Sleep problems are significant contributors to road traffic accidents, costing the industry millions and workers their health and quality of life.
In this piece, ahead of his talk at the Microlise Transport Conference, Chartered Psychologist Dr David Lee discusses the issue.
In the UK, the DVLA stipulates that any driver with even mild OSA, or who experiences excessive sleepiness as a result of another sleep condition, must not drive. If any driver has moderate to severe sleep apnoea then they: must not drive; must notify the DVLA; must not resume driving until their symptoms have improved and been controlled for 3 months; and must be reviewed every 3 years for subsequent licensing.
The maximum penalty for causing death by dangerous driving (which includes driving whilst tired) is 14 years in prison. Under the Health and Safety at Work Act, UK companies and organisations have a responsibility for their employees while they are driving for work purposes. This means that they may be liable for road crashes caused by or involving employees who are suffering from excessive sleepiness.
Professionals drivers are an at-risk group for sleep disordered breathing, which is easy to diagnose and treat, but remains under-diagnosed in this group. Estimates suggest that around 1.5 million people in the UK may have obstructive sleep apnoea (OSA), but that, currently, only 330,000 have a confirmed diagnosis. If OSA were treated in these remaining undiagnosed people an estimated 40,000 less road traffic collisions would occur per year in the UK and an estimated £55 million would be saved in direct costs relating to accidents and treating co-morbidities in people with OSA.
People with OSA are at a 2.5-fold increased risk of road traffic accidents and occupational accidents compared with people without the condition. Professional drivers are also at an increased risk, because of their high mileage per year compared with non-commercial drivers, potentially increasing their risk to around 5-fold over healthy sleepers. Research suggests that up to 41% of professional drivers in the UK may have a diagnosable sleep problem and that around 16% may have severe sleep apnoea that requires immediate treatment.
There are a range of treatment options for managing OSA including: weight loss, mandibular advancement devices, ulvulorhinoplasy, tonsillectomy, and continuous positive airway pressure (CPAP) therapy. Adherence to the use of CPAP therapy has been shown to normalise risk in professional drivers with OSA.
Access to effective diagnostic and treatment protocols is thought to be problematic for up to 85% of people with OSA and there is an inequitable distribution of health service provision across the UK at the present time.
This presentation will introduce delegates to a fast and effective diagnostic tool (the STOP-BANG questionnaire) for identifying sleep disordered breathing, identifying at-risk drivers, and providing a care pathway that can rapidly and effectively treat their symptoms, and keep them safely at work. This questionnaire has recently been reviewed against the range of other metrics available and has been recommended as having the highest sensitivity for identifying sleep disordered breathing.