Pneumology Department and Center for Sleep Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Respiration. 2009;78(3):241-8. doi: 10.1159/000222811. Epub 2009 May 30.
Obstructive sleep apnea has been associated with a high risk for motor vehicle accidents, probably the highest of all risks due to medical conditions. Treatment of sleep apnea with nasal continuous positive airway pressure appears to reduce the risk of traffic accidents to the one of the general population. The risk for accidents may also be increased in untreated patients in the home and work environment. The increased risk seems unrelated to the symptom of daytime excessive sleepiness, and in many studies lacks a clear dose-response relationship with respect to the severity of apneas and hypopneas. The association of sleep apnea, chronic sleep deprivation and consumption of hypnotics or alcohol has not been thoroughly studied, although alcohol has been considered as a confounding variable in some studies. The cost of traffic accidents due to sleep apnea has been estimated to be so high that diagnosing and treating all drivers with sleep apnea in the USA would be cost saving and result in a decrease in society costs related to the disease. Driving licenses are delivered according to national legislations. These are all but uniform, especially concerning sleep apnea. Even within the European Union, where a minimum set of rules is mandatory for all countries, sleep apnea is not included in the minimum. Therefore, drivers are left in a very uncomfortable position, behaving according to the law in one country but being unlawful once the border with the neighbor country is crossed. Physicians are also in a very difficult position if they have to counsel their patients on the best attitude when travelling by car. The situation is even worse for commercial drivers, for whom the legislation is more severe but leaves sleep apnea uncovered in many countries. This is all the more disturbing if one considers that sleep apnea can be suspected, screened and diagnosed with relative ease, and that once diagnosed the adequate treatment allows for safe driving. The inclusion of sleep apnea in the European traffic license regulations would represent a step forward towards safe routes for patients and healthy people alike.
阻塞性睡眠呼吸暂停与机动车事故风险增加相关，这可能是所有与医疗状况相关风险中最高的。使用持续气道正压通气治疗睡眠呼吸暂停似乎可以将交通事故风险降低到一般人群的水平。在未接受治疗的患者的家庭和工作环境中，发生事故的风险也可能增加。这种风险的增加似乎与白天过度嗜睡的症状无关，并且在许多研究中，与呼吸暂停和低通气的严重程度之间缺乏明确的剂量反应关系。睡眠呼吸暂停、慢性睡眠剥夺以及催眠药物或酒精的使用与事故风险增加之间的关联尚未得到彻底研究，尽管在一些研究中，酒精已被认为是一个混杂因素。由于睡眠呼吸暂停导致的交通事故成本估计非常高，因此在美国诊断和治疗所有患有睡眠呼吸暂停的驾驶员将节省成本，并降低与该疾病相关的社会成本。驾驶执照的发放依据国家立法。但这些立法并不统一，尤其是涉及睡眠呼吸暂停时。即使在欧盟，所有国家都必须遵守一套最低规则，但睡眠呼吸暂停并不包含在其中。因此，驾驶员处于非常尴尬的境地，在一个国家遵守法律，但一旦跨越邻国边界，就会变得违法。如果医生必须就驾车旅行的最佳态度向患者提供建议，那么他们也处于非常困难的境地。对于商业司机来说，情况更糟，因为他们的立法更为严格，但在许多国家都没有涵盖睡眠呼吸暂停。如果考虑到睡眠呼吸暂停可以相对容易地被怀疑、筛查和诊断，并且一旦确诊，适当的治疗可以允许安全驾驶，那么这种情况就更加令人不安了。将睡眠呼吸暂停纳入欧洲驾驶执照法规将是朝着为患者和健康人提供安全路线迈出的一步。
