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Debate over Inclusion of Sleep Apnea in the Standards for Driving

Obstructive Sleep Apnea (OSA) is a disease that not many people know about although they may even suffer from it. Patients are unable to sleep and breathe at the same time: during sleep (and during sleep only) the throat collapses and air can no longer reach the lungs.

Breathing stops despite frantic efforts and oxygen drops… until sleep is interrupted, the throat pops open with a loud snoring, breathing resumes and sleep proceeds until the next apnea. The average patient experiences 250 to 400 apneas per night, and is completely unaware that this is happening…

OSA leads to snoring and daytime sleepiness, high blood pressure as well as cerebral and cardiac accidents; it also increases the risk of traffic accidents by seven times. Data from Germany, Spain, Switzerland, Australia, Canada and the USA are concordant: OSA has been estimated to be responsible for 5 to 10 % of all motor vehicle accidents.

Despite clear evidence of this dangerous effect, and of its possible correction with an adequate treatment, only nine European Countries include sleep apnea among the diseases to be considered at the time of delivering a driving license. Moreover, there is no unique attitude among different countries on how to assess the severity of the disease, or the effects of treatment, or who is to decide on the fate of the potentially dangerous driver.

Every effort should be made to put Sleepiness and Obstructive Sleep Apnea on the agenda of European Transport Authorities. The Comitology procedure appears as a pragmatic and feasible approach. OSA could be included in the next amendment to Annex III while sleepiness could be addressed with information and education campaigns.

On 12 and 13 October 2007, COST Action B26 hosted a working meeting with international experts to discuss the best way to include OSA within the health disorders representing a serious risk for traffic accidents in the entire European Union. The meeting was organised by the Centre for Sleep Medicine, Cliniques universitaires Saint-Luc, Université catholique de Louvain in Brussels.

Further to this initiative, a meeting with the High Commission on transport was held, where COST Action B26 had the chance to present their suggestions for the future inclusion of OSA under the Annex III for European Driving Regulations.

Obstructive Sleep Apnea is not important only in itself; if introduced in the driving license regulations in all European Countries it may also serve as a marker for the whole domain of fatigue and sleepiness while driving. We are convinced that this domain needs to be brought to the attention of all drivers, private and professionals alike. Are you?

Daniel Rodenstein | alfa
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