The dangers of driving with sleep apnoea – and the legal situation

The dangers of driving with sleep apnoea – and the legal situation

The most common symptom of obstructive sleep apnoea, and the most dangerous by far, is daytime drowsiness. This is accompanied when you sleep by heavy snoring, and choking sounds or gasping for breath on numerous occasions throughout the night. It’s a deadly problem to have.

OSA and driving

Drowsy driving may result and this is defined as operating a motor vehicle while being cognitively impaired by lack of sleep. Leading Motoring Associations in the UK and USA state that drivers with untreated sleep apnoea pay less attention to the road, react more slowly when braking suddenly, and make bad driving decisions that may lead to an accident.

Obstructive Sleep Apnoea is very common among middle-aged men, especially if they are overweight. Studies show that drivers with untreated OSA are five times more likely to be involved in road accidents with 25% of motorway or expressway accidents can be attributed to drowsiness. Most countries have had numerous examples in the headlines recently where this has caused tragedy both on the roads and on the rail systems.

In December 2014 a bin lorry careered out of control in a busy shopping street in Glasgow leading to the tragic death of six people. The accident inquiry into the incident has led to increased concern among doctors about their responsibility to disclose information about their patients to the DVLA.

A Doctor’s responsibility is to explain to the patient that they have a medical condition that may affect their ability to drive and that they have a legal obligation to inform the DVLA or DVA, and to stop driving if they are not having treatment for the problem. It is the driver’s legal responsibility to inform the authorities and it is a criminal offence for the driver to fail to do so.  The decision on whether the patient’s licence will be withdrawn rests with the DVLA or DVA and not the doctor.

Doctors in the UK have said they are anxious about disclosing information to the DVLA or DVA but have now been issued with a step-by-step approach by the General Medical Council approach that will allow them to deal with these difficult discussions more confidently. It runs as follows:

  1. Tell the patient to inform the Licensing Authority (DVLA)
  2. Assess the patient’s medical condition against required standards
  3. Try to persuade the patient to stop driving
  4. Only disclose the minimum information
  5. Keep detailed records

In Australia, NSW will soon have instant health checks for the 400,000 motorists who need to prove they are capable of driving. The checks are for elderly drivers who need to prove they can drive safely, heavy ­vehicle drivers, and motorists with epilepsy, sleep disorders and diabetes.

Doctors assess elderly drivers aged 75 or over each year to determine if their eyesight, motor function and attention is at a level where it is safe to drive. For holders of a class MC licence drivers have to be assessed at age 21 and then every 10 years, and after then at age 40 and then every five years

The state government will automate fitness-to-drive medical assessments, so GPs can send them to Roads and Maritime Services instantly. Roads Minister Duncan Gay said it meant doctors could instantly send applications to the RMS licence ­review unit, and elderly drivers would not be forced to queue at service centres or post offices to send application forms.

Although drinking while driving is a very serious problem, the deadliest habit is proving to be even more widespread: drowsy driving. In 2014, over 33 per cent of all U.S. drivers fell asleep behind the wheel of a car.

There are 42 drowsy drivers for every drunk driver on the road today.

In the USA however the greatest focus has been on commercial drivers, who are required to pass a health screening in order to drive. Regulators overhauled the system in 2014 and have disqualified roughly 70,000 truckers since then, out of some 8.5 million.

Treatment for OSA, bringing high restorative sleep, has been proved in research to overcome the problem. Oral appliances are approved and available for a very small cost and without any form of prescription so the solution is seen to be in the hands of those who wish to continue driving.

It brings a whole new meaning to the old phrase ‘Keep Death off the road’.

John Redfern