Université de Montréal, 2900 Edouard-Montpetit Blvd., Montreal, QC H3T 1J4, Canada; Jewish General Hospital, 4333 Côte-Ste-Catherine Rd., Montreal, QC H3T 1E4, Canada.
Jewish General Hospital, 4333 Côte-Ste-Catherine Rd., Montreal, QC H3T 1E4, Canada; McGill University, 845 Sherbrooke W., Montreal, QC H3A 0G4, Canada.
Sleep Med Rev. 2018 Feb;37:130-137. doi: 10.1016/j.smrv.2017.02.002. Epub 2017 Feb 20.
Excessive daytime sleepiness and reduced cognitive functioning secondary to obstructive sleep apnea (OSA) have been identified as an important health-related risk in commercial transportation with, possibly, an increased chance of road accidents. This has resulted in a variety of policies and restrictions imposed on commercial drivers. Here we review current knowledge to assess whether available data are sufficient to guide policy decisions concerning restrictions for non-commercial drivers. The review shows that there is a lack of uniformity among different consensus conferences and guidelines as to how to deal with drivers with OSA. Clear guidelines are limited and few are evidence based. It is unclear which aspect of OSA is the most valid measure of severity (e.g., apnea-hypopnea index vs oxygen desaturation index). Traditionally, sleepiness has been invoked as a major risk factor for impaired driving. Recently, there also has been an awareness that daytime fatigue, as distinct from sleepiness, has an impact on driving behavior. However, the precise effect of fatigue on driving, as well as its role in the formulation of guidelines, remain to be evaluated. We conclude that there are at least two major difficulties for the driving recommendation process: a) there is no accurate metric quantifying severity of driving risk associated with OSA, and b) there are substantial individual differences among those with OSA, both experiential and behavioral. We present implications from this review for future research and policy formulation.
过度日间嗜睡和认知功能下降继发于阻塞性睡眠呼吸暂停（OSA），已被确定为商业运输中的一个重要健康相关风险，可能会增加道路交通事故的几率。这导致对商业司机实施了各种政策和限制。在这里，我们回顾现有知识，以评估有关非商业司机限制的政策决策是否有足够的数据来指导。审查表明，对于如何处理 OSA 驾驶员，不同共识会议和指南之间缺乏一致性。明确的指导方针有限，很少有基于证据的指导方针。尚不清楚 OSA 的哪个方面是严重程度的最有效衡量标准（例如，呼吸暂停-低通气指数与氧减饱和指数）。传统上，嗜睡被认为是驾驶受损的主要危险因素。最近，人们也意识到白天疲劳与嗜睡不同，会影响驾驶行为。然而，疲劳对驾驶的确切影响及其在指导方针制定中的作用仍有待评估。我们得出的结论是，驾驶建议过程至少存在两个主要困难：a）没有准确的指标来量化与 OSA 相关的驾驶风险的严重程度，b）OSA 患者之间存在很大的个体差异，既有经验性的，也有行为性的。我们提出了从本次审查中得出的对未来研究和政策制定的影响。
