From the Research
The College of Physicians and Surgeons of Ontario (CPSO) requires physicians to report patients with severe obstructive sleep apnea (OSA) who continue to drive despite medical advice to refrain, specifically those with an Apnea-Hypopnea Index (AHI) greater than 30 events per hour, excessive daytime sleepiness, and a history of motor vehicle collision or near-miss due to sleepiness, fatigue, or inattention. The reporting requirement applies when patients refuse to comply with treatment recommendations and continue driving against medical advice, as highlighted in various studies 1, 2, 3, 4, 5. Key points to consider in managing OSA and driving include:
- Assessing the severity of OSA and its impact on driving safety
- Discussing driving risks and treatment recommendations with patients
- Attempting to address the patient's condition through appropriate treatment options, such as CPAP therapy, which is typically considered effective when used for at least 4 hours per night for 70% of nights
- Documenting discussions with patients about driving risks, treatment recommendations, and any reporting actions taken
- Balancing patient confidentiality with public safety concerns, as untreated severe OSA significantly increases collision risk due to impaired alertness, reaction time, and cognitive function caused by chronic sleep fragmentation and intermittent hypoxemia, as noted in a study published in the Journal Postgraduate medicine 2. It is essential to prioritize the most recent and highest quality study, which in this case is the 2021 study published in Postgraduate medicine 2, to guide clinical decision-making and ensure the best possible outcomes for patients with severe OSA.