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Driving with Obstructive Sleep Apnoea

Dr Sophie West on the best advice for drivers and the benefits of treatment

Wednesday, October 17, 2018

Obstructive Sleep Apnoea (OSA) is very common in the adult population in the UK.

OSA can be truly asymptomatic, but it can also be associated with excessive sleepiness, and this may have an adverse effect on driving whilst OSA is untreated. These people are therefore at an increased risk of motor vehicle collisions. 

Welcome to Respiratory Futures Dr Sophie West. You are a respiratory consultant working in Newcastle upon Tyne - can you outline why this issue is so important?

Driving advice for people with OSA remains a concern.  

The Sleep Apnoea Trust Association (SATA) reports that patients are still contacting them, having received poor, or even incorrect, driving advice from some Sleep clinics.

This is despite the BTS Driving and OSA position statement published in 2018, which discusses aspects of sleep and driving in more detail, in order to provide more consistency in advice given across the UK.

SATA say they have provided concerned patients contacting their helpline with copies of the BTS position statement, which the patients have then passed on to the Sleep Clinic, so it seems some centres are still unaware of this document.

It is vital that patients are given current advice and are not deterred from seeking medical advice and treatment due to concerns about driving and potential loss of licence and livelihood.

It is vital that patients are given current advice and are not deterred from seeking medical advice and treatment due to concerns about driving and potential loss of licence and livelihood.
Dr Sophie West

 

What guidance is currently available to clinicians?

The “Excessive Sleepiness including OSA” section of the DVLA “Assessing Fitness to Drive – a guide for medical professionals” was updated in October 2017. These updated guidelines are clearer than their predecessor and easier for clinicians to follow and give accurate driving advice.

They are included in the BTS position statement (https://www.brit-thoracic.org.uk/standards-of-care/quality-improvement/sleep-apnoea/ ), along with helpful case studies.

 

Can you summarise what the current guidance says?

  • Anyone who has “excessive sleepiness having or likely to have an adverse effect on driving” must not drive
  • This is the driver’s responsibility
  • Only those people with excessive sleepiness due to sleep study confirmed moderate or severe OSA syndrome need to inform the DVLA
  • Those patients who are not sleepy do not need to inform the DVLA

 

You are a respiratory consultant, but a wide range of healthcare professionals work with patients with OSA.

Absolutely. Sleep clinics in the UK may include specialists from Respiratory, Neurology, ENT and Anaesthetics, with doctors, nurses, physiologists and sleep technicians all seeing patients.

However, any health care professional who sees patients who drive but have excessive sleepiness should be giving them standard safe driving advice, whether they are in the sleep clinic or not, that is “if you have excessive sleepiness having likely to have an adverse effect on driving, you must not drive”

I would also support the BTS view that although patients will initially present to primary care, specific advice about driving and sleep disorders should be part of the assessment made by the specialist team.

 

The DVLA does consult with professional organisations and patient groups.  Is the DVLA continuing to work with stakeholder organisations to improve the situation?

The DVLA has indeed shown commitment in working with groups with expertise in OSA to improve the previous confusion and difficulties faced by drivers with OSA. The groups, including SATA, BTS, ARTP, BSS and the OSA Partnership, recognise this collaborative working has been crucial to improving the situation of medical licensing for drivers.

Ongoing work with the DVLA should see all documents – including those for patients, and those for health care workers - are consistent, clear and easy to complete. Ensuring the same terminology is used across these documents is important, to minimise any ambiguity. This work is not yet complete, but there is optimism that the situation will further improve.

The immediate effects of Continuous Positive Airway Pressure (CPAP) are often described as life changing, with long term benefits to alertness when driving, relationships, quality of life and blood pressure.
Dr Sophie West

 

It seems there is still more that can be done to disseminate the messages from the guidance.  For example, what would you recommend all healthcare professionals read?

It is crucial that patients receive consistent, accurate, safe driving advice, from all health professionals, but we hear they still are receiving inappropriate information.

The BTS position statement summarises where we are now and was worked on by an experienced panel from many different organisations including the DVLA, so I would urge people to start with this.

I would also recommend all healthcare professionals look at the SATA website, giving the patient perspective on OSA and Driving. For example, SATA continue to advise on their website that patients only write to the DVLA, as they have experience of variations in responses to patients who contacted the DVLA by phone, email or the online medical forms, and therefore recommend patients keep a document trail. This is useful advice for health care workers to replicate.

 

Finally, what would you say to vocational drivers who have concerns about attending clinic and potentially being told to stop driving, with a risk to their income?

I’d say it is important to attend the sleep clinic, get a proper diagnosis and receive treatment for their condition, particularly if their driving is potentially being affected by their sleepiness. The immediate effects of Continuous Positive Airway Pressure (CPAP) are often described as life changing, with long term benefits to alertness when driving, relationships, quality of life and blood pressure. 

Some Sleep clinics offer a “Fast track” 4 week wait style system to prioritise vocational drivers to minimise any time they may be unable to drive. This aims to have diagnosis, CPAP treatment and review with return to driving all completed within 4 weeks from the GP referral. The OSA Partnership and SATA are keen that all clinics offer this service – it is a helpful and cost neutral way to manage these cases in a time efficient manner, which is appreciated by patients.

 

More information about OSA and indeed how Sophie and her team are implementing this “Fast Track” 4 week wait system, is available in the following video:

https://www.youtube.com/watch?v=FKhHfeMGO2k

 

Related links:

DVLA - https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals 

          - https://www.gov.uk/government/publications/tiredness-can-kill-advice-for-drivers

Sleep Apnoea Trust - http://www.sleep-apnoea-trust.org/

OSA Partnership Group - http://www.osapartnershipgroup.co.uk/

British Sleep Society - https://www.sleepsociety.org.uk/

The Academy for Healthcare Science - https://www.ahcs.ac.uk/

Association for Respiratory Technology and Physiology - http://www.artp.org.uk/

 

 

Dr Sophie West is a Respiratory Consultant and Lead of the Newcastle Regional Sleep Service: http://www.newcastle-hospitals.org.uk/services/cardiothoracic_services_sleep.aspx