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Some Australian Doctors see the problem with Driver Reporting
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Moriarty Offline

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Post: #1
Some Australian Doctors see the problem with Driver Reporting
http://www.abc.net.au/news/2013-10-11/dr...ea/5016324

Doctors are worried a mandatory reporting system aimed at making roads safer could be achieving the opposite effect.

In South Australia, doctors are obliged to report patients who are suffering from sleep apnoea who might be a risk to other drivers or themselves.

Sometimes this results in the patient having their licence taken away.

Sleep apnoea is a disorder where the soft tissue at the back of the throat cuts off the air flow during sleep.

Studies suggest one in four South Australian men suffers from the condition which, in its extreme form, can leave the patient so exhausted during the day they suffer from involuntary naps or blackouts.

One sufferer Troy Seyfang said the condition disrupted his sleep hundreds of time each night and that led to ramifications in his waking hours.

"You couldn't go out and socialise, for instance couldn't go to movies because you'd be sitting there going to sleep, it was just impossible," he said.

"At work you’d be sitting at a computer having micro-second noddies and I absolutely dreaded [meetings] because you'd turn up and virtually slap yourself in the face and say 'please don't fall asleep'."
Change of onus urged

Doctors treating sleep apnoea understand why they must report patients to authorities, due to the risk of road accidents.

There is no specific data on accidents caused by sleep apnoea, but studies attribute 10 per cent of road crashes to people's medical conditions.

No one is arguing about the logic of the law, but the president of the Australasian Sleep Association, Nick Antic, believes it is achieving a reverse effect, with patients not reporting their condition to doctors for fear it could lead to a loss of their driver's licence.

"Those sorts of people are out there and they are untreated at the moment and some of them are probably very sleepy and some of them are at risk on the roads," he said.

"They are not having a treatable medical condition treated because of this perceived threat and I don't think that is good for South Australia."

Medical professionals say they have been threatened by people who are fearful of losing their licences and livelihoods.
Video: Response from Deputy Registrar of Motor Vehicles Tim Harker (7.30 South Australia)

Associate Professor Antic said he needed a security guard with him in the consulting room while treating one patient.

"It was a very unpleasant environment and entirely unproductive to providing health care to people," he said.

Doctors argue the law needs to change so the responsibility for reporting to the licensing authority is put on the driver, leaving doctors to get on with their job of managing patients.


The actual ABC (Australia) story linked above has a link to the response by the Licencing authority.
(This post was last modified: 12-23-2013 11:13 PM by Moriarty.)
12-23-2013 11:11 PM
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Moriarty Offline

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Post: #2
RE: Some Australian Doctors see the problem with Driver Reporting
Note the Australian English spelling of Apnoea is used...
12-23-2013 11:12 PM
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zonk Offline

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Post: #3
RE: Some Australian Doctors see the problem with Driver Reporting
Its the same in Toronto Canada, doctors there get handful of dollars by reporting sleep apnea patients

I,m in NSW, get a form once a year from RTA and my GP sign the form otherwise I cannot keep my license and continue driving. Its easier to live with that than the alternative which might be killing someone or/and myself
I,m all of it, it can save lives, saving lives is more important than some little inconvenience or some doctors worries
12-23-2013 11:34 PM
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DeepBreathing Offline
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Post: #4
RE: Some Australian Doctors see the problem with Driver Reporting
Here in WA we're supposed to advise the Dept of Transport if we have sleep apnea, and..
    ADD and ADHD
    Alcohol dependency
    Alzheimer's disease
    Arthritis (chronic) and other joint problems
    Dementia
    Depression and other mental health problems, like schizophrenia, bipolar disorder, psychosis
    Diabetes
    Drugs – illicit/prescription and over the counter
    Epilepsy
    Eye problems, like glaucoma, cataracts, macular degeneration
    Fainting
    Fits
    Giddiness
    Heart disease
    High/low blood pressure
    Injuries and physical disabilities, including limb amputation and partial or complete paralysis
    Lung disease
    Parkinson's disease and other neurological disorders
    Sleep disorders, like sleep apnoea
    Stroke

A list this broad is just asking to be ignored.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-24-2013 02:32 AM
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me50 Offline

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Post: #5
RE: Some Australian Doctors see the problem with Driver Reporting
While I can understand some on the list, I cannot understand some of it. As far as taking a license away from someone that is being treated for OSA, that is crazy! Untreated, I would understand!
12-24-2013 06:48 AM
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Post: #6
RE: Some Australian Doctors see the problem with Driver Reporting
(12-24-2013 06:48 AM)me50 Wrote:  While I can understand some on the list, I cannot understand some of it. As far as taking a license away from someone that is being treated for OSA, that is crazy! Untreated, I would understand!

