Public health and medicolegal implications of sleep apnoea

⇓The sleep apnoea syndrome represents something of a paradox in clinical medicine. On the one hand, this disorder has been recognised only in recent decades, and is still regarded as a niche interest by many clinicians, particularly those from clinical disciplines other than respiratory medicine, neurology and otolaryngology. On the other hand, the syndrome is now recognised as being very common and current epidemiological data indicate that sleep apnoea syndrome is second only to asthma in the prevalence league table of chronic respiratory disorders 1. Furthermore, there is increasing evidence that sleep apnoea syndrome is associated with a considerable number of adverse sequelae, both behavioural and physical. Behavioural consequences include daytime sleepiness, impaired concentration and neuropsychological dysfunction, whereas physical consequences include cardiovascular disorders, particularly hypertension. In 1997, the European Respiratory Society (ERS) established a Task Force to examine the Public Health and Medicolegal Implications of the Sleep Apnoea Syndrome with particular reference to the impact of sleepiness on patient and public safety. The following report represents the outcome of several meetings and discussions of the Task Force membership and also includes a review of current European Regulations concerning driver licensing prepared by one of the members (J. Krieger). Obstructive sleep apnoea syndrome (OSAS) is a condition characterised by repetitive obstruction of the upper airway, often resulting in oxygen desaturation and arousals from sleep. The principal daytime manifestation is excessive sleepiness but other symptoms such as unrefreshing sleep, poor concentration and fatigue are commonly reported. Early definitions of the syndrome were based on an apnoea frequency without reference to symptoms 2. However, as epidemiological data from many studies made it clear that apnoeas during sleep are very common in the general population, the definition of a clinical syndrome was revised to include certain symptoms, particularly daytime sleepiness. Hypopnoeas …