Public health and medicolegal implications of sleep apnoea

European Respiratory Journal 2002 20: 1594-1609; DOI: 10.1183/09031936.02.00404502

Tables

  • Table 1

    Sleep-related breathing disorders

    DescriptionSynonymsICD-9-CM code
    Obstructive sleep apnoea syndromeObesity hypoventilation syndrome
    Pickwickian syndrome780.53-0
    Central sleep apnoea syndromeNonobstructive sleep apnoea
    Cheyne-Stokes respiration780.51-0
    Central alveolar hypoventilation syndromePrimary alveolar hypoventilation
    Nonapnoeic alveolar hypoventialtion780.51-1
    Primary snoringSimple snoring780.53-1
    Infant sleep apnoeaApnoea of prematurity
    Apnoea of infancy
    Apparent life-threatening event
    Obstructive sleep apnoea syndrome770.8
    Congenital central hypoventilation syndromePrimary alveolar hypoventilation syndrome
    Ondine's curse770.81

    • International classification of diseases (ICD)-9 and ICD-9-CM codes for a number of recognised sleep-related breathing disorders in the International Classification of Sleep Disorders Diagnostic and Coding Manual

    • ICD-9: World Health Organization: International Classification of Diseases, ninth edition

    • ICD-9-CM: North American Clinical Modification of ICD-9

  • Table 2

    Prevalence of obstructive sleep apnoea in various epidemiological studies

    First author [ref.no.] (country)Population SubjectsAge yrsCriteriaPrevalence %
    Lavie 9 (Israel)1262 M18–67AI >10, symptomatic1.0–5.9
    Telakivi 10 (Finland)1939 M30–69Snoring, EDS and RDI >100.4–1.4
    Gislason 11 (Sweden)3201 M30–69Snoring, EDS and AHI >100.7–1.9
    Cirignotta 12 (Italy)1170 M30–39AI >10, symptomatic0.2–1.0
    40–59AI >10, symptomatic3.4–5.0
    60–69AI >10, symptomatic0.5–1.1
    Stradling 13 (1991)893 men35–65ODI4 >20, symptomatic0.3
    ODI4 >101.0
    ODI4 >54.6
    Young 8 (USA)352 M30–60Hypersomnia and RDI >54.0 (M)
    250 F30–602.0 (F)
    Gislason 14 (Iceland)2016 F40–59Habitual snoring, EDS and verification of OSAS in PSG>2.5
    Olson 151233 M35–69AHI >154–18
    (Australia)969 FAHI >107–35
    AHI >514–69
    Bearpark 16294 M40–65RDI >1010.0
    (Australia)Subjective EDS and RDI >53.0
    Gislason 17 (Iceland)555 Children6 months–6 yrsHabitual snoring or apneic episodes, and ODI4 >3>2.9
    Ohayon 18 (UK)2078 M15–100N/A2.4–4.6
    2894 F15–100N/A0.8–2.2
    Kripke 19 (USA)165 M40–64ODI4 >205.4–13.2
    190 F40–64ODI4 >202.1–8.3
    Bixler 20 (USA)4364 M20–100AHI >10 and clinical criteria fulfilled with daytime symptoms3.3
    Subsample: 74145–64 yrs: 4.7
    Duran 21 (Spain)1050 M30–70AHI ≥1019
    1098 F15

    • AI: apnoea index

    • EDS: excessive daytime sleepiness

    • RDI: respiratory disturbance index

    • AHI: apnoea/hypopnoea index

    • ODI4: oxygen desaturations >4% per hour

    • OSAS: obstructive sleep apnoea syndrome

    • PSG: polysomnography

    • N/A: not applicable

    • M: male

    • F: female

  • Table 3

    Existing regulations concerning Group 1 licences

    CountryRegulationsDateDisordersInitial applicationRepeated
    EDSSASNarcoPLMSIHOtherDriverDoctorOther
    EU
     BY03/98+++ QYC#(+)
     FY05/97+++++ QN
     GBY03/98++++ QY
     EY06/97+++Insomnia (hypnotics)++2 yr
    Circadian rhythm disorders
     SY06/96+++Ronchopathy+ QN+§
     PN##+ QNC+ƒ
     AUN##
     DKN##+ C>70
     FIN§§
     GR++N##
     Iƒƒ
     IRL++N
     LN+ CAt age 50, 60, 70, then every 3 yrs after 70 yrs, every year after 80 yrs
     NL++Y/N1994Disturbances of consciousness other than epilepsyƒƒ+ QNNot until 70 yrs
     D++
    Non-EU
     NN##+ QN¶¶+¶¶No
     CHN##QN+ƒ>70: 2 yr

