An Official American Thoracic Society Clinical Practice Guideline: Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers. An Update of a 1994 Statement

Abstract

Background: Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk. Methods: A multidisciplinary panel was convened to develop evidence-based clinical practice guidelines for the management of sleepy driving due to OSA. Pragmatic systematic reviews were performed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to formulate and grade the recommendations. Critical outcomes included crash-related mortality and real crashes, whereas important outcomes included near-miss crashes and driving performance. Results: A strong recommendation was made for treatment of confirmed OSA with continuous positive airway pressure to reduce driving risk, rather than no treatment, which was supported by moderate-quality evidence. Weak recommendations were made for expeditious diagnostic evaluation and initiation of treatment and against the use of stimulant medications or empiric continuous positive airway pressure to reduce driving risk. The weak recommendations were supported by very low-quality evidence. Additional suggestions included routinely determining the driving risk, inquiring about additional causes of sleepiness, educating patients about the risks of excessive sleepiness, and encouraging clinicians to become familiar with relevant laws. Discussion: The recommendations presented in this guideline are based on the current evidence, and will require an update as new evidence and/or technologies becomes available. EXECUTIVE SUMMARYObstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness; it is a risk factor for both drowsy driving and car crashes due to falling asleep. The purpose of these Guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, driving risk, and sleep-disordered breathing, the most common of which is OSA. The intended audience is the practitioner who encounters patients with sleep disorders. Conclusionsd OSA versus non-OSA is associated with a two-to threetimes increased overall risk for motor vehicle crashes, but prediction of risk in an individual is imprecise.d A high-risk driver is defined as one who has moderate to severe daytime sleepiness and a recent unintended motor vehicle crash or a near-miss attributable to sleepiness, fatigue, or inattention.d There is no compelling evidence to restrict driving privileges in patients with sleep apnea if there has not been a motor vehicle crash or an equivalent event.d Treatment of OSA improves performance on driving simulators and might reduce the risk of drowsy driving and drowsy driving crashes.d Timely diagnostic evaluation and treatme...

Self-Reporting by Unsafe Drivers Is, with Education, More Effective than Mandatory Reporting by Doctors

“…7 While such legislation covers all disciplines of medicine it is clear that some specialists such as neurologists (epilepsy, dementia) and sleep physicians (narcolepsy, obstructive sleep apnea syndrome [OSAS]) may have a higher proportion of patients who are eligible to be reported. 13 Severe OSAS, for instance, increases accident risk by as much as 1.2-4.9 times. 14,15 Section 148 may lead some SA drivers to avoid medical assessments in an attempt to protect their licence, thereby resulting in an actual decrease in public road safety.…”

Obstructive sleep apnea and driving risk: The current Turkish legislation, controversies, and future perspectives

“…OSA is an important contributor to the occurrence of EDS in general population [11,12], and the condition is associated with a two-to sevenfold increased risk for MVA [11,13,14]. Crashes due to EDS typically involve running off the road or into the back of another vehicle [15].…”

Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center

“…Rather, studies suggest psychologically based factors such as health beliefs, attitudes, knowledge, and early adherence behavior patterns also play a significant role 20,21,25 ; PAP therapy adherence patterns observed within as little as one week can predict future therapy use. [26][27][28][29] Interventions based on health behavior change concepts appear to have…”

“…[26][27][28][29] The group adherent at 1 week showed much higher proportions of adherent participants at subsequent time points compared to those participants who were non-adherent at 1 week. For non-adherent participants at week 1, the number adherent at 1 year in our study was quite low (11.7%).…”