The threat of sleepy drivers at the helm of multi-ton commercial trucks is a problem that multiple agencies, private and public, continue to address with vigor. With the release of new clinical practice guidelines, the American Thoracic Society (ATS) is recognizing that non-commercial drivers also pose a significant risk.
The guidelines on sleep apnea, sleepiness, and driving risk for non-professional drivers are an update of a 1994 ATS statement on this topic. The full guidelines appear in the June 1, 2013 American Journal of Respiratory and Critical Care Medicine.
“Up to 20 percent of crashes that occur on monotonous roads can be attributed to sleepiness, and the most common medical cause of excessive daytime sleepiness is obstructive sleep apnea (OSA),” said Kingman P. Strohl, MD, director of the Center for Sleep Disorders Research at Case Western Reserve University and chair of the committee that drafted the guidelines. “With these new guidelines, we aimed to provide healthcare practitioners with a framework for the assessment and management of sleepy driving in the evaluation of OSA.”
• All patients undergoing initial evaluation for suspected or confirmed OSA should be asked about daytime sleepiness and recent unintended motor vehicle crashes or near misses attributable to sleepiness, fatigue, or inattention. Patients with these characteristics are considered high-risk drivers, and should be warned about the potential risk of driving until effective therapy is initiated.
• Additional information that should be elicited during initial evaluation for suspected or confirmed OSA includes the clinical severity of the OSA and treatment that the patient has received, including behavioral interventions. Adherence and response to therapy should be assessed at subsequent visits. Drowsy driving risk should be reassessed at subsequent visits if it was initially increased.