They don't necessarily take your licence, but once your name's on the list you never know what the bureaucrats will do in future.

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-24-2013 07:19 AM
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zonk Offline

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Post: #7
RE: Some Australian Doctors see the problem with Driver Reporting
Sleep Apnea Plays Role in Car Crashes
http://www.medpagetoday.com/Pulmonology/SleepDisorders/42270

Excessive daytime sleepiness from obstructive sleep apnea (OSA) contributed to excess car crashes, particularly in untreated men, a study showed.

Among sleep clinic referrals, men who scored high for sleepiness reported about a quarter more motor vehicle accidents and nearly five-fold more near misses than those scoring in the normal range, Kim Ward, BSc, of the University of Western Australia in Crawley, and colleagues found


Sleepiness score also correlated with crashes among women (P=0.02), although without a dose effect, the group reported in the Oct. 15 issue of the Journal of Clinical Sleep Medicine.

Overall, untreated OSA patients had a crash rate three times greater than that of the general population (0.06 versus 0.02 motor vehicle accidents per person-year).

While the link between OSA and accidents came as no surprise, the results suggested increased sleepiness put people at the highest risk regardless of OSA severity, "underlining the importance of advising such patients, and the community generally, against drowsy driving," the researchers wrote.

Prior studies have shown that treating OSA with continuous positive airway pressure (CPAP) reduced the risk of car accidents, they pointed out.

It's not worth the agony of hurting yourself or somebody else because you didn't seek treatment. The treatments work," agreed W. Christopher Winter, MD, in practice at Virginia's Charlottesville Neurology and Sleep Medicine.

A few states have enacted legislation against drowsy driving, although difficult to enforce.

However, there has been a move toward treating sleep apnea much like epilepsy among drivers, Winter told MedPage Today.

That has particularly been true in the commercial trucking industry, which has been targeted with some proposed federal legislation for screening, testing, and treatment of sleep apnea.

The Federal Motor Safety Administration has warned about the risks posed by sleep apnea and is reportedly considering regulations for commercial vehicle drivers with the disorder.

Many states already have medical regulations that call sleep apnea a disqualifying condition for truckers.

An estimated 20% to 50% of commercial drivers have sleep apnea. That high proportion may be in part due to the sedentary nature of long-haul trucking that contributes to obesity as a risk factor for sleep apnea, according to a statement from the American Academy of Sleep Medicine in support of federal legislation.

Winter, a spokesperson for that organization, warned that laws to indiscriminately disqualify anyone with sleep apnea from holding a commercial drivers license will drive people away from getting diagnosed and thus treated.

It's important that individuals at risk for driving have a pathway to get the help they need and return to operating a motor vehicle safely," he said in an interview.

For the noncommercial driver, American Thoracic Society guidelines released in June suggested that physicians should routinely determine the driving risk for patients with sleep apnea and educate patients about that risk.

"Clearly, it is important that OSA is diagnosed and the degree of associated sleepiness assessed to expedite treatment and minimize risk," Ward's group concluded.

Their retrospective case-series included 2,673 patients referred for assessment of suspected sleep disordered breathing at a tertiary hospital-based sleep clinic as part of the West Australian Sleep Health Study cohort.

Self-completed questionnaire responses indicated moderate to severe excessive sleepiness in 17% as marked by an Epworth Sleepiness Score (ESS) of 16 or higher.

Most of the cohort reported having ever had a motor vehicle crash (69%), and among them 11% said it was because they felt sleepy or fell asleep behind the wheel.

Near misses due to sleepiness were reported by 26%; while 32% reported having fallen asleep behind the wheel irrespective of whether it caused a crash.

People with any OSA -- nearly the entire cohort with an Apnea-Hypopnea Index of at least 5 events per hour -- were 3.07 times more likely to report any crash compared with the community-wide rate (95% CI 2.98-3.17).

That risk rose significantly with severity of OSA in men, but was lower with severe OSA among women. Near misses followed the same pattern.

However, both genders showed more risk linked with sleepiness.

Men who fell into the "very sleepy" category with an ESS score of 15 to 24 reported 4.86-fold more near misses (95% CI 3.07-7.14) and 1.27-times more car accidents than those in the normal ESS range (95% CI 1.00-1.61) after adjustment for potential confounders.

The majority of the cohort was male, middle-aged, and obese. Men had higher apnea scores compared with women, averaging 31 apnea-hypopnea events per hour compared with 18 per hours on overnight laboratory-based polysomnography (P<0.001).

Sleepiness was associated with accidents among women overall (P=0.02) but without a significant trend by ESS categories (P=0.40).

"The gender differences found in our study may be confounded by driving exposure, which we did not measure," the researchers noted.

