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.

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

Medical standards for licensing – Sleep disorders
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)

Commercial standards

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

Sleep apnoea (also see text)

A person is not fit to hold an unconditional licence:

  • if the person has 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 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 is compliant with treatment; and
  • the response to treatment is satisfactory.

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

A person is not fit to hold an unconditional licence:

  • if the person has 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 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 is compliant with treatment; and
  • the response to treatment is satisfactory.

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

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 six 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, or reinstating 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 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.

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 Multiple medical conditions and age-related change).

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 3.3.1 and step 6 of the assessment and reporting process).

References and further reading

  1. Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd edition, November 2010. Available: http://monashuniversity.mobli/muarc/reports/muarc300.html.
  2. George CF. Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax. 2001; 56(7): 508–512.
  3. Findley LJ, Kabrizio MJ, Knight H, Norcross BB, LaForte AJ, Suratt PM. Driving simulator performance in patients with sleep apnea. The American Review of Respiratory Disease. 1989; 140(2): 529–530.
  4. Stutts JC, Wilkins JW, Vaughn BV. Why do people have drowsy driver crashes? AAA Foundation for Traffic Safety: Washington. 1999: 1–85.
  5. Howard M, Desai AV, Grunstein RR, Hukins C, Armstrong JG, Joffe D, Swann P, Campbell DA, Pierce RJ. Sleepiness, sleep-disordered breathing, and accident risk factors in commercial vehicle drivers. American Journal of Respiratory and Critical Care Medicine. 2004; 170(9): 1014–1021.
  6. Masa JF, Rubio M, Findley LJ. Habitually sleepy drivers have a high frequency of automobile crashes associated with respiratory disorders during sleep. American Journal of Respiratory Critical Care Medicine. 2000; 162(4 Pt 1): 1407–1412.
  7. Turkington PM, Sircar M, Allgar V, Elliott MW. Relationship between obstructive sleep apnea, driving simulator performance, and risk of road traffic accidents. Thorax. 2001; 56(10): 800–805.
  8. Vakulin A, Baulk SD, Catcheside PG, Antic NA, van den Heuvel CJ, Dorrian J, McEvoy RD. Effects of alcohol and sleep restriction on simulated driving performance in untreated patients with obstructive sleep apnea. Annals of Internal Medicine. 2009; 151(7): 447–455.
  9. Colquhoun C, Casolin A. Impact of rail medical standard on obstructive sleep apnoea prevalence. Occupational Medicine. 2016; 66(1): 62–68.
  10. Lloberes P, Levy G, Descals C, Sampol G, Roca A, Sagales T, de la Calzada MD. 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. 2000; 94(10): 971–976.
  11. Sharwood LN, Elkington J, Stevenson M, Grunstein RR, Meuleners L, Ivers RQ, Haworth N, Norton R, Wong KK. Assessing sleepiness and sleep disorders in Australian long-distance commercial vehicle drivers: self-report versus an ‘at home’ monitoring device. Sleep. 2012; 35(4): 469–475.
  12. Philip P, Chaufton C, Taillard J, Sagaspe P, Léger D, Raimondi M, Vakulin A, Capelli A. Maintenance of Wakefulness Test scores and driving performance in sleep disorder patients and controls. International Journal of Psychophysiology. 2013; 89(2): 195–202.
  13. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. American Journal of Respiratory & Critical Care Medicine. 2000; 163(6): 1457–1461.
  14. Aldrich MS, Chervin RD, Malow BA. Value of the multiple sleep latency test (MSLT) for the diagnosis of narcolepsy. Sleep. 1997; 20(8): 620–629.