New advice on how to assess fitness to drive in people with sleep apnoea

A summary of a new task force report in the European Respiratory Journal

Sleep apnoea is a known risk factor for driving accidents and recent European regulations specify that people with severe symptoms should not be allowed to drive unless they are receiving effective treatment. However, it is not certain how doctors can assess this. A new report from the European Respiratory Society aims to give practical advice to doctors on how to decide whether people with sleep apnoea are fit to drive, based on expert views.

How was the report put together?

The report is based on expert views from a number of people working in the fields of respiratory-sleep medicine, neurology, psychiatry and public health, as well as a patient representative. The report analysed the latest data in a number of key areas including: how often people with sleep apnoea have driving accidents, the causes of excessive daytime sleepiness and what tools can be used to measure sleepiness and fitness to drive.

What are the key findings?

The report summarises a large amount of data across these topics. Key findings include:

• Current screening tools miss a high number of people at risk of a driving accident.
• Poor performance on a driving simulator does not predict accidents during real driving, but may raise concern about whether that individual is safe to drive.
• Evidence showed that treatment with continuous positive airway pressure (CPAP) reduced the risk of an accident, improved daytime sleepiness and improved brain function, including the gathering and processing of information.  

The report included four key takeaway points for doctors treating people with sleep apnoea:

• Assessment of sleep apnoea severity based just on how often breathing stops during sleep (AHI score) does not alone predict fitness to drive.
• Excessive sleepiness is a major factor in determining accident risk, but does not relate to the AHI score and may be partly due to other factors such as depression and obesity.
• Where there is doubt about self-reported sleepiness, further tests are needed.
• Effective treatment with CPAP largely reduces the risk of accidents and a person can continue to drive once this has been shown.

The report also highlighted gaps in the current data to suggest further areas for research. This included a strong need for good quality studies on how best to diagnose sleep apnoea and detect sleepiness in drivers.

Why is this important?

This in-depth report provides an overview of current research in this area. It includes a practical overview on a range of topics to help clinicians manage people with sleep apnoea. By highlighting the gaps in research, the authors hope that further studies can contribute to this field and help manage this risk in people with the condition.

Read the original research paper

Title: European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

https://erj.ersjournals.com/content/early/2020/09/28/13993003.01272-2020