Does apnea impair your patient’s ability to drive?
Evidence-based medicine provides no easy answers for a physician who must decide whether to report an obstructive sleep apnea patient to the state department of motor vehicles. Numerous studies have failed to identify a method for determining which individuals with obstructive sleep apnea are more likely to have motor vehicle accidents. There is no correlation between symptoms and objective measures of vigilance or performance. People with the disorder are more likely to be in a motor vehicle accident, but the overall risk is low. In one report, patients had more crashes than did a control group during a 3-year period (odds ratio 2.6). Some patients had two and three crashes, but most did not have any accidents, and no physiologic markers predicted which patients were at greater risk. How individuals respond to sleep loss varies. In study after study, objective measures such as scores on the Epworth Sleepiness Scale, Karolinska Sleepiness Scale, respiratory disturbance index, and the apnea-hypopnea index did not predict reaction time or driving performance. He cited a US Department of Transportation-commissioned review of the literature from 1960 to 2000 (Report no. DOT HS 809 690), which concluded that commonly used measures of sleep apnea severity “are not very useful” in identifying people at risk for crashes. In a more recent trial, 20 obstructive sleep apnea patients and 40 controls took a battery of tests, including a driving simulator, said that almost all the apnea patients had some impairment of vigilance or attention, but no one test predicted ability to remain awake and stay attentive.
Effectiveness of measures to counteract night drowsiness also is highly variable. Drinking caffeine or taking a nap helped most participants in another study, but the effects ranged widely among individuals. A doctor referred physicians treating sleep apnea patients to recommendations of the American Thoracic Society and a statement on commercial drivers from a Joint Task Force of the
They got to live with their self, and do what they think is right. Don’t be afraid to use your clinical judgment because nothing is a strong predictor of risk.
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