Apnea and dangerous driving

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Sleep apnea is a risk factor, that is larger than other complications associated with an increase in accidents such as sight or hearing defects, neurological diseases, alcoholism, drug use or mental disorders. Alcohol consumption and sleep apnea as a trigger, explain most of the accidents involving the human factor. The poor quality of sleep stays behind the changes in behavior, irritability, cognitive impairment, decreased motor function and reduced sensory abilities and is a direct result of a decline in perceptual abilities and reduced attention.

Experts warn about the dangers of poor sleep and the dream combination of bad driving, that can be lethal. Also, traffic accidents related to sleepiness, usually overlap more serious . In this type of accident is usually repeated a standard pattern, involved excessive speed, usually at high speed frontal crashes, without braking or avoiding prior maneuvers and without the capacity of reaction by a driver, who usually travels alone. The poor quality of sleep causes a loss of attention, which is shown increasingly on motorways and monotonous roads. The incidents usually occur during the morning and early afternoon, coinciding with the highest peaks tendency to sleep, from 00:00 to 06:00 pm and 14:00 to 17:00 (after lunch).

It is important to raise awareness among professional or occasional drivers, that sleep apnea is a serious problem, that causes disease-related traffic accidents for which effective treatments exist. An estimated 500 accidents could be prevented each year by warning drivers of the importance of a good night sleep. This campaign of awareness orchestrated from all public and private actors is the best defense to stop road deaths associated with OSAHS. In 2009, the slogan, who chaired the World Sleep Day said "drive awake, arrive safely." The recommendations of SEPAR in the campaign to eliminate driving under the influence of sleepiness, insist on educate drivers, to detect symptoms of a driving affected by sleep, restlessness, continuous movements, yawning, difficulty in the perception of distance and lateral displacement of the car. Recognizing these attitudes, they shall be warned of imminent incidents.

This symptoms can be more aggravated by years of non treatment in irritable behavior, low work performance, loss of attention, disinterest in work and personal areas, decreased libido, which encourages vulnerable states, which increase the likelihood of being involved in a accident or traffic accident.

In suspected sleep apnea cases, it has to be made provisions, basically in the case of professional drivers, with a precise diagnosis, which is the best prevention. The conditions triggering traffic accidents, have many ties in common, acute sleep deprivation, night hours or a days of variable shifts (night driving disrupts circadian rhythms reversing the normal sleep-wake coincides with day-night) long hours without rest, intake of depressant drugs, sedatives, antidepressants, or antihistamines.

The statistics are worrisome, the numbers of claims for deaths and injuries are very high in response to sleepiness as a trigger. One of the greatest dangers facing drivers on microsleeps conditions are sleepy periods of unconsciousness of very short duration, but very significant in severity. It is in this episode of "waking dream", in which the drivers remain with their eyes open and their behavior reproduce the conditions of wakefulness, but minimal unconsciousness is sufficient to cause an accident by failing to respond to a turn or an unexpected need for braking.

One study found out, that accidents caused by drowsy drivers are four times more lethal, than those caused by driving under the influence of alcohol. The intoxicated person reacts with slow reflexes, clumsiness and lack of expertise, but the driver fails completly to react. Despite the popular risk drinking and driving, it is shown that accidents due to sleepiness are more severe than those caused by ingestion of alcohol. In patients literally asleep at the wheel,there didn't exist any braking reaction as an automatic response to an impending collision, that could mitigate the consequences of the accident. Studies, that equate to 17 hours of continuous wakefulness, with a reduction in driving skills comparable to a blood alcohol level of 0.05 mg / ml maximum rate allowed by the European Union. The Article 65 of the Road Safety Act makes it a very serious offense driving, while having consumed alcohol at rates above those permitted and in any case, driving under the influence of drugs, psychotropic substances and any other substance with similar effects, while aspects such as apnea and drowsiness are not yet sufficiently covered by the legislation.

The Royal Decree 818/2009 of 8 May, which approves the regulations on drivers in Annex IV regulates the mental and physical fitness required to obtain or extend the term of the permission or drivers license. In this annex, which typify the diseases and deficits, which are the reason for refusal or adaptations, movement restrictions and other limitations in obtaining or renewal of permission or drivers license. In paragraph 7, which concerns the pathology associated with respiratory system diseases, the paragraph 7.02 states, that it is not possible to obtain or renew a driving license for drivers with obstructive sleep apnea syndrome "OSA is not allowed, the disorders related to it, or other causes of excessive daytime sleepiness neither. "On the adjustments, restrictions and on other limitations on people, vehicles or movement permission or license the subject, on restrictive conditions state, that are affected by the apnea syndrome or obstructive sleep related disorders, are able to obtain or renew a permission or license with a favorable report of a sleep unit, in which is stated, that they are being subjected to treatment and control of daytime symptoms.

The recognition centers of drivers make about 4 million visitors a year. Evidences of psychometric tests carried out by these centers authorized to certify the suitability of drivers, do not include questions about sleep. If a patient have stated voluntarily OSAHS, he will be diverted to a sleep unit for evaluation and certification, whether the severity of the disease is a disqualification from holding a driving license. In Spain, the waiting list for units of sleep can become up to two years, which the patient should expect and in the case of professional drivers, precluding the performance of their work and therefore of their source of income and their way of life. This vicious cycle locks us into a legal vacuum. The more or less responsible drivers, obviate their condition, avoid or fail to declare the treatment prescribed to them, with which certificate a permission or renewal would be allowed. The law doesn't protect the patients right to receive treatment and doctors have to respect the right of confidentiality and professional secrecy about the history. The society is helpless against drivers licenses or renewals of the same, knowing they will perform their work in unsafe conditions. While driving in these conditions is illegal, the current legal framework has not developed sufficient standards and jurisprudence on the civil responsability and the obligations about doctor-patient relationship. The current legislation is inadequate and unspecific to address the problem of OSAHS and driving.

Some European countries have established provisions to eradicate the problem by identifying high-risk drivers, including a large representation of drivers with obstructive sleep apnea or other sleep-related disorders. These European national standards deal different with the problem of OSA and sleep disorders in the processing of registration of certificates. Excessive daytime sleepiness is referred to in nine of them, whereas apnea syndrome is collected in 10 countries. It is surprising that in the case of rare diseases such as narcolepsy (with an estimated prevalence of 0.26%) it is systematicaly considered as a risk factor for driving safety, while the references referring to OSAHS continue staying minor. Under these shortcomings of the legislation it is urgent and legitimate to claim a european directive on apnea and traffic accidents. This was the objective of a recent meeting bringing together experts from several European countries to manage on the implementation of a uniform european policy to regulate on the borders of the union the implications of sleep apnea on driving. In consensus, were drafted recommendations on obtaining european drivers license listed under the title "Driving in Europe: The Need of a common policy for drivers with obstructive sleep apnea syndrome." The authors recommend the publication to include all diseases in which pathological sleepiness, police reports should explicitly consider sleep as a potential cause, add sleep-wake theme to the education program for professional drivers, incorporating the aptitude test questions about drowsiness and driving, habitual snoring and sleep apnea, and the Epworth Sleepiness level and body mass index. Experts warn that incorporate more detailed policies in the legislation would mitigate the consequences of avoidable accidents.