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Safety campaigners call for four-week wait limit for sleep apnoea diagnosis

06 March 2015 #Bus and Coach #Features & Interviews #Logistics #Policy #Truck #Van

Nodding off at your desk because you had a poor night’s sleep is embarrassing. Nodding off at the wheel of a truck for the same reason could prove catastrophic.

In both cases the cause could be OSAS – Obstructive Sleep Apnoea Syndrome. A problem that particularly affects middle-aged men, especially if they are overweight, and usually accompanied by snoring, it is due to the airway behind the tongue partially or totally closing while you are asleep. The sufferer wakes up briefly to restore normal breathing, then goes back to sleep again.

This can happen hundreds of times says the Sleep Apnoea Trust, so you never get a proper night’s slumber. As a consequence you feel drowsy the next day and become an accident waiting to happen if you drive.

The Trust points out that studies have shown that a driver with untreated OSAS is between three and nine times more likely to have a crash; and the crash is liable to be a serious one.

It is a problem that can affect lorry drivers in particular because they lead a sedentary life, tend to be in their forties and fifties and sometimes considerably older – the UK has an ageing truck driver population – and do not always eat healthily. As a consequence there is the risk that they will pile on the pounds.

“A key reason for OSAS is upper body obesity,” says leading respiratory consultant, Professor John Stradling. “I’m talking here about weight around the neck and stomach in particular.”

The good news is that there is a treatment for OSAS, which is present in about 5% of the UK’s population. The bad news is that many drivers are not taking advantage of it because they fear that if they admit to having a problem, then they will lose their vocational licence and thus their livelihood.

Anyone diagnosed as suffering from OSAS to the extent that their ability to drive safely is impaired must inform the Driver and Vehicle Licensing Agency (DVLA). They must than cease driving until the problem is resolved and they are pronounced fit to be behind the wheel again.

Unfortunately the pressure on the National Health Service is such that it can take up to six months before a driver gets the OK; and that’s half a year’s wages gone. “Once someone has been referred to a sleep unit by their GP then it may be up to 16 weeks before they are seen and their treatment may not start until some time after that,” says Stradling.

In response, the OSA Partnership Group, which includes clinicians – Stradling is a member – academics, patient groups and health and safety organisations as well as the RAC and DVLA, has launched the ‘Four-Week Wait’ campaign. It is calling on the Department of Health to issue guidance to hospitals, local GPs and clinical commissioning groups to speed up the treatment of truck, bus and lorry drivers so that they can be back at work no more than four weeks after being referred to an NHS sleep centre by their doctor.

That breaks down into waiting no more than two weeks after referral before they make their first contact with a centre, no more than a week until treatment is supplied, and no more than a week until confirmation that it is working and the patient is safe to drive.

Stradling believes that should make drivers more willing to come forward, which means they will be less of a danger to other road users, and to themselves.

Research the group conducted in conjunction with the Freight Transport Association reveals that, as things stand, 98% of fleet managers believe that drivers who think they might have OSAS are unlikely to raise concerns for fear of losing their licence. Over 15% of LGV drivers may suffer from it, suggests Stradling.

The group has recently worked with the Freight Transport Association to develop a module for the driver’s Certificate of Professional Competence that explains what OSAS is, its risks and its treatment.

In the majority of cases the treatment required to manage the symptoms is simple and involves something called CPAP – Continuous Positive Air Pressure. It is made up of a face-mask which the user wears at night, plus an air pump housed in a sound-proofed case that maintains sufficient pressure to keep the airway open.

While the face-mask can be a little difficult to get used to, the arrangement does work.

Losing weight is of course another option, and a highly desirable one, but that can be difficult for many people says Stradling, author of the campaign paper. It can take time too; and then you’ve got to keep the weight off.

“In my experience vocational drivers are often the safest on our roads,” he says. “But those with OSAS have no control over their sleepiness.”

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