Abstract
Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea–hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
Abstract
Drivers with obstructive sleep apnoea and sleepiness are at risk of driving accidents; this is removed by effective therapy, and recent European regulations have been implemented on this topic https://bit.ly/3mXDhV1
Footnotes
This ERS statement was endorsed by the ERS Executive Committee on 2 September, 2020, and by the ESRS on 12 October 2020.
This article has supplementary material available from erj.ersjournals.com
Conflict of interest: M.R. Bonsignore has nothing to disclose.
Conflict of interest: W. Randerath reports grants and personal fees for lectures from Philipps Respironics, Heinen & Löwenstein and Resmed, outside the submitted work.
Conflict of interest: S. Schiza has nothing to disclose.
Conflict of interest: J. Verbraecken reports grants and personal fees for advisory board work from ResMed and Bioprojet, personal fees for consultancy from Philips, personal fees for lectures from Sanofi, Agfa-Gevaert, Springer and AstraZeneca, grants and personal fees for study participation from Jazz Pharmaceutics, grants and personal fees for lectures from SomnoMed, grants from AirLiquide, Westfalen Medical, Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance, Heinen & Löwenstein, Accuramed, Bekaert Deslee Academy and UCB Pharma, outside the submitted work.
Conflict of interest: M.W. Elliott has nothing to disclose.
Conflict of interest: R. Riha has nothing to disclose.
Conflict of interest: F. Barbe has nothing to disclose.
Conflict of interest: I. Bouloukaki has nothing to disclose.
Conflict of interest: A. Castrogiovanni has nothing to disclose.
Conflict of interest: O. Deleanu has nothing to disclose.
Conflict of interest: M. Goncalves has nothing to disclose.
Conflict of interest: D. Leger reports grants from grants from Philips (Netherlands), Vanda (USA), Sanofi, Vitalaire International, Merck, Jannsen, Jazz and RYTHM outside the submitted work.
Conflict of interest: O. Marrone has nothing to disclose.
Conflict of interest: T. Penzel reports grants from Cidelec and Philips, personal fees for consultancy from Heel Pharmaceuticals, personal fees for advisory board work from Bayer, outside the submitted work; and is a shareholder of Advanced Sleep Research, Somnico, Nukute, and The Siestagroup GmbH.
Conflict of interest: S. Ryan has nothing to disclose.
Conflict of interest: D. Smyth has nothing to disclose.
Conflict of interest: C. Turino has nothing to disclose.
Conflict of interest: W.T. McNicholas has nothing to disclose.
- Received April 27, 2020.
- Accepted August 25, 2020.
- Copyright ©ERS 2021
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- Article
- Abstract
- Abstract
- Introduction
- Methods
- Epidemiology of MVA in patients with OSA
- Pathophysiology and predictors of EDS in OSA
- Role of questionnaires as screening tools for OSA in drivers
- Evaluation of sleepiness
- Driving simulators in the evaluation of fitness to drive
- Effectiveness of CPAP treatment in OSA among commercial and noncommercial motor vehicle drivers
- Discussion and conclusions
- General recommendations for future research
- Supplementary material
- Shareable PDF
- Footnotes
- References
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