European Respiratory Society statement on sleep apnoea, sleepiness and driving risk

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 (CPAP) 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 for 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 for MVA.

Excessive Daytime Sleepiness in Obstructive Sleep Apnea Patients Treated With Continuous Positive Airway Pressure: Data From the European Sleep Apnea Database

“…Obstructive sleep apnea (OSA) is characterized by complete or partial collapse of the upper airway during sleep, intermittent snoring, increasing inspiratory efforts, sleep fragmentation, and cyclic hypoxemia and hypercapnia ( 1 ). Excessive daytime sleepiness (EDS) is a major symptom of OSA, occurring in approximately a quarter to half of OSA patients ( 1 , 2 ) and is associated with increased risk of accidents at work or while driving ( 3 , 4 ). Continuous positive airway pressure (CPAP) is the most effective and commonly used treatment for OSA ( 5 ).…”

“…CPAP application through a tightly fitted nasal or oronasal mask, at a sufficient pressure level titrated in each patient, prevents upper airway collapse and the pathophysiological consequences of OSA. CPAP treatment improves EDS either assessed subjectively by the Epworth Sleepiness Scale (ESS) or objectively by the Maintenance of Wakefulness Test (MWT) ( 5 ) and prevents sleepiness-related driving accidents ( 4 ).…”

Risk Factors for Sleepiness at the Wheel and Sleep-Related Car Accidents Among Patients with Obstructive Sleep Apnea: Data from the French Pays de la Loire Sleep Cohort

“…[10][11][12] Obstructive sleep apnea is highly prevalent, with recent general population studies indicating that 20% to 30% in men and 10% to 15% in women have moderate or severe sleep-disordered breathing. 13,14 Excessive daytime sleepiness (EDS), a major symptom of OSA, is reported in approximately 25% to 50% of OSA patients 15 and studies have shown that EDS while driving is an important factor in road accidents or work-related accidents. 13,16 While OSA has been recognized by the European Respiratory Society (ERS) as a risk factor for road accidents, 13 there is still uncertainty about the relative importance of OSA severity indices of OSA, and the degree of sleepiness as a risk factor for accidents.…”

Use of the pictorial Sleepiness and Sleep Apnoea Scale in Chinese patients with suspected obstructive sleep apnoea syndrome

“…In clinical population samples (i.e., patients admitted or followed for disease other than OSAS), on average the BQ showed a higher sensitivity compared to the STOP-Bang. Clearly, the data indicate that questionnaires neither reliably rule in nor rule out OSA (20).…”

“…The recently published European Respiratory Society statement on sleep apnoea, sleepiness and driving risk (20) concludes that certainly with regards to driving none of the existing screening questionnaires is satisfactory and calls for more research on new questionnaires. In the general population, extreme variation can be found in the sensitivities and specificities for all established questionnaires (ESS sensitivity 18-85%, specificity 22-98% (21-23); BQ sensitivity 40-97%, specificity 6-100% (24-30); STOP sensitivity 33-98%, specificity 10-95% (31); STOP-Bang sensitivity 0-100%, specificity 0-100% (25,(31)(32)(33), even taking into account the cut-off thresholds for OSA (AHI ≥5 events/h, AHI ≥15 events/h, AHI ≥30 events/h).…”