Sleepiness and difficulty concentrating are the dominant symptoms of the obstructive sleep apnoea/hypopnoea syndrome (OSAHS). These symptoms are worst in monotonous situations such as driving on major roads and motorways, consequently drivers with OSAHS have an increased risk of road accidents. As OSAHS affects 1-4% of drivers this is a significant public health issue. This was highlighted in a recent report by a working party of the European Respiratory Society. Although OSAHS patients tend to under-report driving difficulties, over one-third report having had an accident or near accident due to falling asleep at the wheel.[1] Falling asleep while driving is also common in the general population, with 19% of men admitting to doing so in one study.[2] Objective evidence indicates raised accident rates in sleep apnoeics. A study of all drivers presenting to an accident department showed that those with frequent apnoeas were six times more likely to be road accident drivers than subjects without sleep apnoea.[3] Retrospective studies in patients prior to the diagnosis of OSAHS being established suggest a three-fold risk of road accidents compared to other drivers.[4] There is also convincing evidence from vigilance tasks and driving simulators[5] that driving performance is impaired in patients with OSAHS. Indeed drunk normal subjects perform better on a driving simulator than sober OSAHS patients.[6] Interestingly the impairment is not just limited to periods when patients actually fall asleep; their response is also impaired when they are awake, reflecting impaired vigilance and delayed reaction times.[7] Treatment of OSAHS significantly improves driving performance. Prospective studies have found that therapy with continuous positive airway pressure (CPAP) improves OSAHS patients' performance on driving simulators[8,9] and decreases the frequency and severity of road accidents. A recent analysis[10] showed that CPAP not only returned OSAHS patients' accident rates to the population norm, but also that treating 500 patients with CPAP for five years saved £4·9 million when the expenditure on treatment and follow-up were set against the savings on accident related costs. This is in addition to other well documented benefits of CPAP in terms of sleepiness, quality of life, mood, work performance and blood pressure. This article was stimulated by the report[11] of a Task Force of the European Respiratory Society. This pointed out the need to improve detection and speed of treatment of OSAHS patients in Europe and highlighted the disparity between countries regarding reporting the diagnosis to the driving authorities. There is clearly a need to identify and treat individuals with OSAHS to reduce accident risk and to allow them to return to driving safely again. However, this must be done sympathetically and quickly. Otherwise, if it became apparent that individuals with suspected OSAHS lost their licence for months or years while waiting for investigation and treatment, many would not come forward for diagnosis. This would perpetuate the current situation where around 80% of patients with possible OSAHS remain undiagnosed and untreated to the detriment of themselves and other road users. Ideally patients with a clinical picture suggestive of OSAHS need to be firmly advised of the dangers of driving when sleepy - preferably in writing - and should be advised not to drive while their investigations and treatment are fast-tracked. However, the current waiting times for investigation and treatment can exceed a year in the UK. Such delays are driven by erroneous concepts of economies of healthcare delivery, rather than looking at the wider benefits of offering cheap and effective treatment quickly. Recent recognition of the importance of treatment for OSAHS will hopefully decrease these unacceptable waits.[12] 2006-12-01T14:01:55Z Ex chair, International Medical Advisory Board of ResMed (a US/Australian company which makes CPAP units to treat OSAHS). Sir Neil's Department has previously received research funding from ResMed. 16 2002-04-16T00:00:00Z 2009-03-05T00:00:00Z sleep-apnoea-and-road-accidents 2002-04-16T00:00:00Z

Sleep apnoea is a significantly under-diagnosed condition which causes symptoms of sleepiness and difficulty in concentrating. It can also cause drivers to fall asleep at the wheel. Neil Douglas provides an overview of the link between sleep apnoea and road traffic accidents.

2009-03-05T16:19:04Z