Introduction Clinicians are often asked to complete forms about patients with OSAS by the DVLA. We evaluated the current practice of assessing residual drowsiness, CPAP compliance and whether objective testing is undertaken by clinicians to assess an individual’s fitness for driving.
Methods Clinicians who complete the DVLA medical forms (SL1 and SL1V) were invited to participate in a web-based survey. Respondents were presented with five vignettes of patients with OSAS offered CPAP and to answer the questions posed by the DVLA about residual drowsiness (“excessive” (SL1) or “irresistible” (SL1V)) and adequacy of CPAP compliance. They were also asked about their use of objective tests.
Results 178 respondents completed the survey. There was poor agreement among clinicians regarding the presence of residual drowsiness (McNemar's test, figure-1). In response to the DVLA question about “excessive” drowsiness, the patient had a 1 in 2.57 (range-1.12 to 5.66), and about “irresistible” drowsiness, a 1 in 1.32 (range- 1.04 to 2.84), chance of being given a different answer depending on the clinician seen. Furthermore in each vignette the same clinician was more likely to say “yes” to “excessive” than to “irresistible” (71 +/-12% v/s 42 +/-10%, P-0.0045).There was also a lack of consensus as to what constitutes “adequate CPAP compliance”. Across the vignettes there was minimum of 1 in 1.7 and a maximum of 1 in 6.7 chance of disagreement amongst the clinicians (median- 3, range 1.7 to 6.7). 1% of clinicians always and 4% frequently use objective tests to help in their assessment. They are more likely to use in professional drivers as compared to non professional drivers (52% v/s 38%, P- 0.0002, OR-1.75). Tests used were MSLT (34%), OSLER (29%), MWT (28%) and divided attention driving simulator (9%).
Conclusions The information that the DVLA is given may vary markedly depending upon which clinician completes the form. Furthermore the same clinician may give a different impression to the DVLA depending on which form they are asked to complete. Objective testing is not undertaken routinely. Better guidance and better objective tests are needed to ensure consistency of the information that the DVLA is given.