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Obstructive Sleep Apnoea

21 March

What is OSA and OSAS?
OSA (Obstructive Sleep Apnoea) is the most common sleep related medical disorder, affecting approximately 5% of the population. It is a condition that affects breathing while the sufferer is asleep, due to partial or total closure of the airway behind the tongue. This causes the body to wake up to restore normal breathing, preventing a good night’s rest. The most common symptoms are snoring (as partners will attest) and breathing pauses during sleep.

OSAS (Obstructive Sleep Apnoea Syndrome) is a more severe form of OSA. It includes both disruptive breathing whilst the sufferer is sleeping and symptoms of Excessive Daytime Sleepiness (EDS). The pauses in breathing can happen hundreds of times a night which means a sufferer is getting less of the restorative kind of sleep required for the levels of energy and concentration needed to drive safely. OSAS occurs in approximately a quarter of those with OSA.

Though OSAS symptoms will include excessive daytime sleepiness, it may also include a number of other symptoms (e.g. frequent loud snoring, stopped breathing during sleep, choking episodes during sleep, morning headaches, depression, frequent trips to the bathroom during the night, waking with a dry mouth/sore throat, waking feeling un-refreshed, difficulty concentrating, irritability, high blood pressure).

Is it dangerous?
Because OSAS reduces energy and concentration levels, and increases daytime drowsiness, it can cause unnecessary accidents. The DVLA are most concerned about long distance lorry and bus drivers as most will be driving on monotonous roads and motorways, and the size and nature of their vehicle gives little room for error. Up to 1/5th of accidents on these types of roads may be caused by drivers falling asleep at the wheel, and sleepiness increases the severity of an accident since driver reactions are impaired.

New Medical Standards
Changes to EU legislation (European Commission directive 2014/85/EU) came into force in Great Britain on 31st December 2015 and affect the minimum medical standards for drivers with OSA and OSAS:

OSA

  • Drivers with Obstructive Sleep Apnoea (OSA) (not OSAS) do not need to notify DVLA unless they have symptoms (e.g. daytime sleepiness) that would affect their ability to drive safely.

DVLA does not consider OSA to be an issue in itself. Drivers are only obliged to inform DVLA of the condition if it is accompanied by symptoms which could impair driving. Indeed, one study showed that only 1% of OSA sufferers have had their license removed.

OSAS

  • OSAS is specifically identified as a notifiable medical condition.
  • Drivers with OSAS must inform DVLA by letter, phone or email at the point of diagnosis or recognition of symptoms.
  • The driver must stop driving completely until their condition has been successfully treated.
  • Treatment is widely effective but medical enquiries will be undertaken by DVLA.

The DVLA’s requirements for Group 1 and Group 2 drivers are:

  • Cars and motorcycles (Group 1 entitlement) – driving must stop if there is OSAS and symptoms including excessive sleepiness severe enough to likely impair safe driving. Driving will be permitted once satisfactory control of the symptoms has been achieved.
  • Lorries and buses (Group 2 entitlement) – as above but drivers must also comply with the treatment specified and confirmed to the DVLA by the consultant/specialist.

What action can be taken? Can driving continue?
To inform the DVLA a driver must fill in an SL1V form, asking: whether the condition causes you to feel sleepy; whether one is receiving treatment; whether the treatment is working effectively.

If the answer to all is yes to all SL1V questions the DVLA does not need to revoke the license concerned, and driving can continue. Otherwise driving should stop and medical treatment should be sought. However, driving is only forbidden between getting OSA/OSAS confirmed and the drivers GP confirming that they are receiving successful treatment.

Treatment and Re-licensing
OSAS is a fully treatable condition and if referred to a specialist quickly a driver should be able to get back behind the wheel within a few weeks.

The most widely effective treatment is Continuous Positive Airway Pressure (CPAP) which requires the patient to wear a soft face mask during sleep to regulate breathing. This enables them to have a good night’s rest, reducing daytime sleepiness and improving concentration. Lifestyle changes can also be effective: weight loss and cutting back on alcohol can both help ease OSAS symptoms.

It is important for a driver to mention to the GP or medical consultant that they are a commercial driver as they should be able to fast-track diagnosis and treatment to limit the time off the road. NHS can often (but not always) provide equipment on the same day as diagnosis if they are aware that a livelihood depends on driving. Once a medical consultant is satisfied that treatment is successfully being received (normally 1-2 weeks), and therefore the symptoms are fully controlled, driving can resume safely.

Once the condition has been controlled, it is necessary to reapply for a license(s). If the license was voluntarily surrendered, this will be a similar process to when the DVLA was notified. After the DVLA receives an application – plus the corresponding SL1 or SL1V – and the consultant has confirmed successful treatment, driving can be resumed under section 88 of the Road Traffic Act (though it is possible for them to withhold the licence until medical reports are received).

However, if the license was previously refused or revoked by the DVLA driving cannot continue until a licensing decision has been made on the application. This may be a lengthy process if the DVLA has a heavy work volume, hence the importance of voluntarily declaring the condition.

Group 2 license holders will be asked for an annual review after treatment to confirm that the therapy is still working well. It is best to do this in advance to help make the process as smooth as possible, and should be little more than a formality.

Legal Obligations
There is no excuse for falling asleep at the wheel and it is not an excuse in law. Under the Road Traffic Act 1988 all drivers have a duty of care to be fit to drive, which includes being fully alert. The DVLA considers all drivers who fall asleep at the wheel to have had a degree of warning.

It is also a legal requirement to inform the DVLA about any medical condition that effects driving. Failure to do so can lead to a £1000 fine, invalidated insurance and guilty of driving without a valid license. It could potentially lead to a criminal record.

Any effect on Insurance?
According to advice given by the Association for British Insurers (ABI), there should be no effect on insurance premiums for drivers who have been diagnosed with OSAS where the symptoms are being controlled through treatment, providing the DVLA have been informed and have given permission to drive.

However, insurance companies are entitled to request medical details for any condition currently under treatment (in the small print of any insurance policy there will be a statement saying that you must inform them of any circumstances that might alter the terms of the insurance). If OSAS was undeclared insurers may refuse to support any claim.

This reinforces the importance of drivers informing employers at the earliest opportunity. Failure to do so could also have a detrimental effect on an employer’s insurance policy.

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