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It’s time for new guidance on Sleep Apnoea

Thursday, March 5, 2015

The following was published in The Huffington Post

The Department of Health should issue new guidance on Obstructive Sleep Apnoea Syndrome (OSAS) to Clinical Commissioning Groups, hospitals and GPs, according to a new report by the OSA Partnership Group.

The report demands that ‘the treatment of vocational drivers with obstructive sleep apnoea syndrome (OSAS) should be expedited to allow driving again within a maximum of four weeks following first referral’.

I am wholeheartedly behind this campaign because it will save lives.

OSAS is common amongst middle-aged men in the UK, particularly those who are overweight, a group over-represented amongst drivers with Heavy Goods Vehicle (HGV) licenses. Those with OSAS are at risk of falling asleep driving, possibly causing damage, personal injury and death.

It is a condition whereby the muscles in the throat relax, causing an obstruction in the airway during sleep and the individual stops breathing. They then automatically start and waken, thereby disturbing their sleep rhythm. Some stop breathing hundreds of times a night, and others have periods during which their breathing is restricted.

Untreated OSA can have a profound impact on the quality of life of those affected. It has been proven to cause high blood pressure, as well as being associated with a host of other health conditions such as heart disease, heart failure, stroke and diabetes.

I was made aware of the devastating consequences of undiagnosed sleep apnoea in 2006, when a constituent approached me whose nephew had been killed when a lorry ploughed into his car. Toby Tweddell was just 25 years old when a HGV driver who had fallen asleep at the wheel of his vehicle crashed into a line of cars, resulting in his death. Left behind were Toby’s fiancée Jenny, parents Monica and Nic, his uncle, my constituent Seb Schmoller, and many others.

The sequence of events leading to Toby’s death also devastated the driver, Colin Wrighton, who had seen his doctor just five months earlier complaining of tiredness. Tests to find out whether he was diabetic returned negative, and he was told he was probably suffering from stress. The medical profession’s failure to diagnose sleep apnoea and refer him to a specialist in sleep medicine meant that he was left having to come to terms with the awful result of the accident.

There is an immeasurable cost to the families of those involved in fatalities, and there are financial implications too. A fatal accident is estimated to cost almost £2 million, with a serious accident at over £0.2 million. Rapid diagnosis and treatment is absolutely essential.

Treatment for OSAS is simple and effective, the main treatment is continuous positive airway pressure, or CPAP. Unfortunately drivers who suspect they might have OSAS are reluctant to come forward.

It is important that we understand why. A recent survey conducted by the Freight Transport Association shows that 98% of drivers who thought they might have OSAS would not come forward for fear of losing their licence. Although by no means excusable, the reluctance of drivers to come forward is understandable – there is a real risk of them losing their livelihood. 

Even those that do come forward are faced with hospital waiting lists often stretching into months rather than weeks. There is no universal fast track service for vocational drivers, and CPAP therapy is not available to all who need it - despite NICE acknowledging it should be.

Drivers will only come forward if rapid diagnosis and treatment can be guaranteed. Without this rapid service, drivers at risk of falling asleep will remain undiagnosed, untreated and on the road, thereby running the risk of increasing the number of OSAS-related road traffic accidents.

The Department for Transport has shown itself reluctant to act to address these issues. It refuses to look at tightening the requirements for identifying potential sufferers by requiring regular screening of public service vehicle and large goods vehicle drivers as part of the licensing process. Road haulage and passenger transport operators are also reluctant to have screening processes in place. In addition the Health and Safety Executive does not investigate the number of people killed in road accidents whilst at work.

The government must act to make it easier for drivers to come forward and the OSA Partnership Group report sets out how this can be achieved:

·        No vocational driver should have to wait more than two weeks, following initial referral, for first contact with the local sleep service,

·        They should wait no more than one further week until the supply of treatment (usually CPAP),

·        They should wait no more than one further week for confirmation that symptoms have resolved and that driving is safe once more.

Then drivers and their employers can be confident that four weeks would be the maximum time off driving, during which they should be assigned to alternative non-driving duties.

This is a model that is simple, sensible and cost effective.

The cost of untreated OSA was estimated in 2008 by Primary Care Trust’s to be more than £4.2 million, with the cost of CPAP treatment per annum approximately £2.3 million. NICE values CPAP at just £5,000 per quality-adjusted life year gained. Given that OSA is associated with many other conditions such as heart disease, stroke and diabetes, some savings are also made in the reduction of medication for those conditions.

Current estimates suggests that OSAS is prevalent in over 15% of HGV drivers and in 2013 alone there were 1,713 fatal road traffic accidents. The large vehicles on our roads recorded more of these fatalities than any other vehicle type.

OSAS remains a huge problem, but it is not one without a solution, and a 4 week one at that. 

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