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Sleep Med Rev. 2018 Feb;37:130-137. doi: 10.1016/j.smrv.2017.02.002. Epub 2017 Feb 20.

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

Author information

1
Université de Montréal, 2900 Edouard-Montpetit Blvd., Montreal, QC H3T 1J4, Canada; Jewish General Hospital, 4333 Côte-Ste-Catherine Rd., Montreal, QC H3T 1E4, Canada. Electronic address: dorrie.rizzo@umontreal.ca.
2
Jewish General Hospital, 4333 Côte-Ste-Catherine Rd., Montreal, QC H3T 1E4, Canada; McGill University, 845 Sherbrooke W., Montreal, QC H3A 0G4, Canada.
3
McGill University, 845 Sherbrooke W., Montreal, QC H3A 0G4, Canada; Mount Sinai Hospital, 5690 Cavendish Blvd., Montreal, QC H4W 1S7, Canada.
4
Jewish General Hospital, 4333 Côte-Ste-Catherine Rd., Montreal, QC H3T 1E4, Canada; McGill University, 845 Sherbrooke W., Montreal, QC H3A 0G4, Canada; Dawson College, 3040 Sherbrooke W., Montreal, QC H3Z 1A4, Canada.
5
Université de Montréal, 2900 Edouard-Montpetit Blvd., Montreal, QC H3T 1J4, Canada; Hôpital du Sacré-Cœur de Montréal, 5400 Gouin W., Montreal, QC H4J 1C5, Canada.

Abstract

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.

KEYWORDS:

Cognitive function; Driving behavior; Driving risk; Fatigue; Guidelines; Motor vehicle crashes; Obstructive sleep apnea; Sleepiness

PMID:
29092783
DOI:
10.1016/j.smrv.2017.02.002
[Indexed for MEDLINE]

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