Determinants of policy decisions for non-commercial drivers with OSA: An integrative review. (February 2018)

• Record Type: Journal Article
• Authors: Rizzo, Dorrie; Libman, Eva; Creti, Laura; Baltzan, Marc; Bailes, Sally; Fichten, Catherine; Lavigne, Gilles
• Is Part Of: Sleep medicine reviews. Volume 37(2018)
• Page Start: 130
• Page End: 137
• Publication Date: 2018-02
• Subjects: Obstructive sleep apnea -- Driving behavior -- Driving risk -- Guidelines -- Cognitive function -- Motor vehicle crashes -- Sleepiness -- Fatigue; AHI apnea-hypopnea index -- ESS Epworth sleepiness scale -- OSA obstructive sleep apnea; Sleep disorders -- Periodicals; Sleep Disorders -- Periodicals; Sommeil, Troubles du -- Périodiques; Electronic journals; 616.8498
• DOI: 10.1016/j.smrv.2017.02.002
• Languages: English
• ISSNs: 1087-0792

Abstract

Summary: Excessive daytime sleepiness and reduced cognitive functioning secondary to obstructive sleep apnea (OSA) have been identified as an important health-related risk in commercial transportation with, possibly, an increased chance of road accidents. This has resulted in a variety of policies and restrictions imposed on commercial drivers. Here we review current knowledge to assess whether available data are sufficient to guide policy decisions concerning restrictions for non-commercial drivers. The review shows that there is a lack of uniformity among different consensus conferences and guidelines as to how to deal with drivers with OSA. Clear guidelines are limited and few are evidence based. It is unclear which aspect of OSA is the most valid measure of severity (e.g., apnea–hypopnea index vs oxygen desaturation index). Traditionally, sleepiness has been invoked as a major risk factor for impaired driving. Recently, there also has been an awareness that daytime fatigue, as distinct from sleepiness, has an impact on driving behavior. However, the precise effect of fatigue on driving, as well as its role in the formulation of guidelines, remain to be evaluated. We conclude that there are at least two major difficulties for the driving recommendation process: a) there is no accurate metric quantifying severity of driving risk associated with OSA, and b) there are substantial individual differences among those with OSA, both experiential and behavioral. We present implications from this review for future research and policy formulation.