Implementation of European national driving regulations for obstructive sleep apnoea: challenges and recommendations

Background Obstructive sleep apnoea (OSA) carries an increased risk of motor vehicle accidents, which resulted in the European Commission introducing a legal directive (2014/85/EU) restricting driving in patients with moderate/severe OSA and sleepiness, unless effectively treated. We assessed the implementation of the directive in European Union (EU) member and non-member states. Methods National sleep societies and/or selected other sleep specialists in EU member states and selected other European countries completed a questionnaire on the local introduction of the EU Directive, or similar, the OSA severity to restrict driving, criteria to resume driving, and the validity period for different driving licences. Results Data were obtained from 25 out of 27 EU member states and all eight non-member states included, representing a population of ∼770 million. All EU members had introduced the Directive into national regulations, largely unchanged, although some countries applied stricter criteria such as mild OSA and a minimum treatment period before resuming driving. Only five non-member states had driving regulations for OSA. Problems with implementation of regulations were reported in most countries, including inadequate resources to diagnose/treat OSA patients, excessive restrictions regarding disease severity and certification to resume driving, and under-reporting of symptoms by patients fearing the loss of their licence, especially professional drivers. Conclusions Driving regulations for OSA apply in most European countries, but excessively strict criteria for OSA severity, sleepiness and delayed permission to resume driving are questionable. Further research is needed on whether such regulations result in fewer accidents and on the objective identification of sleepiness.