Sleep Apnea and Driving. Recommendations for Interpreting Spanish Regulations for Drivers

Terán-Santos, Joaquín; Santaolalla, Carlos Egea; Montserrat, J.M.; Jiménez, Fernando Masa; Escribano, Maria Villar Librada; Mirabet, Enrique; Rodríguez, Elena Valdés

doi:10.1016/j.arbr.2016.11.035

Cited by 4 publications

(6 citation statements)

References 16 publications

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“…The information on CPAP compliance and CPAP efficacy is based on objective data, but the information on treatment effects on daytime sleepiness was based on subjective, self‐reported information in the clinical setting of our sleep centre. Given the complexity of the fitness to drive certification process, only a few medical professional organizations have defined national guidelines (British Thoracic Society , Teran‐Santos ). More effort at the European level is warranted (Bonsignore ).…”

Section: Discussionmentioning

confidence: 99%

“…This evaluation may result in a fitness to drive medical certificate (Bonsignore et al, ). 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, ).…”

Section: Introductionmentioning

confidence: 99%

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

Grote

Svedmyr

Hedner

2018

Journal of Sleep Research

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New European Union (EU) regulations state that untreated moderate to severe obstructive sleep apnea (OSA) coincident with excessive daytime sleepiness (EDS) constitutes a medical disorder leading to unfitness to drive. However, fitness to drive can be re-established by successful treatment of OSA and EDS. The aim of the current study was to compare patients undergoing the certification process with those of an unselected OSA patient cohort. The study compared consecutive patients in the certification group (n = 132) with a representative group of OSA patients with a current driving license and an Apnea Hypopnea Index (AHI) ≥ 15 n/h (n = 790). The adherence to positive airway pressure (PAP) therapy and the change in EDS (Epworth Sleepiness Scale [ESS] score) with treatment were analysed. Patient characteristics and severity of sleep apnea did not differ significantly between groups (certification/reference group: BMI 30 ± 5/31 ± 5 kg/m , AHI 33 ± 20/36 ± 20 n/hr, ESS 12 ± 6/11 ± 5). However, the certification group was oversampled with elderly drivers (70-85 years: 22% vs. 9%, p = 0.001). PAP compliance was higher in the certification group than in the reference group (PAP use ≥ 4 hr/night in 96% vs. 53%, p = 0.001) and mean ESS reduction was -8.0 (-8.9 - -7.1) versus -4.0 (-4.4 - -3.5), respectively (p < 0.001). Patients attending the fitness to drive evaluation reported almost complete adherence to continuous positive airway pressure (CPAP) and elimination of EDS symptoms. Besides possible baseline differences, this strong response may be explained by factors such as a selection process of elderly patients, a self-rating component in the assessment of the treatment response and the threat of a driving license suspension. Our data suggest that an improved certification process with objective rather than subjective components, along with a reduced selection bias, is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Grote

Svedmyr

Hedner

2018

Journal of Sleep Research

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“…Obstructive sleep apnea (OSA) is defined by the presence of an apnea-hypopnea index (AHI) ≥ 5/h accompanied by excessive daytime sleepiness, unrefreshing sleep, extreme tiredness, and/or impaired quality of life (QoL) related to sleeping or not justified by other causes [1]. OSA increases the risk of incidence of cardiovascular disease [2], and traffic accidents [3], as well as reduced QoL [4]. A prevalence of 26.2% in men and 28% in women (age 30-70 years) is estimated [5].…”

Section: Introductionmentioning

confidence: 99%

Quality of Life Impact of Hypoglossal Nerve Stimulation with Inspire® Device in Patients with Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure Therapy

Baptista¹,

Frisco

Urrestarazu³

et al. 2022

Life

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Patients with obstructive sleep apnea (OSA) that do not tolerate/accept continuous positive airway pressure (CPAP) are candidates for surgical alternatives. Hypoglossal nerve stimulation (HNS) through the implantation of the Inspire®® device constitutes a minimally invasive operative option. The main objective of this study is to estimate, under real-world clinical practice conditions, the 3-month impact on the quality of life (IQoL) of the HNS in patients with moderate/severe OSA who do not tolerate or accept CPAP, compared to patients who did not receive HNS. As a baseline, the unadjusted EuroQol utility index was 0.764 (SD:0.190) in the intervention group (IGr) and 0.733 (SD:0.205) in the control group (CGr); three months later, the indexes were 0.935 (SD: 0.101) and 0.727 (SD:0.200), respectively. The positive impact on quality of life was estimated to be +0.177 (95% CI: 0.044–0.310; p = 0.010. All dimensions in the IGr improved compared to CGr, especially for usual activities (p < 0.001) and anxiety/depression (p > 0.001). At the end of the follow-up, there was no significant difference in the quality of life between the general Spanish population and the IGr (difference: 0.012; CI95%: −0.03 to −0.057; p = 0.0578) for the same age range; however, there was a difference concerning the CGr (difference: −0.196; CI95%: −0.257 to −0.135; p < 0.001). In conclusion, patients with moderate/severe OSA implanted with the Inspire®® device showed a positive IQoL.

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“…Therefore, a screening strategy can be implemented only when the driver’s license is issued or renewed, as indicated by the EU Directive; this document, however, does not indicate any specific protocol to be followed, and national regulations have to be developed and implemented by each member state. To date, only the Spanish Sleep Society in Europe has published an updated protocol to address the issuing or renewing of drivers’ licenses according to the EU Directive 29 .…”

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confidence: 99%

Sleep apnea and its role in transportation safety

Bonsignore

2017

F1000Res

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Obstructive sleep apnea (OSA) is a main cause of excessive daytime sleepiness and increases the risk for driving accidents, which can be normalized by treatment with continuous positive airway pressure ventilation. Since it is estimated that OSA is not diagnosed in about 80% of cases, recognition of patients at risk for driving accidents is a problem from both medical and societal points of view. Strategies to screen and identify subjects at high risk for driving accidents are under study in order to improve safety on the road, especially for commercial drivers, who show a high prevalence of OSA.

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Sleep Apnea and Driving. Recommendations for Interpreting Spanish Regulations for Drivers

Cited by 4 publications

References 16 publications

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

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

Quality of Life Impact of Hypoglossal Nerve Stimulation with Inspire® Device in Patients with Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure Therapy

Sleep apnea and its role in transportation safety

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