Introduction Advice about driving is a key component of the management of OSAS patients. No objective tests have been shown to predict reliably whether an individual is safe to drive or not and therefore the advice given will depend upon the opinion of clinicians. We evaluated the current practice of advice given regarding fitness to drive in OSAS patients.
Methods Clinicians were invited to participate in a web-based survey. The questionnaire included six clinical vignettes describing a variety of OSAS patients. For each the respondent chose from options ranging from driving without restriction to advising not to drive at all. For ease of presentation the data are summarised as whether would allow driving or not.
Results 467 respondents completed the survey. The advice given by the respondents to various clinical vignettes was variable (figure-1). In the least contentious scenario (vignette-1) there was 1 in 14.6 chance and in the most (vignette-4) there was a 1 in 2 chance of an individual being told whether they could drive or not. Respondents were more likely to advise patients to refrain from driving if the AHI was worse (P- < 0.0001, OR-3.9), if the Epworth sleepiness score was high (P-< 0.0001, OR-23.5) and if the patient admitted to any problems at all while driving (P- 0.0098, OR-1.6). Males were more likely to allow OSAS patients to drive. Consultants without an interest in sleep medicine and respondents seeing less than 5 patients per month were more likely to advise against driving. The advice given was not related to the age of the clinician.
Conclusions This survey has shown that there is considerable variability in the advice given by clinicians, with in some situations a patient having an even chance of receiving opposite advice, depending on who they see. Restriction of driving has major implications for an individual, both social and financial. Allowing someone to drive who is not safe to do so has potentially disastrous consequences for them and others. The issue of how to improve consistency of advice needs to be addressed.