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Lack of consensus on driving and sleep apnoea

Doctors need to be more aware of the effects of sleep apnoea on driving, according to a leading expert in the field.

Speaking at the Irish Thoracic Society Annual Scientific Meeting in Cork, Prof Walter McNicholas, Newman Clinical Research Professor at UCD and Director of the Pulmonary and Sleep Disorders Unit and Consultant Respiratory Physician at St Vincent’s University Hospital, Dublin, outlined recent research that showed variability in clinicians’ opinions regarding fitness-to-drive in patients with obstructive sleep apnoea (OSA) syndrome.

Prof McNicholas said that the given the seriousness of the issue a working group will be established under the joint auspices of the European Respiratory Society and European Sleep Research Society on how to assist in the evaluation of patients regarding suitability to drive.

An editorial will be published jointly in the European Respiratory Journal and in the Journal of Sleep Research in January next year on the topic. “It is very clearly identified that sleep apnoea represents a major risk of motor vehicle accident,” according to Prof McNicholas.

“The other important message is that when you effectively treat patients with OSA with CPAP [continuous positive airway pressure] therapy this increased accident risk is removed.”

The immediate risk factor led the European Commission in 2012 to establish a working group to advise on this matter, of which Prof McNicholas was chair, which ultimately resulted in a revision to annex III of the EU Driving Directive issued in June 2014.

Member States are under the obligation to implement the Directive by the end of 2015.

Prof McNicholas also contended that the prevalence of sleep apnoea, which is a sleep disorder characterised by pauses in breathing or instances of shallow or infrequent breathing during sleep, is often under-estimated.

Between 10-to-25 per cent of people are affected by the disorder, depending on the part of the world they live in and the circumstances of the studies.

“Really this is something that everybody is experiencing in their daily practice,” Prof McNicholas told delegates.

“It is surprising at times to hear people say ‘I don’t see patients with sleep apnoea’. If you don’t see patients with sleep apnoea you are just not recognising it.”

He added that the current diagnostic criteria pose major resource problems related to overnight investigations, particularly given the high prevalence of OSA, and it is not practical to perform polysomnography, or even in-lab monitoring, in every suspected case.

 As a result of these challenges it is estimated that up to 85 per cent of patients remain undiagnosed and, therefore, there is a need to establish more cost efficient modalities of investigation, which will likely involve home monitoring for most patients.

Prof McNicholas also said that CPAP, in spite of the criticisms it has received, remains a highly effective therapy.

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