181 Obstructive sleep apnea syndrome and fitness to drive of commercial motor vehicle drivers – state-of-the-art review

Abstract

Introduction Obstructive Sleep Apnea Syndrome (OSAS) is a very common disease with potentially severe health and social consequences. Untreated OSAS is associated with increased risk of motor vehicle accidents, caused by excessive daytime sleepiness (EDS). Sleepiness at the wheel is the cause of accident in 5 tot 7% of the cases. The overall risk of accidents for OSAS patients is elevated by a factor 2.4 to 3.7. OSAS is more common among commercial motor vehicle (CMV) drivers, due to obesitas for example. Methods We performed a literature review regarding the fitness to drive among CMV drivers with OSAS. Result CMV drivers are a high risk, underserved occupational group. Occupational demands and working conditions result in a sedentary lifestyle and irregular sleeping patterns, contributing to overweight and fatigue. Occupational risks and morbidities include e.g. hypertension, metabolic syndrome and diabetes. Subjective EDS can be assessed by questionnaires (e.g. STOP-Bang, Berlin Questionnaire, Epworth Sleepiness Scale), unfortunately with reporting bias. Measurement of height and weight (body mass index), neck circumference and blood pressure during physical examination offers an opportunity to assess objective risk factors for OSAS without relying on the subjective report. Discussion OSAS is both underdiagnosed and undertreated. Identifying CMV drivers, with OSAS and treating them effectivily should decrease crash-related fatalities and injuries. There is a need for an active response from (occupational health) physicians, the sleep disorder specialists, the transport industry and the governments to create an effective OSAS screening among drivers and to accomplish patient compliance with the best treatment. An objective evaluation is expensive, time consuming and not applicable on a large scale. New tools are necessary to assess the fitness to drive. There is a lack of such tools, as well as practical guidelines, so there is no consensus on the driving ability of untreated and treated OSAS patients.