<p>Therapeutic Strategies for Mitigating Driving Risk in Patients with Narcolepsy</p>

Abstract

Narcolepsy is a central nervous system hypersomnia disorder characterized by uncontrollable episodes of daytime sleep, sleep state instability, and cataplexy (sudden loss of muscle tone precipitated by emotion). Individuals with narcolepsy report more frequent sleep-related crashes, near crashes, and drowsy driving than drivers with other sleep disorders. As such, evaluating risk of sleep-related crashes is of great importance for this patient population. There are no established guidelines for ensuring driving safety in patients with narcolepsy; however, many providers currently use a combination of subjective report, report of prior crashes or near-misses, report of previously falling asleep while driving, sleepiness screening tools, and maintenance of wakefulness testing (MWT) to determine risk. Driving simulator tests, though often unavailable to the clinician, provide data to support the use of MWT for evaluation of alertness in drivers with narcolepsy. Treatments such as modafinil may improve driving performance; however, the impact of other treatments such as stimulants and sodium oxybate on driving has not been extensively studied. Behavioral and lifestyle modifications may also reduce risk, including scheduled naps, driving only short distances, and avoiding driving after meals, sedating medications, and alcohol intake. Even with effective treatment, alertness in patients with narcolepsy may never reach that of normal drivers; however, studies have suggested that narcolepsy patients may be able to drive safely with appropriate limitations.

Comparing objective wakefulness and vigilance tests to on‐the‐road driving performance in narcolepsy and idiopathic hypersomnia

“…Other treatments such as with stimulants, sodium oxybate, and lifestyle changes have not been evaluated in regard to driving. A recent review concluded that treated patients with narcolepsy may be able to drive safely with appropriate limitations (McCall & Watson, 2020 ). The person’s ability to judge his or her state of sleepiness and driving safety, and ability to act accordingly, may be the most important factor indicating driving fitness.…”

Optimising sleep in adolescents: The challenges

“…Certain sleep disorders might additionally increase the risk of motor vehicle accidents, such as untreated OSA 80 and narcolepsy. 81 Narcolepsy is important to consider in adolescent patients because the onset of symptoms occurs during childhood and adolescence in 50% of cases, 82 and diagnosis has specific implications for driving. Referral to a sleep specialist should be considered once other causes of excessive daytime sleepiness have been excluded.…”

Sleepless on the road: Are mothers of infants with insomnia at risk for impaired driving?

“…Research examining the effects of drowsy driving has mainly focused on certain at‐risk populations, such as individuals with sleep disorders (e.g. obstructive sleep apnea, narcolepsy; McCall & Watson, 2020; Rizzo et al, 2019) and night‐shift‐workers (Lee et al, 2016; Smith et al, 2020). However, parents of young children may also be a population at risk for drowsy driving due to the sleep disturbance they may experience during this developmental phase of their child's life.…”