    • EU: countries belonging to the European Union

    • Non-EU: not belonging to the EU

    • EDS: excessive daytime sleepiness

    • SAS: sleep apnoea syndrome

    • Narco: narcolepsy

    • PLMS: periodic leg movement syndrome

    • IH: idiopathic hypersomnolence

    • Y: yes

    • N: no

    • C: certificate

    • Q: questionnaire

    • QY: the questionnaire includes question(s) concerning EDS

    • QN: questionnaire includes no question concerning EDS

    • B: Belgium

    • F: France

    • UK: United Kingdom

    • E: Spain

    • S: Sweden

    • P: Portugal

    • AU: Austria

    • DK: Denmark

    • Fin: Finland

    • GR: Greece

    • I: Italy

    • IRL: Ireland

    • L: Luxembourg

    • NL: Netherlands

    • D: Germany

    • N: Norway

    • CH: Switzerland

    • #: if applicant cannot complete all items in the questionnaire

    • : only if driver is a danger to themself or others

    • +: medical centre specific for driver evaluation

    • §: mandatory disclosure

    • ƒ: any doctor is allowed to report any disorder which may constitute a public hazard

    • ##: general rule, medical conditions that impair the ability to drive safely

    • ¶¶: physician act and road traffic act obligate physicians (and license holders) to report to the county medical officer

    • ++: responded, but did not complete the questionnaire

    • §§: did not respond

    • ƒƒ: includes syncope, narcoleptic episodes, cataplectic attacks, and SAS

  • Table 4

    Group 1 licences (continued)

    CountryAfter licenseFurther informationLicense Returned after Tx
    DriverDoctorPoliceCourtOtherDriverReport DrQuestion DrSleep specialistOther specialistOther Tx efficacyFw-up
    EU
     B+++NeuYY#2 yr
     F++++ préfet+++YNV
     GB++++++YNN
     E++++YN2 yr
     S++++++YNV
     P++++Adminis+NeuYN1 yr
     AU++++
     DK+ƒ+++
     FIN
     GR
     I
     IRLYN
     L+ C+ C+++N
     NLNeu§Y§Y§1 yr§
     D
    Non-EU
     N+##+##+++N
     CH+ ¶¶++++YN1 yr

    • Tx: treatment

    • Fw-up: follow-up

    • V: variable

    • Neu: neurologist

    • B: Belgium

    • F: France

    • UK: United Kingdom

    • E: Spain

    • S: Sweden

    • P: Portugal

    • AU: Austria

    • DK: Denmark

    • Fin: Finland

    • GR: Greece

    • I: Italy

    • IRL: Ireland

    • L: Luxembourg

    • NL: Netherlands

    • D: Germany

    • N: Norway

    • CH: Switzerland

    • #: narcolepsy, 6 months without symptoms, sleep apnoea syndrome (SAS) 1 month after efficient Tx started

    • : narcolepsy, 2-yr max, SAS 2 yr once without limitation if normal after 2 yr

    • +: Board of doctor(s) appointed by the Licensing Authority (from a list among general practitioners and/or specialists)

    • §: for the case of reported loss of consciousness

    • ƒ: informs the police

    • ##: physician act and road traffic act obligate physicians (and license holders) to report to the county medical officer

    • ¶¶: any doctor is allowed to report any disorder which may constitute a public hazard

    • ++: mandatory disclosure

  • Table 5

    Existing regulations concerning Group 2 licences

    CountryRegulationsDateDisordersInitial applicationRepeated
    EDSSASNarcoPLMSIHOtherDriverDoctorOther
    EU
     BY03/98+++ QY C(+)#+5 yr
     FY05/97+++++ QN++5 yr
     GBY03/98++ QY
     EY06/97++++Insomnia (hypnotics)+1 yr
    Circadian rhythm disorders
     SY06/96+++RonchopathyQN C+6b10 yr¶¶
     PNƒ+ QN C+§
     AUNƒ
     DKNƒ+ C5 yr
     FIN
     GR
     I
     IRL
     LN+ C10 yr before age 50 yrs 5 yr after age 50 yrs
     NLY/N1994Disturbances of consciousness other than epilepsy+ QN+Not until 70 yrs
     D
    Non-EU
     NNƒ+##+##10 yr
     CHNƒC++<50: 5 yr, >50: 3 yrs

