Variability in clinicians’ opinions regarding fitness to drive in patients with obstructive sleep apnoea syndrome (OSAS): Table 1

Abstract

We evaluated clinicians' current practice for giving advice to patients with Obstructive Sleep Apnoea Syndrome (OSAS). Clinicians were invited to complete a web based survey and indicate the advice they would give to patients in a number of scenarios about driving; theywere also asked what they considered to be residual drowsiness and adequate compliance following CPAP treatment. In the least contentious scenario, 94% of clinicians would allow driving; in the most contentious a patient had a 50% chance of being allowed to drive.Following treatment with CPAP, clinicians' interpretation of what constituted residual drowsiness was inconsistent. In each vignette the same clinician was more likely to say "yes" to "excessive" than to "irresistible" (71+/12% v/s 42+/ 10%, P= 0.0045). There was also a lack of consensus regarding "adequate CPAP compliance"; "yes" responses ranged from 13% to 64%. There is a need for clearer guidance; a recent update to the DVLA guidance, and a statement from the BTS, making it clear that sleepiness while driving is the key issue, may help.2

Certification of fitness to drive in sleep apnea patients: Are we doing the right thing?

“…The reduction of EDS and OSA intensity, as well as several other MVA risk factors, needs to be considered prior to attestation (Karimi et al, ) and there are currently only few published national guidelines for the process (British Thoracic Society, ; Terán‐Santos et al, ). Moreover, clinical practice already varied considerably between countries and sleep centres before this new EU directive (Alonderis et al, ; Dwarakanath et al, ). Data on the driving license attestation procedures in Europe are lacking and this limits systematic attempts to improve a certification process that is important to both society and the individual OSA patient (Bonsignore, ).…”

Identifying and treating obstructive sleep apnea in sleepy drivers: Everybody wins

“…Although apparently clear, these regulations have resulted in anxiety and some confusion among drivers with OSA and their treating clinicians (Dwarakanath et al., ). The EU directive does not specify the level of sleepiness that should apply, although some countries have qualified sleepiness in their national regulations as sleepiness while driving.…”

New rules on driver licensing for patients with obstructive sleep apnoea: EU Directive 2014/85/EU

“…The need for practical guidelines for clinicians is particularly evident in a recent report demonstrating a lack of consensus in clinicians' judgement of fitness to drive in both untreated and CPAPtreated patients with OSA [11].…”