Division of Pulmonary and Sleep Medicine, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
School of Law, University of Missouri-Kansas City, Kansas City, MO, USA.
Sleep Breath. 2019 Jun;23(2):611-617. doi: 10.1007/s11325-019-01799-2. Epub 2019 Feb 8.
There are no universally accepted guidelines for assessing driving readiness in adolescents with narcolepsy. The purpose of the present study was to survey pediatric sleep medicine providers regarding their current practice patterns for assessing driving readiness in adolescents with narcolepsy, knowledge of their state laws regarding physician reporting of unsafe drivers, and opinions regarding what physician duty ought to be.
This was an anonymous web-based survey distributed via the PedSleep listserv, which serves as a hub of communication for pediatric sleep medicine providers.
A total of 52 pediatric sleep providers from 25 different states completed the survey. Eighty-eight percent of providers routinely assess driving readiness in adolescents with narcolepsy. Factors rated as "absolutely essential" by at least 50% of respondents included the following: history of previous fall-asleep crash or near miss, sleepiness (reported by patient), sleepiness (reported by caregiver), and cataplexy (reported by patient). Providers included maintenance of wakefulness testing: never (34%), if patient reports no/mild sleepiness (10%), if patient reports moderate/severe sleepiness (25%), or always regardless of patient symptoms (30%), and the median minimally acceptable result was 30 min (25-75th: 20-40 min). There was substantial lack of knowledge regarding legal obligations for reporting.
These results demonstrate great variability in practice patterns among pediatric sleep medicine providers for assessing driving readiness in adolescents with narcolepsy. In addition, it shows limited knowledge of the providers about their respective states' laws. Further studies are required to identify the best approach to assess residual sleepiness in this population.
目前尚无评估青少年发作性睡病患者驾驶能力的通用指南。本研究旨在调查儿科睡眠医学提供者在评估青少年发作性睡病患者驾驶能力方面的当前实践模式、他们对所在州医生报告不安全驾驶员相关法律的了解，以及他们对医生职责的看法。
这是一项通过 PedSleep 邮件列表以匿名网络调查的形式进行的研究，该列表是儿科睡眠医学提供者的交流中心。
共有来自 25 个不同州的 52 名儿科睡眠提供者完成了这项调查。88%的提供者会定期评估青少年发作性睡病患者的驾驶能力。至少有 50%的受访者认为以下因素“绝对必要”：既往瞌睡相关撞车或险些撞车史、患者自述的瞌睡、照料者报告的瞌睡、以及患者报告的猝倒。提供者包括维持清醒试验：从不（34%）、如果患者报告无/轻度瞌睡（10%）、如果患者报告中度/重度瞌睡（25%）或无论患者症状如何均进行（30%），而可接受的最低结果中位数为 30 分钟（25-75 百分位数：20-40 分钟）。在报告义务方面，存在着对法律义务的严重知识欠缺。
这些结果表明，儿科睡眠医学提供者在评估青少年发作性睡病患者驾驶能力方面的实践模式存在很大差异。此外，这也表明提供者对各自州法律的了解有限。需要进一步研究来确定评估该人群残余嗜睡的最佳方法。
