title: Medico-legal implications of sleep apnoea syndrome: driving license regulations in Europe.
abstract: BACKGROUND
  Sleep apnoea syndrome (SAS), one of the main medical causes of excessive daytime sleepiness, has been shown to be a risk factor for traffic accidents. Treating SAS results in a normalized rate of traffic accidents. As part of the COST Action B-26, we looked at driving license regulations, and especially at its medical aspects in the European region.
  
  
  METHODS
  We obtained data from Transport Authorities in 25 countries (Austria, AT; Belgium, BE; Czech Republic, CZ; Denmark, DK; Estonia, EE; Finland, FI; France, FR; Germany, DE; Greece, GR; Hungary, HU; Ireland, IE; Italy, IT; Lithuania, LT; Luxembourg, LU; Malta, MT; Netherlands, NL; Norway, EC; Poland, PL; Portugal, PT; Slovakia, SK; Slovenia, SI; Spain, ES; Sweden, SE; Switzerland, CH; United Kingdom, UK).
  
  
  RESULTS
  Driving license regulations date from 1997 onwards. Excessive daytime sleepiness is mentioned in nine, whereas sleep apnoea syndrome is mentioned in 10 countries. A patient with untreated sleep apnoea is always considered unfit to drive. To recover the driving capacity, seven countries rely on a physician's medical certificate based on symptom control and compliance with therapy, whereas in two countries it is up to the patient to decide (on his doctor's advice) to drive again. Only FR requires a normalized electroencephalography (EEG)-based Maintenance of Wakefulness Test for professional drivers. Rare conditions (e.g., narcolepsy) are considered a driving safety risk more frequently than sleep apnoea syndrome.
  
  
  CONCLUSIONS
  Despite the available scientific evidence, most countries in Europe do not include sleep apnoea syndrome or excessive daytime sleepiness among the specific medical conditions to be considered when judging whether or not a person is fit to drive. A unified European Directive seems desirable.
authors.affiliation: Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania.
authors.forename: A
authors.initials: A
authors.lastname: Alonderis
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authors.initials: F
authors.lastname: Barbé
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authors.initials: M
authors.lastname: Bonsignore
authors.forename: P
authors.initials: P
authors.lastname: Calverley
authors.forename: W
authors.initials: W
authors.lastname: De Backer
authors.forename: K
authors.initials: K
authors.lastname: Diefenbach
authors.forename: V
authors.initials: V
authors.lastname: Donic
authors.forename: F
authors.initials: F
authors.lastname: Fanfulla
authors.forename: I
authors.initials: I
authors.lastname: Fietze
authors.forename: K
authors.initials: K
authors.lastname: Franklin
authors.forename: L
authors.initials: L
authors.lastname: Grote
authors.forename: J
authors.initials: J
authors.lastname: Hedner
authors.forename: P
authors.initials: P
authors.lastname: Jennum
authors.forename: J
authors.initials: J
authors.lastname: Krieger
authors.forename: P
authors.initials: P
authors.lastname: Levy
authors.forename: W
authors.initials: W
authors.lastname: McNicholas
authors.forename: J
authors.initials: J
authors.lastname: Montserrat
authors.forename: G
authors.initials: G
authors.lastname: Parati
authors.forename: M
authors.initials: M
authors.lastname: Pascu
authors.forename: T
authors.initials: T
authors.lastname: Penzel
authors.forename: R
authors.initials: R
authors.lastname: Riha
authors.forename: D
authors.initials: D
authors.lastname: Rodenstein
authors.forename: A
authors.initials: A
authors.lastname: Sanna
authors.forename: R
authors.initials: R
authors.lastname: Schulz
authors.forename: E
authors.initials: E
authors.lastname: Sforza
authors.forename: P
authors.initials: P
authors.lastname: Sliwinski
authors.forename: Z
authors.initials: Z
authors.lastname: Tomori
authors.forename: P
authors.initials: P
authors.lastname: Tonnesen
authors.forename: G
authors.initials: G
authors.lastname: Varoneckas
authors.forename: J
authors.initials: J
authors.lastname: Zielinski
authors.forename: K
authors.initials: K
authors.lastname: Kostelidou
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence / Q000517:prevention & control; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D003431:Cross-Cultural Comparison; D006970:Disorders of Excessive Somnolence / Q000150:complications / Q000175:diagnosis; D005060:Europe; D006801:Humans; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis*