Sleep apnea and driving license regulations in the European Union

Abstract

Sleep apnea (OSA) is one of the main medical causes of excessive daytime sleepiness (EDS). It is a risk factor for traffic accidents. Treating sleep apnea results in a normalization of the rate of traffic accidents. As part of the European Science Foundation COST Action B-26, we looked at the medical aspects of driving license regulations in the European Union (EU). Up to now, we obtained data from 19 countries (Austria, A; Belgium, B; Czech Republic, Cz; Denmark, Dk; Finland, Fin; France, F; Germany, D; Ireland, Irl; Italy, I; Lithuania, Lt; Luxembourg, L; Malta, M; Netherlands, Nl; Poland, Pl; Portugal, P; Slovakia, Sk; Spain, E; Sweden, S; United Kingdom, UK). EDS is mentioned in 7 countries (B, Fin, F, D, E, S, UK) whereas OSA is mentioned in 8 (the above 7 plus Pl). A patient with untreated OSA is considered unfit to drive. To retrieve the driving capacity, 7 countries rely on a general practitioner or specialist medical certificate (B, Fin, F, D, Pl, E, UK) based on symptoms control and compliance with therapy (B, UK). Only 1 country (F) requires a normalized maintenance of Wakefulness Test for group 2 (professional) drivers. In many countries, rare conditions (e.g. narcolepsy) are considered whereas sleep apnea is not mentioned. As a comparison, epilepsy is almost universally included in the regulations. When OSA is mentioned, its diagnosis involves for the physician the duty to alert the administrative authorities issuing the driving licenses in Fin, Pl, E and the UK, but not in B. In conclusion, most countries in the EU don't include sleep apnea or excessive daytime sleepiness in driving regulations. A unified European Directive seems necessary to reach a uniform and coherent situation.