DOCTORS ON DRIVING
 
Diabetes & Driving Disabilities & Driving Vision & Driving
Dementia & Driving Snoring & Driving Old Age & Driving
Heart Diseases & Driving Epilepsy & Driving Driver Checkup
 

Snoring and Driving

Can a patient with snoring drive?
 

Patients with sleep apnea (abnormal snorers) exhibit poorer performance than control subjects on several types of driving simulators. In addition, the automobile crash rate for these patients has been estimated as two to three times greater than for all drivers.

How does one know a particular person with snoring is at risk?
 

Men with 5 or more apneas (stopped breathing) and hypopneas (less breathing) per hour of sleep are 3 to 4 times more likely to have had an automobile accident in the preceding 5 years than were men without sleep-disordered breathing
Men and women combined with 15 or more apneas or hypopneas per hour of sleep are 7 times more likely to have had an accident in the preceding 5 years than were non-apneic men and women. Patients with an apnea-hypopnea index >10 have an odds ratio of 7.2 for having a traffic accident despite adjustment for alcohol consumption, visual acuity, age, years of driving, and distance driven per year.

Does treatment of snoring help?
 

Successful treatment of sleep apnea improves performance on driving simulator tests and decreases reported automobile crashes.

What is the risk?
 

The risk is of falling asleep while driving a motor vehicle. If a patient chooses to operate an motor vehicle with knowledge that he or she frequently falls asleep while driving or that he or she suffers from a condition that makes it dangerous to drive, the individual's actions may be considered negligent and may lead to civil or criminal liability in the event that someone is injured or killed.

What are the responsibilities of a physician when he deals with a poatiebt of sleep apnea?
  The physician is expected to :
Diagnose sleep apnea
Assess the patient's risk for motor vehicle accidents
Inform the patient of these risks
Treat the patient effectively
Have a plan of follow-up in order to determine if the treatment has decreased the patient's risk for accidents.

How is sleep apnea diagnosed?
  Physicians should be alert for excessive sleepiness or other symptoms of sleep apnea in any patient who drives, but especially in patients who drive a bus or who are otherwise occupationally responsible for driving.

 How the risk is assessed?
 

The physician must assess the risk for an accident in each patient. A patient is considered to be at high risk for an accident if he or she is severely sleepy and has a history of a previous motor vehicle accident. Consequently, all patients with sleep apnea should be questioned about sleepiness while driving and about any history of auto accidents.

Do patient need be informed about the diagnosis?
 

Once a patient has been diagnosed with sleep apnea, the physician must warn the patient of the potential risk of operating a motor vehicle while sleepy or inattentive. All high-risk patients must be warned of the risk of driving until adequate therapy is instituted. The patient should ideally be given written information about this risk.

Internationally does a doctor need to report patients with sleep apnea?
 

Diabetes mellitus and travel - Although north-south international travel does not necessitate alterations in diabetic management, east-west travel across times zones often requires adjustments in insulin dosing [34]. The American Thoracic Society recommends reporting the following high-risk patients.
Patients who insist on driving before treatment is begun
Patients who refuse to comply with treatment
Patients whose occupation involves driving, for whom the risk of an accident poses significant public injury, eg, bus drivers or truck drivers transporting hazardous waste.
Travelers need to carry their syringes, medications, and snacks in carry-on bags.

Can a patient with epilepsy drive?
 

The most common requirement is that patients be free of seizures for a specified period of time and submit a physician's evaluation of their ability to drive safely. Most countries require a one-year seizure-free period. A seizure that occurs due to a temporary illness or related to an isolated event that is unlikely to recur may not require any driving restriction. It is reasonable to advise patients to avoid driving until a full evaluation is completed and it is determined that the risk of seizure recurrence is sufficiently low that the patient may resume driving safely.

Can a patient with dementia drive?
  The American Academy of Neurology has issued guidelines for driving in patients with AD based upon the clinical dementia rating.
Patients and their families should be told that a CDR of 1 or greater is associated with a substantially increased accident rate and driving performance errors; these patients should not drive an automobile.

Patients and their families should be told that patients with possible AD and a CDR of 0.5 pose a significant traffic safety problem when compared with other elder drivers. Referral of the patient for a driving performance evaluation by a qualified examiner should be considered. Dementia severity and appropriateness of continued driving should be reassessed every six months.

 
 
   

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