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

Alonderis, A.; Barbé, F.; Bonsignore, M.; Calverley, P.; De Backer, W.; Diefenbach, K.; Donic, V.; Fanfulla, F.; Fietze, I.; Franklin, K.; Grote, L.; Hedner, J.; Jennum, P.; Krieger, J.; Levy, P.; McNicholas, W.; Montserrat, J.; Parati, G.; Pascu, M.; Penzel, T.; Riha, R.; Rodenstein, D.; Sanna, A.; Schulz, R.; Sforza, E.; Sliwinski, P.; Tomori, Z.; Tonnesen, P.; Varoneckas, G.; Zielinski, J.; Kostelidou, K.; COST Action B-26,

doi:10.1016/j.sleep.2007.05.008

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Volume 9, Issue 4 , Pages 362-375, May 2008

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

A. Alonderis
- Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania
F. Barbé
- Hospital Arnau de Vilanova, Respiratory Department, Lleida, Spain
M. Bonsignore
- Istituto di Medicina Generale e Pneumologia, Universita di Palermo, Italy
P. Calverley
- University Hospital Aintree, Liverpool, UK
W. De Backer
- Respiratory Department, Universiteit Antwerpen, Belgium
K. Diefenbach
- Charite – Interdisciplinary Center of Sleep Medicine, Berlin, Germany
V. Donic
- Physiology and Sleep Laboratory, University of P. J. Safarik, Kosice, Slovakia
F. Fanfulla
- Sleep Laboratory, Pulmonary Division, Scientific Institute of Montescano, S. Maugeri Foundation, Italy
I. Fietze
- Charite – Interdisciplinary Center of Sleep Medicine, Berlin, Germany
K. Franklin
- Folkhälsa och klinisk medicin, Umea Universitet, Sweden
L. Grote
- Sahlgrenska akademien, Göteborgs Universitet, Sweden
J. Hedner
- Sahlgrenska Universitetssjukhuset, Göteborg, Sweden
P. Jennum
- Center for Sleep Medicine, University Hospital Glostrup, Denmark
J. Krieger
- Clinique Neurologique, Hôpital Civil, Strasbourg, France
P. Levy
- Grenoble University Hospital, Sleep Laboratory and EFCR, Grenoble, France
W. McNicholas
- Department of Respiratory Medicine, St. Vincent’s University Hospital, Dublin, Ireland
J. Montserrat
- Servei respiratorio, Hospital Clinic, Barcelona, Spain
G. Parati
- Cardiologia, 2, Ospedale San Luca, Milano, Italy
M. Pascu
- COST Office, Brussels, Belgium¹
T. Penzel
- Charité, Universitätsmedizin, Berlin, Germany
R. Riha
- Sleep Medicine, The Royal Infirmary Edinburgh, Scotland, UK
D. Rodenstein
- Service de Pneumologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
- Corresponding author. Address. Service de Pneumologie, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Av. Hippocrate 10, 1200 Brussels, Belgium Tel.: +32 2 764 2886; fax: +32 2 764 2831.
A. Sanna
- U. O. di Pneumologia, Azienda USL3 di Pistoia and Sleepiness and Driving Accident Commission, Italian Sleep Medicine Association, Italy
R. Schulz
- Schlaflabor Medizinische Klinik II, Giessen, Germany
E. Sforza
- Service de Neurologie, Hôpitaux universitaires de Genève, Switzerland
P. Sliwinski
- National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
Z. Tomori
- Physiology and Sleep Laboratory, University of P. J. Safarik, Kosice, Slovakia
P. Tonnesen
- Pulmonary Research, Gentofte Hospital, Copenhagen, Denmark
G. Varoneckas
- Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania
J. Zielinski
- National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
K. Kostelidou
- COST Office, Brussels, Belgium¹
COST Action B-26
- COST is an intergovernmental European framework for international cooperation between nationally funded research activities. COST creates scientific networks and enables scientists to collaborate in a wide spectrum of activities in research and technology. COST activities are administered by the COST Office. ESF provides the COST Office through an European Commission contract. COST is supported by the European Union RTD Framework programme.

Received 22 February 2007; received in revised form 9 May 2007; accepted 13 May 2007.

Abstract

Background

Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked 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 sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the 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 normalized electroencephalography (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 excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.

Keywords: Obstructive sleep apnoea, Driving license regulations