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Obstructive Sleep Apnoea

Assessment - Fitness to Drive

According to the Assessing Fitness to Drive guidelines any patient with suspected OSA and excessive daytime sleepiness should be referred to a sleep specialist for assessment and sleep study.

Untreated OSA is a risk factor for motor vehicle accidents, especially single-vehicle accidents at night. Austroads and the National Transport Commission have produced medical standards for licensing and clinical management guidelines for commercial and private vehicle drivers. Medical standards for sleep disorders and the roles and responsibilities for health professionals are outlined. The document Assessing Fitness to Drive is freely available on the Austroads website. Provide advice on whether or not the patient should report a condition to the Driver Licensing Authority - it is the responsibility of the individual to report to their driver licensing authority any chronic illness that is likely to affect their driving safety, including OSA and falling asleep (e.g. having a high ESS score) at the wheel.

Table. Severity of daytime drowsiness

Low severity of daytime drowsiness

Drowsiness occurring in monotonous situations that require little attention such as watching television, reading or while traveling as a passenger

Medium severity of daytime drowsiness

Drowsiness occurring in situations requiring attention, where there is also social pressure to stay awake, such as during concerts, movie visits, meetings

High severity of daytime drowsinessDrowsiness occurring during activities that clearly require attention, such as eating, having a conversation, walking, cycling or driving - social or professional problems may arise

Assessing fitness to drive - guidelines

The Assessing Fitness to Drive guidelines recommend that any patient with suspected OSA and excessive daytime sleepiness should be referred to a sleep specialist for assessment and sleep study. Referral should also be considered in persons involved in a motor vehicle crash that may have been caused by sleepiness.

Management in relation to driving is relevant if the patient is in a high-risk occupation (e.g., commercial driver, heavy machine operator), has an Epworth sleepiness score (ESS) of 16 - 24, or reports: severe daytime sleepiness, self-reported sleepiness while driving, driving accident related to inattention or sleepiness.

An urgent specialist referral needs to be arranged as these patients may not be fit to hold unconditional licences. Consider advising patient not to drive until diagnosed and treated.

Assessing fitness to drive - advice

Advice should be provided to all patients suspected of having sleep apnoea, or other sleep disorders, of the potential effect it may have on their driving ability. Advice should be provided to all patients with OSA that it is their responsibility to avoid driving if sleepy, to comply with follow up and treatment (e.g. CPAP) and to honestly report their condition to their physician.

Some general advice includes:

  1. Minimising unnecessary driving
  2. Avoiding driving at times when they would normally be asleep (e.g. night-time driving)
  3. Avoiding alcohol and sedative medications
  4. Avoiding use of over the counter or other non-prescribed substances for maintaining wakefulness
  5. Allowing adequate time for sleep and avoiding driving after having missed a large portion of their normal sleep (e.g. after sleep restriction)
  6. Resting and limiting driving if they are sleepy
  7. Heeding the advice of a passenger that the driver is dozing off
  8. Taking regular rest breaks and sharing the driving, especially if sleepy (pull over and stop driving as soon as they notice any warning signs of sleepiness e.g. head nods, eyes blinking, yawning, feeling warm, or lane deviations)

AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

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