As many as one in five accidents are caused by drowsy drivers, and new guidelines from the American Thoracic Society call on doctors and clinicians to ask patients with sleep apnea about daytime sleepiness and their traffic records — regardless of whether their jobs involve commercial driving.
The new guidelines, published in the American Journal of Respiratory and Critical Care Medicine, urge that all patients undergoing initial evaluation for suspected or confirmed obstructive sleep apnea be asked about daytime sleepiness and recent unintended motor vehicle crashes or near-misses attributable to sleepiness, fatigue, or inattention.
The guidelines also recommend that patients with these characteristics are considered high-risk drivers and be warned about the potential risk of driving until effective therapy is initiated.
"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," said Kingman P. Strohl, M.D., 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."
Among the other guideline recommendations:
- When evaluating patients for potential apnea, clinicians should ask about drowsy driving in initial exams and in follow-up visits.
- Patients with probably apnea who have been deemed high-risk drivers should undergo a sleep clinic test. Those with confirmed apnea should be treated with continuous positive airway (CPAP) therapy.
- Stimulant medications for the sole purpose of reducing driving risk in such patients are not recommended.
- Clinicians should inform patients and their families about drowsy driving and other risks of excessive sleepiness and methods that may reduce those risks.
"Addressing the issue of drowsy driving requires the combined effort of physicians, patients, and policy makers," said Dr. Strohl. "The assessment for sleepiness before and with treatment of OSA, as outlined in these new guidelines, is an essential part of these joint efforts."
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