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Obstructive Sleep Apnea (OSA) is a sleep disorder that is prevalent in 2-4% of general population. Individuals with OSA are generally obese, snore heavily at night and have increased daytime sleepiness and drowsiness.

The snoring is secondary to recurrent upper airway obstructions during sleep. These airway obstructions cause repeated awakenings or micro arousals during night, compromising on the sleep quality and duration. Sleep deprivation at night shows up the next day as daytime fatigue, drowsiness and sleepiness. Since the sleep deprivation is chronic, many individuals may be habituated to these symptoms or attribute it to some other causes.   

The daytime sleepiness can put the OSA individual at risk if they are employed in work requiring alertness which includes driving vehicles, operating heavy machinery etc. Studies have shown increased risk of road traffic accidents in drivers with untreated or undiagnosed sleep apnea. Individuals with the shortest sleep latencies (length of time required to fall asleep) were found to have the highest risk for accidents.  Similarly obese individuals had higher risk for accidents than non-obese individual.

Ideally all applicants for driving license should be screened for OSA but it may not be feasible in the near future. In contrast to private drivers, professional drivers spend a significant part of their life driving vehicles and generally carry multiple passengers. It is suggested that atleast professional drivers who drive buses, trains, trucks, taxis be screened for OSA. If suspected to have OSA based on screening they may be advised to undergo a full night sleep study (polysomnography).

Drivers who are found to have OSA based on polysomnography are advised CPAP treatment. Fortunately with regular CPAP treatment the risk of road traffic accidents has been shown to drop. In one study CPAP treatment was associated with an estimated 55% reduction in real crashes. The regulatory authorities and physicians can cross check the compliance with treatment from the operational data record of the CPAP machine. The currently recommended compliance criteria for fitness to drive in OSA patients is CPAP use of greater than 4 hours per night on greater than 70% of nights.

Screening for OSA in all driving license applicants can help bring down the road traffic accidents. As a first step, atleast professional drivers need to be screened. This policy may be later extended to private drivers to bring down the risk associated with road travel.

Reference
http://www.ncbi.nlm.nih.gov/pubmed/21921796