European Respiratory Society statement on sleep apnoea, sleepiness and driving risk

Obstructive sleep apnoea is a type of sleep disordered breathing (SDB) and is very common. Men are especially affected, and recent studies suggest that up to 1 in 2 men may have moderate to severe SDB. Having obstructive sleep apnoea can lead to symptoms such as excessive daytime sleepiness; this can cause lots of problems and is especially dangerous when driving.

In 2014 the European Union (EU) introduced regulations that restrict people with obstructive sleep apnoea from driving until they receive effective treatment for their condition. They then require a doctor’s letter to confirm that they are able to drive again. Doctors were concerned about the tests used to evaluate how severe obstructive sleep apnoea is and whether sleepiness can be accurately measured.

Because of the EU regulations and the concerns of doctors, the European Respiratory Society (ERS) developed a task force to address the topics of obstructive sleep apnoea, sleepiness and driving. The task force produced this report to provide an overview for doctors treating people with the disorder.

The task force was made-up of experts from respiratory sleep medicine, neurology, psychiatry and public health, and there was a patient representative involved.

The task force worked on a detailed review of more than 30 years’ worth of medical literature.

The topics covered in the report are broken down into several important areas:

• Epidemiology (patterns in a population) of motor vehicle accidents in patients with obstructive sleep apnoea
• Pathophysiology (how diseases or conditions develop in the body) and predictors of excessive daytime sleepiness in obstructive sleep apnoea
• The role of questionnaires as screening tools for obstructive sleep apnoea in drivers
• Evaluation of sleepiness
• Driving simulators in the evaluation of fitness to drive
• Effectiveness of continuous positive airway pressure (CPAP) treatment in obstructive sleep apnoea among commercial and non-commercial motor vehicle drivers

The report goes into detail about each of these areas, it looks at what is already known about them and recommends further research.

As a result of the report, the task force members were able to issue a statement for clinicians about assessing the risk of driving in people with obstructive sleep apnoea.

They advise that:

• Obstructive sleep apnoea severity assessed as apnoea-hypopnoea (AHI) alone does not predict fitness to drive in obstructive sleep apnoea patients. AHI is used to indicate how severe obstructive sleep apnoea is – it measures how many events happen within an hour.
• Excessive sleepiness is a major risk factor in determining accident risk in obstructive sleep apnoea, but it does not relate to AHI and may be partly due to other non-obstructive sleep apnoea factors.
• Where a doctor is uncertain if a person is being accurate about how sleepy they are, further investigation, such as the maintenance of wakefulness test, is warranted, especially in professional drivers.
• Effective and compliant treatment of obstructive sleep apnoea with CPAP largely reverses the increased accident risk and driving can resume once a patient is successfully treated.

They also recommend future research into:

• Better ways of detecting levels of sleepiness
• Screening for obstructive sleep apnoea to identify those at high risk for motor vehicle accidents
• New technologies to prevent accidents related to sleepiness

This report is important because it provides guidance for doctors who are supporting people with obstructive sleep apnoea and carrying out tests for them to be able to drive again. The report also advises about what research is needed moving forward.

Read the original research paper

Title: European Respiratory Society statement on sleep apnoea, sleepiness and driving risk

https://erj.ersjournals.com/content/57/2/2001272.abstract