PROMISE Dept, University of Palermo, Palermo, Italy.
IRIB-CNR, Palermo, Italy.
Eur Respir J. 2021 Feb 25;57(2). doi: 10.1183/13993003.01272-2020. Print 2021 Feb.
Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk of OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a task force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA; the mechanisms involved in this association; the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance; the impact of treatment on MVA risk in affected drivers; and highlights the evidence gaps regarding the identification of OSA patients at risk of MVA.
阻塞性睡眠呼吸暂停（OSA）的患病率很高，是机动车事故（MVA）的公认危险因素。持续气道正压通气的有效治疗与这种增加的事故风险正常化有关。因此，许多司法管辖区已经出台了规定，限制 OSA 患者在得到有效治疗之前开车的能力。然而，在确定事故风险方面，每小时呼吸暂停-低通气频率和嗜睡程度决定 OSA 严重程度的相对重要性仍存在不确定性。此外，确定 OSA 风险和/或事故风险的患者仍然难以捉摸。官方欧洲驾驶适能法规的出台促使欧洲呼吸学会成立了一个工作组，专门研究睡眠呼吸暂停、嗜睡和驾驶问题，旨在为治疗该疾病的患者的临床医生提供概述。本报告评估了 OSA 患者中 MVA 的流行病学；这种关联涉及的机制；筛查问卷、驾驶模拟器和其他评估嗜睡和/或警觉性受损的技术的作用；治疗对受影响驾驶员中 MVA 风险的影响；并强调了关于识别有 MVA 风险的 OSA 患者的证据差距。
