Medico-legal implications of sleep apnoea syndrome: Driving license regulations in Europe.

Maria Rosaria Bonsignore, Varoneckas, Alonderis, Pascu, Parati, Franklin, Mcnicholas, Sliwinski, Sforza, Sanna, Schulz, Kostelidou, Josep M. Montserrat, Penzel, Gianfranco Parati, Riha, Diefenbach, Fanfulla, Donic, FietzeHedner, Penzel, Tomori, Tonnesen, De Backer, Calverley, Rodenstein, Jennum, Grote, Barbé, Krieger, Levy, Zielinski

Research output: Contribution to journalArticlepeer-review

53 Citations (Scopus)

Abstract

Background: Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be arisk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, welooked at driving license regulations, and especially at its medical aspects in the European region.Methods: We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark,DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg,LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden,SE; Switzerland, CH; United Kingdom, UK).Results: Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleepapnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recoverthe driving capacity, seven countries rely on a physician’s medical certificate based on symptom control and compliance with therapy,whereas in two countries it is up to the patient to decide (on his doctor’s advice) to drive again. Only FR requires a normalizedelectroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy)are considered a driving safety risk more frequently than sleep apnoea syndrome.Conclusion: Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessivedaytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. Aunified European Directive seems desirable.
Original languageEnglish
Pages (from-to)362-375
Number of pages14
JournalSleep Medicine
Volume9
Publication statusPublished - 2008

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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