create effective guidelines and to establish a close network between companies that employ drivers, the agencies involved in issuing and renewing driver’s licenses, and medical institutions in the future.