Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers

Publication Date: June 3, 2013
Last Updated: September 2, 2022

Management

All patients being initially evaluated for suspected or confirmed OSA should be asked about daytime sleepiness, especially falling asleep unintentionally and inappropriately during daily activities, as well as recent unintended motor vehicle crashes or near-misses attributable to sleepiness, fatigue, or inattention. Patients with these characteristics are deemed high-risk drivers and should be immediately warned about the potential risk of driving until effective therapy is instituted. (C, VL)
620
Additional information that should be elicited during an initial visit for suspected or confirmed OSA includes the clinical severity of the OSA and therapies that the patient has received, including behavioral interventions. Adherence and response to therapy should be assessed at subsequent visits. The drowsy driving risk should be reassessed at subsequent visits if it was initially increased. (, )
620

For patients in whom there is a high clinical suspicion of OSA and who have been deemed high-risk drivers:

The ATS suggests that polysomnography be performed and, if indicated, treatment initiated as soon as possible, rather than delayed until convenient. (, VL)

The ATS recognizes that the duration that constitutes “as soon as possible” will vary according to the resources available, but ATS favors the goal of less than 1 month. For appropriately selected patients (e.g., no comorbidities, high clinical suspicion for OSA), at-home portable monitoring is a reasonable alternative to polysomnography.

weak recommendation

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The ATS suggests NOT using empiric continuous positive airway pressure (CPAP) for the sole purpose of reducing driving risk. (, VL)
weak recommendation
620
For patients with confirmed OSA who have been deemed high-risk drivers, the ATS recommends CPAP therapy to reduce driving risk, rather than no treatment (S, M)
This suggestion is for CPAP because only its effects on driving performance have been well studied. Other treatments that could accomplish the same goal have not been evaluated.
620
For patients with suspected or confirmed OSA who have been deemed high-risk drivers, the ATS suggests NOT using stimulant medications for the sole purpose of reducing driving risk (, VL)

weak recommendation

620

Recommendation Grading

Overview

Title

Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers

Authoring Organization

American Thoracic Society

Publication Month/Year

June 3, 2013

Last Updated Month/Year

November 25, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Sleepiness may account for up to 20% of crashes on monotonous roads, especially highways. Obstructive sleep apnea (OSA) is the most common medical disorder that causes excessive daytime sleepiness, increasing the risk for drowsy driving two to three times. The purpose of these guidelines is to update the 1994 American Thoracic Society Statement that described the relationships among sleepiness, sleep apnea, and driving risk.

Target Patient Population

Adults who drive and experience daytime sleepiness

PICO Questions

  1. What performance-based testing is appropriate for those treated with problem sleepiness?

  2. How can public perception of, and attitudes about, the assessment for drowsy driving risk be addressed, not only in regard to personal health but also in regard to the right to drive?

  3. What educational tools are effective in reducing drowsy driving in populations of patients as well as for the public at large?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Management, Prevention

Diseases/Conditions (MeSH)

D012890 - Sleep, D000077260 - Sleepiness

Keywords

sleepiness, driving risk, sleep apnea

Source Citation

Strohl KP, Brown DB, Collop N, et. al.; ATS Ad Hoc Committee on Sleep Apnea, Sleepiness, and Driving Risk in Noncommercial Drivers. An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 Statement. Am J Respir Crit Care Med. 2013;187(11):1259–1266.

Supplemental Methodology Resources

Data Supplement