Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

Alonderis, Audrius; Barbé, Ferrán; Bonsignore, Maria R.; Calverley, PM; Backer, W. De; Diefenbach, Konstanze; Donič, Viliam; Fanfulla, Francesco; Fietze, Ingo; Franklin, Karl A.; Grote, Ludger; Hedner, Jan; Jennum, Poul; Krieger, José Eduardo; Lévy, Patrick; McNicholas, Walter T.; Montserrat, Josep M.; Parati, Gianfranco; Pascu, M.; Penzel, Thomas; Riha, Renata L.; Rodenstein, Daniel; Sanna, Antonio; Schulz, Ronald; Sforza, Émilia; Śliwiński, Paweł; Tomori, Z; Tønnesen, P.; Varoneckas, Giedrius; Zieliński, J; Kostelidou, K.

doi:10.1016/j.sleep.2007.05.008

Cited by 54 publications

(37 citation statements)

References 16 publications

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“…The severity of this problem is known for decades: traffic accidents caused by awareness changes and/or sleepiness are 27% of the total number of accidents; from these 83% are fatal cases. Also here there is a huge circadian influence, with the majority of cases occurring during early morning (Alonderis et al, 2008). According to Hossain and Shapiro (2002) problems with falling asleep or daytime sleepiness affect approximately 35-40% of the adult population of the U.S., and are a cause of morbidity and mortality (Hossain & Shapiro, 2002).…”

Section: Introductionmentioning

confidence: 99%

Translation, cross-cultural adaptation and psychometric properties of the Jenkins Sleep Scale in a sample of Portuguese shift workers

Reis¹

2014

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Section: Introductionmentioning

confidence: 99%

Translation, cross-cultural adaptation and psychometric properties of the Jenkins Sleep Scale in a sample of Portuguese shift workers

Reis¹

2014

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“…OSAS, one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for motor vehicle crashes [70].…”

Section: Sleepiness Caused By Sleep Disordersmentioning

confidence: 99%

“…Treating OSAS normalizes the rate of RA [70,78]. However, performance may remain impaired in patients with severe OSAS even after treatment [79].…”

Section: Sleepiness Caused By Sleep Disordersmentioning

confidence: 99%

Sleepiness, Safety and Transport

Garbarino¹,

Gelsomino²,

Magnavita³

2013

J Ergonomics

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“…This group of experts has produced, between 2005 and 2010, a number of recommendations in the fields of sleep apnoea and cardiovascular disease [3,25], management of OSA [26], and driving [27,28]. Since OSA is now a recognised cause of hypertension, this group, which includes respiratory physicians, sleep experts and cardiologists, considered that there was a need to review the current knowledge and propose recommendations for clinicians and researchers.…”

mentioning

confidence: 99%

Sleep apnoea and hypertension: time for recommendations

Lévy

McNicholas

2013

Eur Respir J

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H ypertension can be caused by obstructive sleep apnoea (OSA), as now recognised in international guidelines [1,2]. The relationship between OSA and hypertension is well established, which has important consequences for the cardiovascular system [3,4]. Many studies have shown an increase in the incidence and prevalence of hypertension in patients with OSA, independent of confounding factors, such as anthropometric parameters, alcohol consumption and smoking [5][6][7][8]. OSA is a recognised cause of hypertension that should be considered in any patient with high blood pressure, particularly in those with resistant hypertension [1,2]. More than 50% of patients with OSA are hypertensive [7,9] and more than 80% of patients with resistant hypertension also have OSA [10]. Hypertension related to OSA is predominantly nocturnal with a frequent non-dipper profile (which corresponds to a limited fall in nocturnal blood pressure) and an increase in diastolic blood pressure in the majority of patients [9,11].The mechanisms linking sleep apnoea and hypertension have been extensively reviewed [3,4,12]. There is increased sympathetic activity, which has been demonstrated in patients with OSA using sympathetic micro-neurography of the nerves supplying muscles, and also using plasma and urinary catecholamine assays. Potential mechanisms contributing to OSA-related hypertension include endothelial dysfunction leading to inhibition of nitric oxide production, decreased vasodilatation, and increased vasoconstriction; systemic inflammation, which favours endothelial dysfunction; oxidative stress, which results in the production of reactive oxygen species and causes vasoconstriction as a result of nitric oxide synthase blockade, increased generation of endothelin-1, and activation of angiotensin II; activation of the renin-angiotensin-aldosterone system, which increases plasma aldosterone levels; and metabolic anomalies leading to hyperinsulinism and resistance to the metabolic effects of leptin, the adipocyte-derived hormone. Activation of the endothelin system results in vasoconstriction and depressed baroreflexes. A genetic contribution to the association between OSA and hypertension might also exist, but there is currently only a limited amount of data available to support this possibility. Although not fully understood, the role of hypoxia in promoting an increase in blood pressure appears prominent, as evidenced both in animal models [13] and more recently in a model developed in normal volunteers [14,15]. In this latter model, it is notable that intermittent hypoxia during the night did not produce an immediate increase in blood pressure, presumably due to vasodilation occurring in response to intermittent hypoxia counteracting the effects of sympathetic activation [15]. However, there was a sustained increase in sympathetic activity that seems to be responsible for the daytime increase in blood pressure observed in these subjects after only one night of intermittent hypoxia, which is more pronounced after 13 nights, and stil...

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Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe

Cited by 54 publications

References 16 publications

Translation, cross-cultural adaptation and psychometric properties of the Jenkins Sleep Scale in a sample of Portuguese shift workers

Translation, cross-cultural adaptation and psychometric properties of the Jenkins Sleep Scale in a sample of Portuguese shift workers

Sleepiness, Safety and Transport

Sleep apnoea and hypertension: time for recommendations

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