    • EU: countries belonging to the European Union

    • Non-EU: not belonging to the EU

    • EDS: excessive daytime sleepiness

    • SAS: sleep apnoea syndrome

    • Narco: narcolepsy

    • PLMS: periodic leg movement syndrome

    • IH: idiopathic hypersomnolence

    • Y: yes

    • N: no

    • C: certificate

    • Q: questionnaire

    • QY: the questionnaire includes question(s) concerning; EDS

    • QN: questionnaire includes no question concerning EDS

    • B: Belgium

    • F: France

    • UK: United Kingdom

    • E: Spain

    • S: Sweden

    • P: Portugal

    • AU: Austria

    • DK: Denmark

    • Fin: Finland

    • Gr: Greece

    • I: Italy

    • Irl: Ireland

    • L: Luxembourg

    • NL: Netherlands

    • D: Germany

    • N: Norway

    • CH: Switzerland

    • #: only if driver is a danger for himself or others

    • : medical centre specific for driver evaluation (or restrictive list of authorised doctors in Belgium)

    • §: any doctor is allowed to report any disorder which may constitute a public hazard

    • ƒ: general rule, medical conditions that impair the ability to drive safely

    • ##: physician act and road traffic act obligate physicians (and license holders) to report to the county medical officer

    • ¶¶: after ages of 45 yrs, from a special district doctor

    • §§: includes syncope, narcoleptic episodes, cataplectic attacks, and sleep apnoea syndrome

  • Table 6

    Group 2 licences (continued)

    CountryAfter licenseFurther infoLicense Returned after Tx
    DriverDoctorPoliceCourtOtherDriverReport DrQuestion DrSleep specialistOther specialistOther Tx efficacyFw-up
    EU
     B++#++++Neu PneumoYY+1 yr§
     F++++ préfet++ƒYNV
     GB+(+)(+)(+)++Y##N1 yr
     E++++YN1 yr
     S++++YNV
     P++++Admin+NeuYN1 yr
     AU++++
     DK+¶¶+++
     FIN
     GR
     I
     IRL
     L+ C+ C+++Y ?N?
     NLNeu++Y++Y++5 yr++
     D
    Non-EU
     N+§§+§§+++N
     CH+++++N1yr

    • Préfet: the representative in each region of the national government

    • Tx: treatment

    • Fw-up: follow-up

    • V: variable

    • Neu: neurologist

    • Pneumo: Pneumologist

    • Admin: administration

    • B: Belgium

    • F: France

    • UK: United Kingdom

    • E: Spain

    • S: Sweden

    • P: Portugal

    • AU: Austria

    • DK: Denmark

    • FIN: Finland

    • GR: Greece

    • I: Italy

    • IRL: Ireland

    • L: Luxembourg

    • NL: Netherlands

    • D: Germany

    • N: Norway

    • CH: Switzerland

    • : for SAS only, not for narcolepsy

    • +: narcolepsy, never, sleep apnoea syndrome (SAS) 1 month after efficient Tx started, after positive statement from a neurologist

    • §: narcolepsy, 2-yr max, SAS, 2 yr once, without limitation if normal after 2 yr

    • ƒ: board of doctor(s) appointed by the Licensing Authority (from a list among general practitioners and/or specialists)

    • government authority

    • ##: more restrictive for narcolepsy

    • ¶¶: informs the police

    • ++: for the case of reported loss of consciousness by a doctor appointed by

Additional Files

  • Correction

    Correction, published in Eur Respir J 2003; 21: 561.

    Files in this Data Supplement:

    • Correction - Correction, published in Eur Respir J 2003; 21: 561.
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Public health and medicolegal implications of sleep apnoea
W.T. McNicholas and J. Krieger on behalf of the Task Force members, Members of the Task Force: W.T. McNicholas (Chairman), P. Levy (Co-Chairman), W. De Backer, N. Douglas, J. Krieger, O. Marrone, J. Montserrat, J.H. Peter, D. Rodenstein
European Respiratory Journal Dec 2002, 20 (6) 1594-1609; DOI: 10.1183/09031936.02.00404502
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