EU’s Approach to CPAP Compliance. “Use it or Lose it” (Your Drivers License)

EU’s Approach to CPAP Compliance. “Use it or Lose it” (Your Drivers License)

EU’s Approach to CPAP Compliance. “Use it or Lose it” (Your Drivers License)

Effective January of 2016 all drivers within the European Union when moderate or severe sleep apnea is suspected, will be referred for further medical advice before a driving license is issued or renewed. [1] Drivers currently under treatment for sleep apnea will require a medical review at least every three years for auto drivers (group 1) and every year for commercial drivers (group 2). What this new EU legislation will mean in practical effect is an OSA patient not demonstrating   could lose their driver’s license.

EU Truckers

EU Truckers

Currently all drivers in EU member nations are required to report certain medical conditions to the Driving License Authority. This directive makes OSA a reportable condition. One of the fears is that this may force patients with OSA “underground”. This fear may be valid from experiences with commercial trucking here in the US prior to 2008 when the Americans with Disabilities Act was amended. This provided job protection for commercial drivers with sleep apnea who were under current and effective treatment. The FAA also found issues with air traffic controllers and sleep apnea. Prior to 2010 changes in Aeromedical Medical Exam procedures for air traffic controllers there was no path to certification for a controller diagnosed with sleep apnea. The FAA noted less than .1% of controllers reported having OSA when from studies of the general population it would be expected that about 10% of controllers should. Anecdotal reports of “John Smith” and “Dick Tracy” getting sleep studies done as cash fee for services patients, and sleep tech conversations leading them to believe the patient worked at the airport were common prior to 2010 when the FAA implemented new fatigue management programs which included treatment options for sleep apnea while letting controllers keep their medical certification.

The EU action does note a trend in a regulatory consensus that an AHI>15 may be the point where driving may not be safe. Here in the US the Federal Motor Carrier Safety Administration (FMCSA) in its bulletin to medical examiners[2] stressed that its goal is to identify drivers with an AHI>15 . This is only a regulatory consensus and there was no research cited in either regulatory action to support the AHI>15. In fact research on commercial drivers, sleep apnea, and crash risk in the US is “mixed at best”.[3]

Reactions to the EU legislation from groups here in the US involved with the regulatory lobbying on sleep apnea in trucking[4] have been mixed. Scott Grenerth Regulatory Affairs Specialist with the Owner Operator Independent Drivers Association which has been opposed to mandatory OSA screening for CMV operators responded. “OOIDA supports testing and treatment for OSA when it is necessary and indicated by a driver’s family physician.  OOIDA suspects that the same interests which are pushing for mandatory screening in the U.S. are behind the mandate in the E.U. No doubt those interests will profit from mandated testing while providing questionable safety benefits to the taxpayers of the E.U. who will be paying for the questionable testing.” Wanda Lindsay founder of The Lindsay Foundation who lost her husband to a truck driver with diagnosed but untreated sleep apnea responded ““In theory testing all drivers would be the ideal.  However, I am afraid the sheer magnitude of monitoring and enforcing something on this scale might bog down the whole process and produce little positive results.  I do believe, from articles I’ve read, that many other countries are far ahead of the U.S. in addressing the problems related to obstructive sleep apnea.”

It will be interesting to watch how this new directive works out with EU member nations.

[1] COMMISSION DIRECTIVE 2014/85/EU of 1 July 2014amending Directive 2006/126/EC of the European Parliament and of the Council on driving licences, http://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32014L0085&from=IT (Accessed 6/14/15)

[2] FMCSA issues advisory on Sleep Apnea, Sleep Scholar 1/23/15 http://www.sleepscholar.com/fmcsa-issues-advisory-on-sleep-apnea/ (Accessed 6/14/15)

[3] Commercial Drivers with Sleep Apnea: It’s Still Hit or Miss, Journal of Clinical Sleep Medicine, April 2015, http://dx.doi.org/10.5664/jcsm.4590 Barbara Phillips, MD, MSPH, FCCP; Bob Stanton, BS (Accessed 6/14/15)

[4] Sleep Apnea Testing in : It’s not medical guidance anymore, It’s full blown politics now, Sleep Scholar,  1/5/2014 http://www.sleepscholar.com/sleep-apnea-testing-in-transportation-its-not-medical-guidance-anymore-its-full-blown-politics-now/(Accessed 6/14/15)