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Assessing Fitness to Drive

Table of Contents

8.3 Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the following table.

Medical standards for licensing – sleep disorders

Health professionals should familiarise themselves with the information in this chapter and the tabulated standards before assessing a person’s fitness to drive.

Condition

Private standards

(Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition in Table 3)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition in Table 3)

Sleep apnoea, excessive sleepiness and other sleep disorders

(e.g. all sleep apnoea, idiopathic hypersomnia and other central disorders of hypersomnolence)

Refer also to narcolepsy.

A person is not fit to hold an unconditional licence:

  • if the person has an established sleep apnoea syndrome (sleep apnoea on a diagnostic sleep study and moderate to severe excessive daytime sleepiness*); or
  • if the person has frequent self-reported* episodes of sleepiness or drowsiness while driving; or
  • if the person has had motor vehicle crash(es) caused by inattention or sleepiness; or
  • if the person, in the opinion of the treating doctor, represents a significant driving risk as a result of a sleep disorder.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by the treating doctor as to whether the following criteria are met:

  • the person complies with treatment; and
  • the response to treatment is satisfactory.

* The treating doctor should not rely solely on subjective measures of sleepiness such as the Epworth Sleepiness Scale to rule out sleep apnoea. Refer to section 8.2.3. Sleep apnoea.

A person is not fit to hold an unconditional licence:

  • if the person has an established sleep apnoea syndrome (sleep apnoea on a diagnostic sleep study and moderate to severe excessive daytime sleepiness*); or
  • if the person has frequent self-reported* episodes of sleepiness or drowsiness while driving; or
  • if the person has had motor vehicle crash(es) caused by inattention or sleepiness; or
  • if the person, in the opinion of the treating doctor, represents a significant driving risk as a result of a sleep disorder.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by a specialist in sleep disorders as to whether the following criteria are met:

  • the person complies with treatment; and
  • the response to treatment is satisfactory.

The treating doctor should not rely solely on subjective measures of sleepiness such as the Epworth Sleepiness Scale to rule out sleep apnoea. Refer to section 8.2.3. Sleep apnoea.

Narcolepsy

A person is not fit to hold an unconditional licence:

  • if narcolepsy is confirmed.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by a specialist in sleep disorders on the response to treatment.

A person is not fit to hold an unconditional licence:

  • if narcolepsy is confirmed.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account

the nature of the driving task and information provided by a specialist in sleep disorders as to whether the following criteria are met:

  • cataplexy has not been a feature in the past; and
  • medication is taken regularly; and
  • there has been an absence of symptoms for 6 months; and
  • normal sleep latency present on MWT (on or off medication).

IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing, suspending or cancelling a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority. Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.

Conditional licences

For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements. The presence of other medical conditions While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive – for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7. Older drivers and age-related changes and section 2.2.8. Multiple medical conditions).

The nature of the driving task

The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.

Reporting responsibilities

Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3 and step 6).

References and further reading

  1. Charlton, J.L., Di Stefano, M., Dow, J., Rapoport, M.J., O’Neill, D., Odell, M., Darzins, P., & Koppel, S. Influence of chronic Illness on crash involvement of motor vehicle drivers: 3rd edition. Monash University Accident Research Centre Reports 353. Melbourne, Australia: Monash University Accident Research Centre. (2021)
  2. George, C. F. P. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 56, 508– 512 (2001).
  3. Karimi, M., Hedner, J., Häbel, H., Nerman, O. & Grote, L. Sleep apnea related risk of motor vehicle accidents is reduced by continuous positive airway pressure: Swedish traffic accident registry data. Sleep 38, 341–349 (2015).
  4. Komada, Y. et al. Elevated risk of motor vehicle accident for male drivers with obstructive sleep apnea syndrome in the tokyo metropolitan area. Tohoku Journal of Experimental Medicine 219, 11–16 (2009).
  5. Mehta, A., Qian, J., Petocz, P., Ali Darendeliler, M. & Cistulli, P. A. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine 163, 1457–1461 (2001).
  6. Findley, L. J. et al. Driving simulator performance in patients with sleep apnea. American Review of Respiratory Disease 140, 529–530 (1989).
  7. Masa, J. F. et al. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. American Journal of Respiratory and Critical Care Medicine 162, 1407–1412 (2000).
  8. Howard, M. E. et al. Sleepiness, sleep- disordered breathing, and accident risk factors in commercial vehicle drivers. American Journal of Respiratory and Critical Care Medicine 170, 1014–1021 (2004).
  9. Turkington, P. M., Sircar, M., Allgar, V. & Elliott, M. W. Relationship between obstructive sleep apnoea, driving simulator performance, and risk of road traffic accidents. Thorax 56, 800–805 (2001).
  10. Ayas, N. et al. Obstructive sleep apnea and driving: A Canadian Thoracic Society and Canadian Sleep Society position paper. Canadian Respiratory Journal 21, 114–123 (2014).
  11. Vakulin, A. et al. Effects of alcohol and sleep restriction on simulated driving performance in untreated patients with obstructive sleep apnea. Annals of Internal Medicine 151, 447–455 (2009).
  12. Gurubhagavatula, I. et al. Management of obstructive sleep apnea in commercial motor vehicle operators: recommendations of the AASM sleep and transportation safety awareness task force. Journal of Clinical Sleep Medicine 13, 745–758 (2017).
  13. Sarkissian, L., Kitipornchai, L., Cistulli, P. & Mackay, S. G. An update on the current management of adult obstructive sleep apnoea. Australian Journal of General Practice 48, 182–186 (2019).
  14. Adams, R. J. et al. Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health 3, 35–42 (2017).
  15. Appleton, S. L. et al. Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep Health 4, 13–19 (2018).
  16. Colquhoun, C. P. & Casolin, A. Impact of rail medical standard on obstructive sleep apnoea prevalence. Occupational Medicine 66, 62–68 (2016).
  17. Douglas, J. A. et al. Guidelines for sleep studies in adults – a position statement of the Australasian Sleep Association. Sleep Medicine vol. 36 S2–S22 (2017).
  18. Strohl, K. P. et al. An official American Thoracic Society clinical practice guideline: sleep apnea, seepiness, and driving risk in noncommercial drivers. American Journal of Respiratory and Critical Care Medicine 187, (2013).
  19. Lloberes, P. et al. Self-reported sleepiness while driving as a risk factor for traffic accidents in patients with obstructive sleep apnoea syndrome and in non-apnoeic snorers. Respiratory Medicine 94, 971–976 (2000).
  20. Farney, R. J., Walker, B. S., Farney, R. M., Snow, G. L. & Walker, J. M. The STOP-Bang equivalent model and prediction of severity of obstructive sleep apnea: relation to polysomnographic measurements of the apnea/hypopnea index. Journal of Clinical Sleep Medicine 7, 459–465 (2011).
  21. Sharwood, L. N. et al. Assessing sleepiness and sleep disorders in Australian long- distance commercial vehicle drivers: Self- report versus an ‘at home’ monitoring device. Sleep 35, 469–475 (2012).
  22. Philip, P. et al. Maintenance of Wakefulness Test scores and driving performance in sleep disorder patients and controls. International Journal of Psychophysiology 89, 195–202 (2013).
  23. Philip, P. et al. Sleep disorders and accidental risk in a large group of regular registered highway drivers. Sleep Medicine 11, 973–979 (2010).
  24. Pizza, F. et al. Car crashes and central disorders of hypersomnolence: a French study. PLoS One 10, e0129386 (2015).
  25. Aldrich, M. S. Automobile Accidents in Patients with Sleep Disorders. Sleep 12, 487–494 (1989).