Driving a motor vehicle demands a lot of mental energy and vigilance to prevent car accidents. No matter the cause, workers dealing with sleepiness are more likely to get into a vehicle collision. Therefore, it is crucial to understand Obstructive Sleep Apnea (OSA), how it affects drivers, and consider the safety recommendations for Canadian commercial drivers.
What is Obstructive Sleep Apnea?
Obstructive Sleep Apnea (OSA) is the most common type of sleep apnea. It occurs when muscles in the throat relax, blocking a person’s airway while asleep. It causes fragmentation and poor sleep quality, leading to daytime sleepiness and decreasing vigilance on the job. Roughly twenty-four percent of middle-aged men and nine percent of middle-aged women have OSA. People with this diagnosis are two to ten times more likely to get into a vehicle collision than those without. These statistics should make it every province’s goal to establish fitness-to-drive recommendations or guidelines for workers with obstructive sleep apnea to help keep people safe.
Provincial Safety Regulations for Canadian Commercial Drivers
Each province in Canada has its fitness-to-drive guideline and regulations regarding workers driving with obstructive sleep apnea. Laws differ in each region because driving safety is a provincial responsibility, not a federal one.
For example, some provinces like British Columbia and Manitoba are more in-depth and base driving regulations on treated versus not treated and confirmed versus not confirmed OSA. While other provinces like Alberta have looser restrictions regarding workers driving with OSA. They state it is primarily the responsibility of the worker with OSA to inform the Ministry of Transportation of their condition. Alberta and Ontario’s provincial regulations permit treating physicians to take an active role in worker safety. Treating physicians can report a worker with OSA to the Ministry of Transportation whom they feel is at serious risk of getting into a motor vehicle collision.
Three Major Topics Concerning OSA and Driving
Medical experts discussed some of the primary concerns of workers with OSA driving. The three questions explored in detail were:
- Which noncommercial drivers with OSA should be considered unfit to drive?
- When should patients with OSA who have been restricted from driving be considered fit to drive again? What is the recommended follow-up?
- Should recommendations be different for commercial drivers? If so, how? Should all professional/commercial drivers be screened for OSA? If so, how?
After answering these three major topics seven key messages were compiled:
- The severity of OSA is not a dependable predictor of vehicle collision risk and should not be the sole reason for assessing a worker’s fitness to drive.
- The severity of OSA should be considered in the context of other factors (e.g., medications, sleep schedule, and history of car accidents).
- A qualified sleep medicine physician is the best person to advise driving authorities on fitness to drive related to OSA.
- For patients prescribed CPAP, at least 4 hours for more than seventy percent of nights should be documented to show its efficiency.
- For patients treated with an oral appliance or surgery, verification of adequate sleep apnea treatment should be obtained by PSG or a level 3 sleep study (self-reported).
- A driver diagnosed with OSA may be recertified as fit to drive based on assessing symptoms and demonstrating compliance with treatment (Performed by a sleep physician or family physician).
- Workers driving commercial vehicles will have a more stringent assessment of fitness to drive.
Medical Expert Panel (MEP) Recommendations for Canadian Commercial Drivers
Through a thorough examination of these three major topics, a Medical Expert Panel (MEP) was able to put together a general recommendations guide on:
- Dealing with workers diagnosed with OSA
- Recertification processes
- What calls for immediate disqualification or certification denial
- What to include in conditional certification
- OSA screening
- Therapy treatment options (PAP, bariatric surgery, Oropharyngeal surgery/facial bone surgery, Tracheostomy, and alternative treatments)
In general, a driver diagnosed with Obstructive Sleep Apnea can be certified if the driver has mild to moderate OSA, does not admit to experiencing excessive sleepiness during their wake period, and is being effectively treated. Drivers with OSA should recertify annually based on their compliance with treatment. Immediate disqualification or certification denials should occur if the driver admits to excessive sleepiness, if they have experienced a crash within the past five years as a result of falling asleep while driving (if effective therapy has not been instituted), or if the driver is non-compliant with treatment.
The Impact of Obstructive Sleep Apnea on Workplace Driving
Driving with Obstructive Sleep Apnea (OSA) is a safety hazard for the worker and everyone around them. If a worker has OSA, ensure they get the proper treatment to resolve or minimize its risks. Understanding this condition and remembering the key takeaways will help keep your organization in compliance with provincial regulations and expert medical recommendations.
Obstructive Sleep Apnea and Driving: A Canadian Thoracic Society and Canadian Sleep Society position paper
Obstructive Sleep Apnea, Symptoms and Causes Mayo Clinic