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Sleep apnoea and driving: how can this be dealt with?

Sleep Disorders Unit, University Hospital Strasbourg, Strasbourg, France.

CORRESPONDENCE: J. Krieger, Clinique Neurologique, 1, Place de l'Hôpital, F-67091 Strasbourg Cedex, France, Fax: 33 388116343. E-mail: krieger.jean{at}laposte.net

Excessive daytime sleepiness has long been known to be associated with an increased risk of often particularly severe traffic accidents. Obstructive sleep apnoea (OSA) is among the most prevalent conditions leading to excessive daytime sleepiness, in addition to impaired cognitive function, both of which are likely to impair driving ability.

An increased risk of traffic accidents has been demonstrated repeatedly, in association with OSA, as well its normalisation with effective treatment. However, it seems that not all patients are at equal risk, but it is not clear how to identify when and how at-risk patients can be identified.

Nevertheless, some European countries have made specific regulations concerning OSA and/or excessive daytime sleepiness and the capacity to obtain or to keep a driving license. Most countries have the general rule that "a driving license should not be given or renewed to any candidate or license holder suffering from a disorder ... likely to compromise safety on the road", without a specific mention of sleepiness and/or sleep apnoea. However, the way in which such a statement is applied and the measures taken to identify unfit drivers vary greatly from country to country. In addition, in those countries that have made specific regulations, no evaluation of their efficacy in reducing sleepiness-related accidents is available.

In practice, it is the physician's responsibility to inform the untreated obstructive sleep apnoea patient about the risk associated with their condition, and about the regulations that prevail in their country, if relevant; only in a few countries, is the physician allowed (or compelled) to report the unfit patient to the licensing authorities. Although it is generally accepted that the treated patient may be allowed to drive, the specific treatment conditions that eliminate the risk are not clearly established.

KEYWORDS: Accidents, cognition, driving, safety, sleep apnoea syndrome, sleepiness