Also, "gender differences may be attributable to a higher degree of self-awareness of symptomology in women who self-regulate risk by avoidance of driving," they suggested.

Ward's group cautioned about the possibility of recall or reporting bias from self-reported data over one's entire driving history, but pointed out that the large sample size and narrow confidence intervals supported the results
(This post was last modified: 12-24-2013 03:01 PM by zonk.)
12-24-2013 02:56 PM
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DeepBreathing Offline
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Post: #8
RE: Some Australian Doctors see the problem with Driver Reporting
Thanks for that interesting info Zonk. I guess the point is that if you are receiving treatment for your apnea then the risk of crashing is greatly reduced. It's the large number of undiagnosed apnea people who are the worry. Before my diagnosis I would commonly have microsleeps behind the wheel - scared the life out of me. At that time I was a risk to myself and others, but I didn't know I had apnea, so I didn't have to report to DOT. Now that I've been diagnosed and treated, I'm no longer a risk, but I'm expected to report myself to DOT?

The DOT list is ridiculous - everybody in the whole community will fall into at least one of those categories. "Prescription medicine / over the counter drugs" - name one person who's going to report themselves to DOT for taking a Panadol. "Illicit drugs" - name one junkie who's going to go in and say "yes I shoot up and snort all sorts of substances that will probably get me arrested". Ain't gonna happen!

The system is seriously flawed - nobody is going to report themselves, especially when the explanation on the DOT website is extremely vague about the procedures and possible consequences. That's why the South Australian method of having the Drs do the reporting is in some ways a better idea, but from the Drs' reaction it obviously doesn't work too well there either.

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12-24-2013 08:48 PM
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Moriarty Offline

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Post: #9
RE: Some Australian Doctors see the problem with Driver Reporting
I really don't think that the worry that one will lose one's licence and possibly one's livelihood is going to encourage a driver who suspects he/she experiences OSA to ask a Doctor's advice. I think it is counter-productive in all sorts of ways to have the government get in the middle of the medical relationship between a doctor and a patient. The areas of mandatory notification for disease is fine since there is usually no penalty to the patient flowing from the registration of their illness.

However once we get into areas of notification of any of the things that doctors (and increasingly teachers) are expected to report to authority we have a problem because the potential for action by the authority inhibits the patients from seeking assistance for that and other issues.

Unless a patient was dozing off during the initial GP consultation I would not expect the GP to pull the patient's drivers licence just on the Epworth score. (Mine didn't - although he could have been obliged to if I was a commercial or heavy vehicle driver)

I'm all for the common sense approach for OSA - report it to the DOT as an ongoing condition after the OSA is under treatment to make it an ongoing condition of the licence.

Chances are the driver has been driving tired for years and the extra couple of weeks to get a Sleep Study, Titration, and a machine - then another couple of weeks to gauge efficacy - will not be any worse than the undiagnosed driver was.

The bigger risk to the community is the undiagnosed drivers that don't realise that they have a problem and so don't have a clue how dangerous they are.

Any programme to address that serious risk to the community should start with a carrot to encourage diagnosis - with the big stick held in reserve for those that don't go on to therapy or stick with the therapy.

Where are the public road safety campaigns to alert drivers (or their spouses) to the connection between OSA and Road Traffic Crashes...

Where are the public health campaigns to explain to the public that their partner's snoring isn't just a nuisance when they are trying to get to sleep - it could be something that is trying to kill them.

It seems to me that there is room in this space for the players in the burgeoning OSA diagnosis and treatment industry to step up and fund public education in the same way that the drug companies do for their areas of treatment.

The OSA 'Industry' and the government in Australia also has a part to play in getting the Medical Insurers to recognise that treating OSA provides a downstream 'wellness' benefit to their clients claim profiles and that providing more than the token rebates for machines (and zero rebates for consumables) will be an advantage to their long term bottom line.
12-25-2013 06:17 AM
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zonk Offline

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Post: #10
RE: Some Australian Doctors see the problem with Driver Reporting
(12-25-2013 06:17 AM)Moriarty Wrote:  The OSA 'Industry' and the government in Australia also has a part to play in getting the Medical Insurers to recognise that treating OSA provides a downstream 'wellness' benefit to their clients claim profiles and that providing more than the token rebates for machines (and zero rebates for consumables) will be an advantage to their long term bottom line.
Thank you for bringing it up, now as we recognized the problem , we should be able to work on the solution.
If I may draw a parallel with the gay community, this community is very much active and vocal that they make enough loud noises through the media and elsewhere that they've managed to have the laws changed and new ones introduced and there is more to come.
If wanted, we can also make a difference ... greatest oak tree from a little acorn grow
12-25-2013 02:21 PM
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